Composite Y internal thoracic artery–saphenous vein grafts: short-term angiographic results and vasoreactive profile

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Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Innovaciones didácticas para ciencias y matemática asistida por TIC

La enseñanza de ciencias y matemática en niveles secundario y universitario ha permanecido estancada, compartimentizada y orientada a la exposición del docente. Últimamente han aparecido voces sobre necesidad de un cambio sustancial de paradigma, centrado en diversos elementos que se detallan en el trabajo. Al adoptar ese corrimiento de paradigma se introducen nuevas tecnologías y métodos para el aprendizaje experimental de ciencias asistido por TICs. Se realizan experiencias cuyos datos permiten inducir un modelo del fenómeno en estudio, el cual es validado por medio de un ajuste de los valores experimentales con la predicción del modelo. Mediante la aplicación de estas Unidades Didácticas se pretende que los alumnos adquieran las competencias científicas básicas enunciadas en variadas publicaciones. Para cada Sesión de Aprendizaje Activo se presenta una secuencia de experiencias, de tal manera que cada una de ellas dé razón a la siguiente. Se demuestra un ejemplo de modelado de campo magnético producido por una corriente eléctrica en una bobina. Se realizan mediciones con un magnetómetro ligado a interfaz, computadora y programa computacional. Con Unidades Didácticas como la mencionada, los alumnos aprenderán a experimentar y modelar fenómenos de la vida real, que es un objetivo de la capacitación del capital humano.Teaching sciences has long been adapted to lectures given by the professor (chalk and talk). Despite the content, it appears some critics about the way sciences are taught. Perhaps this is the main trouble or cause of why young people are not engaged in sciences and technical careers. The present paradigm of learning sciences is based on the reversal procedures as the former way of teaching sciences. Not only are introduced new technologies but also new pedagogies characterized by inquired based learning, student-centered, hands-on. In the present work different didactic units are introduced based on these “new” pedagogical-technological tendencies. Modeling the system under study and its validation is another characteristic of the present Didactic Units. As an example of part of a Didactic Unit, it is introduced an experiment for measuring a magnetic field created by an electrical current through a coil. The experimental design is completed with a magnetometer connected to an interface and a computer as data logger. Data are analyzed and represented by a computational program. With the kind of these Didactic Units the students may learn to solve real life problems, which is the main objective of science education policy.Facultad de Informátic

Innovaciones didácticas para ciencias y matemática asistida por TIC

La enseñanza de ciencias y matemática en niveles secundario y universitario ha permanecido estancada, compartimentizada y orientada a la exposición del docente. Últimamente han aparecido voces sobre necesidad de un cambio sustancial de paradigma, centrado en diversos elementos que se detallan en el trabajo. Al adoptar ese corrimiento de paradigma se introducen nuevas tecnologías y métodos para el aprendizaje experimental de ciencias asistido por TICs. Se realizan experiencias cuyos datos permiten inducir un modelo del fenómeno en estudio, el cual es validado por medio de un ajuste de los valores experimentales con la predicción del modelo. Mediante la aplicación de estas Unidades Didácticas se pretende que los alumnos adquieran las competencias científicas básicas enunciadas en variadas publicaciones. Para cada Sesión de Aprendizaje Activo se presenta una secuencia de experiencias, de tal manera que cada una de ellas dé razón a la siguiente. Se demuestra un ejemplo de modelado de campo magnético producido por una corriente eléctrica en una bobina. Se realizan mediciones con un magnetómetro ligado a interfaz, computadora y programa computacional. Con Unidades Didácticas como la mencionada, los alumnos aprenderán a experimentar y modelar fenómenos de la vida real, que es un objetivo de la capacitación del capital humano.Teaching sciences has long been adapted to lectures given by the professor (chalk and talk). Despite the content, it appears some critics about the way sciences are taught. Perhaps this is the main trouble or cause of why young people are not engaged in sciences and technical careers. The present paradigm of learning sciences is based on the reversal procedures as the former way of teaching sciences. Not only are introduced new technologies but also new pedagogies characterized by inquired based learning, student-centered, hands-on. In the present work different didactic units are introduced based on these “new” pedagogical-technological tendencies. Modeling the system under study and its validation is another characteristic of the present Didactic Units. As an example of part of a Didactic Unit, it is introduced an experiment for measuring a magnetic field created by an electrical current through a coil. The experimental design is completed with a magnetometer connected to an interface and a computer as data logger. Data are analyzed and represented by a computational program. With the kind of these Didactic Units the students may learn to solve real life problems, which is the main objective of science education policy.Facultad de Informátic

Innovaciones didácticas para ciencias y matemática asistida por TIC

La enseñanza de ciencias y matemática en niveles secundario y universitario ha permanecido estancada, compartimentizada y orientada a la exposición del docente. Últimamente han aparecido voces sobre necesidad de un cambio sustancial de paradigma, centrado en diversos elementos que se detallan en el trabajo. Al adoptar ese corrimiento de paradigma se introducen nuevas tecnologías y métodos para el aprendizaje experimental de ciencias asistido por TICs. Se realizan experiencias cuyos datos permiten inducir un modelo del fenómeno en estudio, el cual es validado por medio de un ajuste de los valores experimentales con la predicción del modelo. Mediante la aplicación de estas Unidades Didácticas se pretende que los alumnos adquieran las competencias científicas básicas enunciadas en variadas publicaciones. Para cada Sesión de Aprendizaje Activo se presenta una secuencia de experiencias, de tal manera que cada una de ellas dé razón a la siguiente. Se demuestra un ejemplo de modelado de campo magnético producido por una corriente eléctrica en una bobina. Se realizan mediciones con un magnetómetro ligado a interfaz, computadora y programa computacional. Con Unidades Didácticas como la mencionada, los alumnos aprenderán a experimentar y modelar fenómenos de la vida real, que es un objetivo de la capacitación del capital humano.Teaching sciences has long been adapted to lectures given by the professor (chalk and talk). Despite the content, it appears some critics about the way sciences are taught. Perhaps this is the main trouble or cause of why young people are not engaged in sciences and technical careers. The present paradigm of learning sciences is based on the reversal procedures as the former way of teaching sciences. Not only are introduced new technologies but also new pedagogies characterized by inquired based learning, student-centered, hands-on. In the present work different didactic units are introduced based on these “new” pedagogical-technological tendencies. Modeling the system under study and its validation is another characteristic of the present Didactic Units. As an example of part of a Didactic Unit, it is introduced an experiment for measuring a magnetic field created by an electrical current through a coil. The experimental design is completed with a magnetometer connected to an interface and a computer as data logger. Data are analyzed and represented by a computational program. With the kind of these Didactic Units the students may learn to solve real life problems, which is the main objective of science education policy.Facultad de Informátic

Development of a Stromal Microenvironment Experimental Model Containing Proto-Myofibroblast Like Cells and Analysis of Its Crosstalk with Melanoma Cells: A New Tool to Potentiate and Stabilize Tumor Suppressor Phenotype of Dermal Myofibroblasts

Melanoma is one of the most aggressive solid tumors and includes a stromal microenvironment that regulates cancer growth and progression. The components of stromal microenvironment such as fibroblasts, fibroblast aggregates and cancer-associated fibroblasts (CAFs) can differently influence the melanoma growth during its distinct stages. In this work, we have developed and studied a stromal microenvironment model, represented by fibroblasts, proto-myofibroblasts, myofibroblasts and aggregates of inactivated myofibroblasts, such as spheroids. In particular, we have generated proto-myofibroblasts from primary cutaneous myofibroblasts. The phenotype of proto-myofibroblasts is characterized by a dramatic reduction of α-smooth muscle actin (α-SMA) and cyclooxygenase-2 (COX-2) protein levels, as well as an enhancement of cell viability and migratory capability compared with myofibroblasts. Furthermore, proto-myofibroblasts display the mesenchymal marker vimentin and less developed stress fibers, with respect to myofibroblasts. The analysis of crosstalk between the stromal microenvironment and A375 or A2058 melanoma cells has shown that the conditioned medium of proto-myofibroblasts is cytotoxic, mainly for A2058 cells, and dramatically reduces the migratory capability of both cell lines compared with the melanoma-control conditioned medium. An array analysis of proto-myofibroblast and melanoma cell-conditioned media suggests that lower levels of some cytokines and growth factors in the conditioned medium of proto-myofibroblasts could be associated with their anti-tumor activity. Conversely, the conditioned media of melanoma cells do not influence the cell viability, outgrowth, and migration of proto-myofibroblasts from spheroids. Interestingly, the conditioned medium of proto-myofibroblasts does not alter the cell viability of both BJ-5ta fibroblast cells and myofibroblasts. Hence, proto-myofibroblasts could be useful in the study of new therapeutic strategies targeting melanoma

Acute aortic pathology, munchausen syndrome, and confirmation bias

BACKGROUND: Munchausen syndrome is a psychiatric disease characterized by pathological lying and malingering. Patients who are affected can set up such complex and compelling clinical scenarios that they can lead to a bias in the diagnostic process and even to unnecessary surgery. CASE REPORTS: Two cases of Munchausen syndrome misrepresenting acute aortic dissection are reported. The two cases occurred at two different institutions where there was considerable expertise in the management of aortic pathology. In both patients, a wrong diagnosis of acute aortic syndrome was made, leading to unnecessary surgery. CONCLUSIONS: Retrospective analysis of the clinical events and the diagnostic process suggests that a confirmation bias played a major role in determining the misdiagnosis. The same mistake is likely to have occurred in the only other case reported in the literatur

What changed in the Italian internal medicine and geriatric wards during the lockdown

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