Cardiovascular risk assessment and outcomes: from childhood to adulthood. "Senectus ipsa est morbus?"

Although the major part of cardiovascular diseases during childhood are the congenital ones, there is a wide spectrum of cardiovascular events that start during young age, arriving to cardiovascular diseases in adulthood. There are also some particular methabolic conditions, infective diseases, some typical and atypical risk factors and some specific drugs, that since childhood can expose to a major cardiovascular risk, that in some situation can present in the adult age. On the other hand, in the last decades, there was an increase in congenital heart defects that arrived since adult age, with the name of grown-up congenital heart disease

Multi-isotope and Hydrogeochemical approach for characterizing Saturnia thermal groundwater (Grosseto, Italy)

Aim of this study is to define the groundwater flow of thermal area of Saturnia, through both chemical and isotope analyses. After a first detailed geological-geophysical survey and a quantification of the available groundwater resources, we analyzed several chemical compounds (Na, Ca, Mg, K, Chlorides, Sulfates, Nitrates, total alkalinity, Li, Sr, B, Fluorides, soluble Silica, free Carbon Dioxide, Sb, As, Se, H2S, Fe, Mn, Hg e Pb) and isotopes (2H; 3H, 3He, 4He, 13C, 18O, 86Sr, 87Sr). Excluding the uncertainties mainly related to a large repetition of measures over time, we concluded the following conclusions. Both Lithium and Boron high values and 87Sr/86Sr values highlighted that "Calcare Cavernoso" limestone geological formation constitutes the Saturnia thermal aquifer. Such samples showed both the same chemical characteristics and source area. Boron, Lithium, δ2H, δ18O and 87Sr/86Sr show the Saturnia thermal aquifer is separated by those of Pitigliano (Latera- Bolsena thermal circuit) and Bagni San Filippo (Mt. Amiata thermal circuit). 18O, 3H e δ13C measured in samples coming from Saturnia thermal spring respectively indicate that water feeding the thermal aquifer infiltrate at 350-440 m a.s.l., that they are almost 30 years old, and finally they that are isolated regarding to external infiltration. Low value of R/Ra tends to exclude the influence of Earth mantle to the geothermal anomaly of Saturnia area. The high content in Selenium indicates a possible interaction between Saturnia spring water and those coming from the Saturnia well, with volcanic fluids. However, considering also the evidence of the separation between the Saturnia groundwater flow and those of neighboring thermal fields (Bolsena and Mt. Amiata), we hypothesized that only a exchange among these volcanic complexes and the source area of thermal water points exists, but not among these complex and Saturnia aquifer

Left Ventricular Function, Epicardial Adipose Tissue, and Carotid Intima-Media Thickness in Children and Adolescents With Vertical HIV Infection.

BACKGROUND: Life expectancy of HIV patients has increased considerably as a result of antiretroviral therapy (ART), and cardiovascular (CV) disease has emerged as an important late concern. People with HIV infection could have an impaired systolic function; however data on diastolic function and markers of CV risk, such as epicardial adipose tissue (EAT) and intima-media thickness (IMT), are lacking. Aim of this study is to evaluate left ventricular function, EAT, and IMT in children and adolescents with vertically acquired HIV infection. METHODS: We enrolled 29 subjects on ART (13, 45% men; median age of 13.0, and interquartile range 9-18), and 29 age-matched controls. All patients and controls underwent echocardiographic evaluation, with study of the systolic and diastolic function and measurement of the EAT, and a carotid ultrasound study for IMT measurement. RESULTS: Comparing HIV-infected patients to healthy controls, we found a statistically significant increase of EAT and IMT (mean ± SD) (EAT: 3.16 ± 1.05 vs 1.24 ± 0.61 mm; P < 0.0001. IMT: 0.77 ± 0.15 vs 0.51 ± 0.11 mm; P < 0.0001), and a significant reduction of ejection fraction, evaluated with the biplane Simpson method (mean ± SD) (58.5% ± 6.66% vs 66% ± 4.24%; P = 0.029). These results are not related with age, gender, degree of lipodystrophy, dyslipidemia, hyperinsulinism, and ART duration or the use of single antiretroviral classes. CONCLUSIONS: Vertically infected HIV children and adolescents show an increased thickness of EAT and IMT, expression of potentially increased CV risk. They also show an impaired systolic function

Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil.

BACKGROUND: The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes. METHODS AND FINDINGS: A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001). No other important differences were observed. CONCLUSIONS: This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN79888843

Validation of PARADISE 24 and Development of PARADISE-EDEN 36 in Patients with Dementia

Dementia was one of the conditions focused on in an EU (European Union) project called “PARADISE” (Psychosocial fActors Relevant to brAin DISorders in Europe) that later produced a measure called PARADISE 24, developed within the biopsychosocial model proposed in the International Classification of Functioning Disability and Health (ICF). The aims of this study are to validate PARADISE 24 on a wider sample of patients with mild to moderate dementia to expand PARADISE 24 by defining a more specific scale for dementia, by adding 18 questions specifically selected for dementia, which eventually should be reduced to 12. We enrolled 123 persons with dementia, recruited between July 2017 and July 2019 in home care and long-term care facilities, in Italy, and 80 participants were recruited in Warsaw between January and July 2012 as part of a previous cross-sectional study. The interviews with the patient and/or family were conducted by health professionals alone or as a team by using the Paradise data collection protocol. The psychometric analysis with the Rasch analysis has shown that PARADISE 24 and the selection of 18 additional condition-specific items can be expected to have good measurement properties to assess the functional state in persons with dementia

Anastrozole-related acute hepatitis with autoimmune features: a case report

<p>Abstract</p> <p>Background</p> <p>Two cases of acute hepatitis occurring during treatment with anastrozole have previously been reported, but the underlying mechanisms of liver injury are still uncertain. We report the case of anastrozole-related acute hepatitis with some autoimmune features.</p> <p>Case presentation</p> <p>A 70-year-old woman developed acute hepatitis associated with serum antinuclear antibodies during anastrozole treatment; after drug withdrawal, liver function parameters rapidly improved and serum auto-antibodies were no longer detectable.</p> <p>Conclusions</p> <p>Anastrozole-induced hepatotoxicity is a very rare event. Drug-drug interactions or metabolically-mediated damage might be involved, with a possible role of individual susceptibility. Our report suggests that an immune-mediated mechanism may also be considered in anastrozole-related liver injury.</p

The role of myocardial scintigraphy in the assessment of coronary artery disease

Single photon emission computed tomography (SPECT) for the assessment of myocardial perfusion was introduced in the early 1970s, following pioneer studies of Gould et al. It has rapidly become one of the most used noninvasive technique for the assessment of myocardial ischemia. Thanks to the current technetium based tracers that allow electrocardiogram gated synchronization, it is possible to assess the regional ventricular systolic function and the evaluation of myocardial perfusion as well. In the last twenty years, beyond its diagnostic role, myocardial SPECT has become also a prognostic technique. Indeed, it has acquired a role for the short-term prediction of major coronary events in a large cohort with known or suspected coronary artery disease (CAD). The aim of this review is to give an update of the correct use and interpretation of myocardial SPECT in patients with known or suspected CAD and without left ventricular dysfunction

Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population

AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (&gt;70% stenosis or 30-70% with FFR 640.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects

Sustainable, empowering and emotional interactive multimedia

This Special Issue is inspired by but not limited to the 2019 Edition of CHItaly, the biannual Conference of the Italian SIGCHI Chapter, an active community that brings together people working on the design, evaluation, and implementation of interactive comput- ing systems for human use. The conference was held from 23 to 25 September 2019 in Padova, Italy. The Special Issue includes a selection of the best papers presented, but the call for papers also solicited high quality contributions from authors that did not attend the conference

Insights into the results of MICHE I - Mobile Iris CHallenge Evaluation

Mobile biometrics technologies are nowadays the new frontier for secure use of data and services, and are considered particularly important due to the massive use of handheld devices in the entire world. Among the biometric traits with potential to be used in mobile settings, the iris/ocular region is a natural candidate, even considering that further advances in the technology are required to meet the operational requirements of such ambitious environments. Aiming at promoting these advances, we organized the Mobile Iris Challenge Evaluation (MICHE)-I contest. This paper presents a comparison of the performance of the participant methods by various Figures of Merit (FoMs). A particular attention is devoted to the identification of the image covariates that are likely to cause a decrease in the performance levels of the compared algorithms. Among these factors, interoperability among different devices plays an important role. The methods (or parts of them) implemented by the analyzed approaches are classified into segmentation (S), which was the main target of MICHE-I, and recognition (R). The paper reports both the results observed for either S or R, and also for different recombinations (S+R) of such methods. Last but not least, we also present the results obtained by multi-classifier strategies