Stroke volume and myocardial contraction fraction in transthyretin amyloidosis cardiomyopathy: A systematic review

BackgroundCardiac amyloidosis (CA) is primarily a restrictive cardiomyopathy in which the impairment of diastolic function is dominant. Despite this, the left ventricular ejection fraction (LVEF) may be depressed in the late stage of the disease, but it poorly predicts prognosis in the earlier phases and does not represent well the pathophysiology of CA. Many echocardiographic parameters resulted important diagnostic and prognostic tools in patients with CA. Stroke volume (SV) and myocardial contraction fraction (MCF) may be obtained both with echocardiography and cardiac magnetic resonance (MRI). They reflect many factors intrinsically related to the pathophysiology of CA and are therefore potentially associated with symptoms and prognosis in CA.ObjectivesTo collect and summarize the current evidence on SV and MCF and their clinical and prognostic role in transthyretin (TTR-CA).Methods and resultsWe performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature database for studies focusing on SV and MCF in patients with TTR-CA. We analysed the following databases: PUBMED, Cochrane Library, EMBASE, and Web of Science database. Fourteen studies were included in the review. Both SV and MCF have important prognostic implications and are related to mortality. Furthermore, SV is more related to symptoms than LVEF and predicts tolerability of beta-blocker therapy in TTR-CA. Finally, SV showed to be an excellent measure to suggest the presence of TTR-CA in patients with severe aortic stenosis.ConclusionStroke volume and MCF are very informative parameters that should be routinely assessed during the standard echocardiographic examination of all patients with TTR-CA. They carry a prognostic role while being associated with patients’ symptoms.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/ME7DS

Erythema nodosum

Erythema nodosum is an acute inflammatory dermatosis characterized by painful nodules which are generally symmetrical and non ulcerative and are mainly located to the extensor surface of the lower legs. The nodules, due to septal panniculitis, are often accompanied by fever and resolve without permanent sequelae. Arthralgia occurs in more than 50% of patients and begins during the eruptive phase or precedes the eruption by 2-4 weeks. Erythema nodosum is presumed to be a hypersensitivity reaction and may occur in association with several systemic diseases or drug therapies, or it may be idiopathic. The most common cause of erythema nodosum is streptococcal infection in children and streptococcal infection and sarcoidosis in adults. Peak incidence occurs at age 18-34 years. Age and sex distributions vary according to etiology and race; women are affected more often than men. It is possible to distinguish between an acute and a chronic form of erythema nodosum; in the acute form, an early stage and a late stage can be detected, both clinically and histologically. Laboratory and instrumental examinations to be performed in case of erythema nodosum are varied and are intended to identify any underlying trigger disease. Erythema nodosum is a self-limited disease, so the therapy is often only symptomatic. Even if the erythema nodosum quickly responds to systemic steroids, in most cases their use is not recommended, nor necessary; is usually sufficient to use NSAIDs (eg, acetyl salicylic acid, ibuprofen, naproxen, indomethacin)

Outpatient Pediatric Dermatologic Surgery: Experience in 296 Patients

From January 2010 to December 2012, 296 skin biopsies were performed in pediatric patients using only local anesthesia (cream and infiltration). The biopsies were divided into three groups: biopsies of skin neoplasms, biopsies of skin rashes and biopsies of follicular-centered lesions. Our data demonstrate the possibility of using this procedure, with the dual advantage of eliminating hospitalization and cost savings

Outpatient pediatric dermatologic surgery: experience in 296 patients

From January 2010 to December 2012, 296 skin biopsies were performed in pediatric patients using only local anesthesia (cream and infiltration). The biopsies were divided into three groups: biopsies of skin neoplasms, biopsies of skin rashes and biopsies of follicular-centered lesions. Our data demonstrate the possibility of using this procedure, with the dual advantage of eliminating hospitalization and cost savings

atrophoderma following the lines of blaschko: an interesting diagnostic dilemma. Linear atrophoderma of moulin, blaschkolinear atrophoderma of pasini and pierini or linear morphea?

Linear atrophoderma of Moulin is a rare skin condition, fist described in 1992 by Moulin et al. who reported 5 patients affected by unilateral, hyperpigmented, depressed plaques self limited along Blaschko’s lines on the trunk and extremites, without any evidence of long-term progression. The main histologic finging was a basal hyperpigmentation, while other epidermal layers and dermis were normal, including normal-appearing collagen and elastic fibers. Thus, the clinical atrophy was initially linked to an alteration of the subcutaneous tissue, but a deep biopsy on both the affected and controlateral sides was originally not performed. Moulin et al. suggested the term “blaschkose” in opposition to “ blaschkitis” with an inflammatory and acquired significance. Later, this skin desease was named “LAM” by Baumman et al. who classified this disease as belonging to the group of acquired linear dermatoses following BL and thought LAM as a variant of prpogressive atrophoderma of Pasini and Pierini. In the literature, the clinical and histopathological criteria for the diagnosis of LAM heve been expanded in the last years and cases with different clinical and histological features have been classified as LA

Physical performance status predicts mortality in aging patients undergoing pacemaker implantation

Background: Aging patients requiring pacemaker implantation are increasing worldwide. Frailty or reduced physical performance status may have an impact on clinical outcomes after pacemaker implantation. Methods: A prospective cohort of patients aged more than 70 years, admitted to the hospital for pacemaker implantation, was enrolled. Patients were evaluated with the Short Physical Performance Battery (SPPB) and Handgrip Strength Test at hospital discharge and at 1 year. Overall mortality was the primary study endpoint. Results: Out of the 119 patients, the majority (71%) of patients had reduced physical performance (defined by an SPPB score <10 points). After a median follow-up of 46 months, the mortality was 31% of the population. SPPB value at discharge predicted death even after adjusting for pertinent confounders (adjusted hazard ratio 0.91, 95% confidence interval (CI) 0.84-0.99, P = 0.02). Patients with a poorer SPPB score at discharge (SPPB 0-3) had also an increased risk of death or rehospitalization at 1 year compared with patients with highest SPPB score (odds ratio OR 4.05, 95% CI 1-16.6). Conclusion: Reduced physical performance is associated with increased mortality in aging patients with bradyarrhythmia requiring pacemaker implantation. The identification of patients with poor SPPB may tailor specific interventions to improve physical performance and outcomes after pacemaker implantation

Application of LCA methodology in the assessment of a pyrolysis process for tyres recycling

According to recent estimations, the total yearly amount of end-of-life tyres (ELTs) arising in Europe exceeds 3 million tons; more than 95% are managed through mechanical and thermal treatments because ELTs represent a useful resource both of materials and energy. For this purpose, the goal of the present work is the assessment of the environmental impacts of a novel pyrolysis process and the comparison with alternative ELTs valorisation or disposal scenarios. Life Cycle Analysis (LCA) methodology has been applied to determine the most critical stages of the process under study, assessing the environmental benefits arising from the recovery of material and energy and the impacts, compared to the technologies already on the market, taking into account treatment processes, materials recovery and disposal of wastewater/residues. The chosen functional unit (FU) is 1 ton of ELTs treated by the plant. The different scenarios investigated have been analyzed through ReCiPe impact assessment method. Considering the pre-treatment, the pyrolysis process results in a lower environmental impact compared to the others, with the 1/3, 1/10 and 1/20 of energy consumption compared to the alternatives considered. The analysis of pyrolysis process showed that the avoided impact due to the recovery of carbon black, steel, oil and syngas exceeds the impact generated by the process, related to the energy consumption and to the emissions into the atmosphere. Compared to other energy-recovery scenarios, a greater advantage results from the pyrolysis process, mostly due to the recovery of valuable materials. Then, comparing it to other material recovery scenarios, a variable influence is given by the different options of recovery, considering which materials could actually be replaced and the commercial value of the materials that is replaced