bluuebunny/crossref_metadata_2025 huggingface dataset:
P415 THE STRANGE CASE OF A LATE POCKET HEMATOMA
Authors: Massara M , Tofoni P , Stronati G , Laura C , Michela C , Federico G , Antonio D
Published: May 2023

Case report: male, 85 years old. Hospitalization in 2013 at the Ancona Cardiology Department due to severe left ventricular dysfunction. In the history of pulmonary lobectomy results (2005). ⦁ EKG: PR 220 msec, left bundle block ⦁ coronary angiography: ed ⦁ blood analysis: hemoglobin 15 g/dl, PLT 229/mm3, Creatinine 1.1 mg/dl, Glycemia 84 mg/dl. ⦁ Echocardiogram: severe LV dilatation (LVVT 105 ml/m2) and severe reduction of LVEF due to diffuse hypokinesia. Strain test for possible CRTD implant: no intraventricular asynchrony. A single–chamber ICD was implanted in primary prevention in the left subclavicular site ( antibiotic prophylaxis with ciprofloxacin 1 g). Chest x–ray showed correct lead placement, no pneumothorax. The patient was discharged with antibiotic therapy. Since then he has continued the cardiological follow–up on a regular basis (cardiological visit + six–monthly ICD check). It should be noted that NOAC (Rivaroxaban 20 mg) was introduced in 2020 for the detection of atrial fibrillation. In December 2021, at last ICD check: no arrhythmic events, no alterations of the electrical parameters, good condition of the PM pocket. On 09.01.22, access to the ER due to the appearance of elastic swelling of the pocket. Apiretic. The ER doctor performed ultrasound (non–trabecular subcutaneous effusion) and proceeded to aspirate 15 cc of serum–blood fluid. He discharged the patient with appointment at the PM clinics. Cardiological consultation or blood chemistry tests were not carried out. On 19.01.22 the patient presented to our clinics: voluminous elastic swelling of the soft tissues overlying the pocket, which appeared floating. No local inflammation or cutaneous ischemic suffering. No solutions of continuity in the skin. No pain. He also reported not having taken the prescribed antibiotic. He denied fever or trauma in the previous weeks. As the blood chemistry tests were not performed in the ER, the blood count (Hb? WBC?), renal function (rivaroxaban overdose?), inflammation indices were not known (CRP? PCT?), coagulation function (spontaneous INR?). Urgent hospitalization was scheduled for surgical revision, pocket decompression, swab culture and blood cultures.

Conclusions

The hypotheses are hematoma during NOAC, pocket infection or cystic hygroma. After surgery evidence of organized hematoma of tissue adjacent to the pocket with negative blood cultures.
P418 WHEN THE GAME IS HARD…. IT‘S BETTER TO COOPERATE! THE INTEGRATED MANAGEMENT OF THE ELECTROPHYSIOLOGIST AND HEMODYNAMIST WHO RESOLVES THE COMPLICATION
Authors: Perniciaro V , Caccavo V , Di Monaco A , Katsouras G , Quadrini F , Sgarra L , Troisi F , Langialonga T , Grimaldi M
Published: May 2023

A 66–year–old woman came to our attention to undergo ablation of monomorphic, frequent and repetitive premature ventricular complex, symptomatic and refractory antiarrhythmic therapy. Mapping of the arrhythmia showed precocity both on the anterolateral segment of the coronary sinus and on the anterolateral mitral annulus (corresponding to the point first identified in the coronary sinus). However, earliness on the anterolateral segment of the coronary sinus was better; radiofrequency was then applied there (maximum power of 30 Watts for 120 seconds). After a few minutes, blood pressure drop and echocardiogram showed tamponade pericardial effusion. Pericardiocentesis was performed and part of the drained blood recovered by connecting an 8F long introducer (inserted in the pericardium) to the introducer in the right femoral vein, thus stabilizing the patient‘s hemodynamics. The coronary sinus was selectively cannulated with an Agilis deflectable long introducer (advanced to the vessel ostium using a deflectable decapular electrocatheter as a guide) thus visualizing the lesion on the vessel wall site of ablation. A guiding catheter for the right coronary artery was inserted into the coronary sinus and a guidewire was advanced to the distal part of the vessel. The lesion was effectively treated by placing a 5 mm by 21 mm covered stent. After approximately one hour of monitoring, the pericardial drainage was removed. There were no recurrences of arrhythmia or pericardial effusion during observation in the ICU or at follow–up. In this complex case, the integrated management of the electrophysiologist and the hemodynamist successfully resolved the complication without resorting to cardiac surgery.
P431 "TELECUORE": EXPERIMENTAL PILOT PROJECT FOR THE INTEGRATED MANAGEMENT OF 250 PATIENTS WITH CHRONIC HEART FAILURE THROUGH THE USE OF TELEMEDICINE IN PIACENZA AUSL
Authors: Matrone B , Sticozzi C , Comastri G , Lisè G , Novara P , Andena A , Aschieri D
Published: May 2023

Background

Heart failure (HF) has an high social–health impact that requires frequent checks and urgent hospital visits. The management of chronicity through telemedicine, integration of hospital–territory care and multidisciplinarity represents a goal of the italian PNRR.

Objectives

The project tests the feasibility of an organizational model of integrated management of heart–failure patients based on multidisciplinary integration and the use of telemedicine.

Materials and Methods

250 heart failure patients will be selected by the Heart Failure Outpatient Department of AUSL Piacenza, with the following characteristics: positive technological anamnesis, NYHA functional class II–III, clinical instability (hospital access for heart failure/need to boost diuretics in the previous 12 months) and management complexity. We will use Aditech devices, which through mobile–app will send the following parameters to the platform on a daily basis: blood pressure, weight, ECG (single track) and saturation. A QoL Assessment Questionnaire (KCCQ) will be administered. 10 GPs will be selected to view the data on the platform and be able to carry out a cardiological Teleconsultation. The Case manager (CM) and a cardiovascular technician (TFCPC) will explain the functioning of the device to groups of 2–3 patients and, in collaboration with the nursing staff, the baseline control of the parameters and blood tests will be carried out. Pre–set alerts will be activated based on the changes in the detected parameters, which will be evaluated by the TFCPC/CM and managed with the Cardiologist for therapy optimization and patient empowerment. Through televisit, the CM will evaluate the case, based on pre–established protocols, will program the necessary diagnostic services (EGC, chest echo/fast echo, performed by the TFCPC using wireless echo probes at community homes) and will plan ways to improve lifestyle. The intervention of the GP or cardiologist will be scheduled after a multidisciplinary briefing based on the clinical case.

Conclusions

The project experiments an integrated hospital–territory service model for the heart failure patient, through the use of telemedicine. The home management of the instrumental parameters and their daily sending should help to quickly manage any problems. Televisit integrated with telemonitoring and teleconsultation should reduce the number of hospital admissions.
P433 LIVER STIFFNESS RELATES TO AN INCREASED RISK FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN PATIENTS WITH NON–ALCOHOLIC FATTY LIVER DISEASE
Authors: Cicco S , Argeri S , Dalbeni A , Lauletta G , Vacca A
Published: May 2023

Obiettivo: l’epatopatia steatosica non alcolica o Nafld, deriva da alterazioni del metabolismo lipidico che comportano un incremento del deposito dei grassi a livello epatico risultando in un danno d’organo. Non ci sono dati chiari circa la connessione tra steatoepatite e malattia cardiaca, tuttavia, molti sono i fattori di rischio sovrapponibili per entrambe le patologie, pertanto, potremmo ritenere plausibile una possibile correlazione tra le due condizioni. Il nostro scopo è stato quello di valutare il rischio di malattia cardiovascolare in un cluster di pazienti affetti da NAFLD. Metodi: Abbiamo coinvolto nel nostro studio 41 pazienti (26 maschi, età media 58,71±13,56) affetti da NAFLD, diagnosticata rispettando i criteri indicati dalle linee guida internazionali e valutata tramite ecografia; abbiamo confrontato i nostri dati con quelli di un gruppo di controllo formato da 88 soggetti, non affetti da NAFLD (55M, età media 57,39±9,91). Abbiamo valutato la rigidità epatica come indicatore di fibrosi, misurandola tramite tecnica “Share Wave ultrasonography”. Per valutare la malattia cardiovascolare abbiamo calcolato per ogni paziente lo score di rischio tramite “ASCVD risk estimator” Risultati: nel gruppo NAFLD è stata riscontrata ipertensione arteriosa nel 58% dei pazienti (n.=24) e diabete mellito nel 34% dei pazienti (n.=14); nessuna differenza significativa, rispetto a questi fattori di rischio, è emersa dal gruppo di controllo. Tuttavia, i pazienti con NAFLD presentavano un aumento della fibrosi epatica (classe metavir 1 [IQR 1–3], p<0,05) ed un aumento del rischio cardiovascolare rispetto al gruppo di controllo (ASCVD–10–yr 17,21 ± 17,99% vs 7,93 ± 7,68, p<0,05). La fibrosi epatica mostrava, inoltre, una diretta correlazione con il rischio cardiovascolare (Spearman r 0,37, p<0,01). La stessa correlazione diretta è stata riscontrata tra ASCVD risk ed il dato relativo alla liver stiffness, misurata in valore assoluto, in kPa (Pearson r 0,39, p<0,05).

Conclusion

i: I nostri dati indicano che la NAFLD possa essere associata ad una ridotta aspettativa di vita, anche per via di una diretta correlazione con l’aumento del rischio di malattia cardiovascolare. Questi dati suggeriscono, quindi di promuovere una valutazione corretta e completa della malattia cardiovascolare nei soggetti affetti da NAFLD allo scopo di ottimizzare la terapia mirata per questi pazienti. Ulteriori studi prospettici sono necessari per confermare i nostri dati.
P436 ASSOCIATION BETWEEN REVERSE–TAKO–TSUBO E NEUROLOGICAL DISORDER
Authors: Alonzo B , Casati M , Montisci R , Cadessu Dessalvi C
Published: May 2023

Reverse–Tako–tsubo (r–TTC) is a rare variant of Tako–tsubo syndrome (TTC). TTC is characterized by transient and reversible left ventricular systolic dysfunction, for which an emotional or physical stressful trigger can usually be identified. Clinically, it mimics an acute myocardial infarction, with elevation of myocardial cytonecrosis enzymes and no obstractive coronary artery stenosis. On imaging, r–TTC is characterized by hypokinesia of the mid–basal regions associated with hyperkinesia of the apical region that resolves spontaneously. Case report: 78–year–old female affected by cerebral atrophy, leukoencephalopathy, cognitive impairment, behavior disorders. Reported episode of loss of consciousness lasting several minutes, associated with spontaneously resolving tremors and left hemisome hyposthenia. When she arrived in the emergency room, the haematological tests found high troponin values. On CT brain without contrast, no evidence of alterations of the encephalic tissues referable to acute lesions, but it showed of diffuse supratentorial leukoaraiosis and widening of the cerebrospinal fluid spaces on an atrophic basis. The neurological evaluation excludes the presence of a seizure. The electrocardiogram showed diffuse negative T waves and QTc 636 ms. The coronary angiography didn’t show significant coronary arteries stenosis and the ventriculography showed normal ventricular dimensions with total akinesia of the mid segments and normokinesia of the apical region with an ejection fraction of 50%. With these findings a diagnosis of mid left ventricular Tako–tsubo (r–TTC) was made. Transthoracic color Doppler echocardiography confirmed the alterations of the left ventricular kinetics observed by ventriculography.

Conclusions

compared to CTT, r–TTC is associated with a lower decline in global systolic function and, as reported in the literature, there is a greater connection to neurological insults as triggering factors, such as episodes of aneurysmal subarachnoid hemorrhage, brain surgery, ischemic stroke seizures and traumatic brain injury. The underlying mechanisms are still unknown, a crucial role in catecholamine–induced cardiotoxicity, coronary microvascular dysfunction or coronary vasospasm and/or estrogen deficiency is hypothesized.
P443 ACUTE ACALCULOUS CHOLECYSTITIS AND CARDIOVASCULAR DISEASE, WHICH CAME FIRST?
Authors: Fiore D , De Rosa S
Published: May 2023

Background

The existence of a close association between disease of the biliary tract and heart‘s disease is known from the mists of time. Acute acalculous cholecystitis (AAC) is a challenging diagnosis. The atypical clinical onset associated to a paucity and similarity of symptoms and to laboratory data mimicking cardiovascular disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC is often associated with gangrene, perforation and empyema as well as considerable morbidity and mortality(up 50%). Early diagnosis is crucial to increase survivability. Even today, there is still a lot of confusion regarding the relationship and consequently the clinical management AAC and CVD. Aim The aim of this review was to provide evidence regarding epidemiology, pathophysiology, clinical presentation and treatment of the complex association between AAC and CVD.

Methods

we searched for publications addressing Acalculous cholecystitis and cardiovascular disease, consulting Medline and Scopus databases. Any retrospective or prospective study design or systematic review focusing on the aforementioned topic was accepted. This study was conducted in accordance with the PRISMA and AMSTAR Guidelines. Our search rendered 1422 hits (995 from Medline and 427 from Scopus). After progressive screening, 268 full texts were assessed for eligibility and 135 studies were included in qualitative synthesis.

Results

According to the literature, 11 cases of AAC were reported after cardiopulmonary bypass surgery. Similarly, in 6 of 7 patients following aortic reconstruction. Small vessel occlusion has shown to be the predominant phenomenon in AAC. Histological analysis suggest involvement of ischaemia and reperfusion mediated injury. The most common ECG alterations noted in AAC are changes in T waves in significant leads, slurring and notching of the QRS complex and elevation or depression of the S–T segment, hypothesizing a vagally reflex mechanism, due to the distention of the common bile duct, with a reduced coronary blood flow. Finally it was reported a resolution of ECG changes due to AAC after cholecystectomy or antibiotic treatment within a few days.

Conclusion

AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases and major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA could be related to a misdiagnosed AAC.
P465 NON–VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN PATIENTS WITH THALASSEMIA
Authors: Capanni A , Clò S , Sirugo P , Guardigli G , Bertini M , Orazio G , Malagù M
Published: May 2023

Apixaban, dabigatran, edoxaban and rivaroxaban (NOACs) are drugs widely used and recommended for the prevention of thromboembolic events in patients with atrial fibrillation (AF) or atrial flutter and to prevent or treat pulmonary embolism (PE) and deep vein thrombosis (DVT). However, very little is reported in literature regarding their use in patients with β–thalassemia, among which high incidence of AF is reported and where the balance between thromboembolic and bleeding risk is of paramount importance. In this study 18 patients with transfusion–dependent β–thalassemia were enrolled. Patients were treated with NOACs for throboembolic prevention due to history of AF or atrial flutter. Mean follow–up duration was 21 ± 15 months for each patient and no thromboembolic events were reported. Three patients had non–major bleeding events without oral anticoagulation interruption. Two patients reported dyspepsia during treatment with dabigatran and were shifted to a different NOAC with resolution of symptom. These data suggest efficacy and safety of NOACs for the prevention of thromboembolic events in patients affected by β–thalassemia.
P471 CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS WITH HEART FAILURE IN THERAPY WITH SGLT2I RELATED TO THE HEART FAILURE OUTPATIENT
Authors: Benvenuto M , Iacoviello M , Gronda E
Published: May 2023

Sodium–glucose co–transporter type 2 inhibitors are the new class of drugs that have been shown to reduce heart failure hospitalizations and cardiovascular deaths in patients with HFrEF with a class of recommendation IB for the treatment of patients with HFrEF in the most recent international guidelines. The objective of this observational study was to analyze the main clinical characteristics, therapeutic associations and any adverse events highlighted in outpatients in which SGLT2i therapy was added. Data from 42 patients on SGLT2i therapy (98.2% dapagliflozin) were analysed. 71% of patients were male, with a mean age of 70.5 years. Approximately 52% of cases had an ischemic heart failure aetiology, 54% had arterial hypertension, and 27% had type 2 diabetes mellitus. Of these, 76% had HFrEF, 14% had HFmrEF and the remaining 9% from HFpEF. At the time of the visit, 11.9% of patients had a serum creatinine value > 1.3 mg/dL. Thirty–one percent of patients were NYHA Class III. The analysis of concomitant drug therapies with the use of SGLT2i showed that 76% of patients were on therapy with a renin angiotensin system inhibitor (62% ACEI/ARBs and 14% ARNI), 71% were on MRA and 91% % beta blockers. 82% of patients were on concomitant diuretic therapy with furosemide. ARNI therapy was suspended due to hypotension in 5% of cases (2 patients). No patient had significant renal deterioration requiring discontinuation of SGLT2i.

Conclusions

From the observed data emerged that the addition of SGLT2i to the optimized therapy is safe and well tolerated. None of the patients had to discontinue this drug and there were no adverse events. The association between SGLT2i and ARNI was also well tolerated and, in accordance with the documented efficacy in the main clinical trials, should be privileged as soon as possible.
P473 SURVEY ON THE USE OF SGLT2I THERAPY: CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS WITH HEART FAILURE IN A GROUP OF CENTERS IN PUGLIA, MOLISE AND ABRUZZO. ANMCO CARDIO RENO METABOLIC AREA
Authors: Benvenuto M , Valenti C , Shehaj E , Panzarella G , Gronda E , Iacoviello M
Published: May 2023

Pharmacological treatment of heart failure with reduced ejection fraction has undergone considerable development in recent years. Type 2 sodium–glucose co–transporter inhibitors represent the most recent class of drugs that has been shown to reduce hospital admissions for heart failure and deaths from cardiovascular causes and have immediately entered in the most recent international guidelines for the treatment of HFrEF patients. The objective of this survey, which involved various cardiologists from Puglia, Molise and Abruzzo, was to analyze the clinical characteristics and therapeutic associations of patients in whom SGLT2i therapy was prescribed. Into the REINFORCE project, each of the cardiologists participating in the survey was asked to provide anonymised data of patients who were initiated on SGLT2i therapy. Each cardiologist provided information on the main clinical and therapeutic characteristics of the patients. Data relating to 788 patients on SGLT2i therapy (98.8% dapagliflozin) were analysed. 71% of patients were male, with a mean age of 69.5 years. Approximately 53.5% of the cases had an ischemic heart failure aetiology, 73% had arterial hypertension and 40.6% had type 2 diabetes mellitus. Of these, 83.9% had HFrEF, the 12.3% from HFmrEF and 3.9% from HFpEF. 38.8% of patients had presented an episode of hospitalization for heart failure (in the previous 6 months). At the time of the visit, 23.2% of patients had a serum creatinine value >1.3 mg/dL. 47% of patients were in NYHA Class I–II, while 53% had an advanced class (NYHA III). The analysis of concomitant drug therapies using SGLT2i showed that: 93.4% of the patients were on therapy with a renin angiotensin system inhibitor (40.5% ACEI/ARBs and 52.8% ARNI), 65.9% were on MRA and 91.5% beta blockers. 86.1% of patients were on concomitant diuretic therapy with furosemide.

Conclusions

Data from the REINFORCE study provide real–world data to help understand the characteristics of heart failure patients prescribed SGLT2i therapy. The data show safety and tolerability of the therapies provided also in the ARNI–SGLT2i association which, associated with efficacy documented in the trials, would suggest to favor this association as soon as possible.
P477 PIRCHE (PREDICTED INDIRECTLY RECOGNIZABLE HLA EPITOPES) ALGORITHM AS A POSSIBLE PREDICTOR OF AMR (ANTIBODY MEDIATED REJECTION) FOLLOWING HEART TRANSPLANT, FROM LAB EXPERIENCE TO CLINICAL PRACTICE: A CASE REPORT
Authors: Fischetti G , Giovannico L , D‘errico Ramirez A , Parigino D , Santeramo V , Margiotta M , Mininni D , Di Bari N , Bottio T , Milano A
Published: May 2023

PIRCHE–II is an algorithm used to estimate the risk for developing alloreactivity towards HLA mismatches. A 35–year–old man with idiopathic dilated cardiomyopathy with several previous hospitalizations for heart failure is admitted to our unit for a new episode in August 2021. After evaluation, the patient was placed on the waiting list for transplant. The following month the patient underwent heart transplant. The donor had a compatible CDC crossmatch and was negative for anti–HLA antibodies. After 46 days, the patient was discharged at home in stable conditions after 2 negative endomyocardial biopsies (EMB): ISHLT’04 0. In January 2021, the patient was newly admitted for dyspnea and oliguria. Imaging revealed bilateral severe pleural effusion, biventricular cardiac disfunction; EMB showed acute rejection (ISHLT’04 3R). Panel–reactive antibody (PRA) screening found 93 % of class I PRA, 3 % of class II PRA with IgM and IgG donor–specific antibodies (DSA), C1q–positive. After 2 months, the patient was placed again on the transplant waitlist for a persistent severe biventricular disfunction, massive tricuspid regurgitation and diffuse myocardial fibrosis; class I PRA was decreasing (41 % in March 2022, 31 % in April 2022). Unfortunately, the patient died of infection before re–transplantation. After the event, which was recognized as AMR caused by class I DSA, a form rarely described in literature, we employed the PIRCHE (Predicted Indirectly Recognizable HLA Epitopes) algorithm to predict indirect donor–recipient alloreactivity: PIRCHE–II was 54. Is a high PIRCHE–II score a reliable predictor of AMR following heart transplant? More data and deeper understanding is surely needed. A correct after–transplant serologic monitoring is definitely needed to search for de–novo DSA.
P483 IMPACT OF AN ENDOCARDITIS TEAM ON PROGNOSIS: PRELIMINARY RESULTS
Authors: Di Domenico A , Carigi S , Amati S , Di Giannuario G , Di Cesare A , Farneti L , Sarti A , Tripodi A , Moscatelli G , Kety L , Vandi G , Mele E , Biagetti C , Santarelli A
Published: May 2023

Infective endocarditis (IE) is a life–threatening microbial infection with high mortality rate (6–50% in–hospital and 19–82% at 5–years)1.Guidelines for management of infective endocarditis underline the importance of multidisciplinary approach with an Endocarditis Team (ET) for the complexity of disease and for prognosis which depends on patients’ characteristics, microorganisms involved and local or systemic complications.ET includes specialists that define multimodality imaging approach to confirm diagnosis and to exclude local or systemic complications, discuss timing of antibiotic therapy, indication and timing of surgical treatments and follow–up. This study was a retrospective analysis based on a population of 86 patients from Infermi Hospital, Rimini, who received a diagnosis of IE from 2019 to 2021 thanks to a multidisciplinary approach. Among 86 patients, 76 (88,4%) had early–diagnosed IE and 10 (11,3%) had late–diagnosed IE.Early–diagnoses IE was defined when diagnoses occurred within 30 days from first symptoms.The aim of this study was to assess the impact of ET on timeliness of diagnosis and prognosis.Comparing the two groups, in the early–diagnosed IE we found higher rate of risk factors for endocarditis and systemic embolisation (27,6% vs. 20%), with Staphylococcus and Streptococcus as the most frequent causative pathogens (43,4% and 31,5%).More frequently the late–diagnosed IE group had mechanical prosthetic valves (20% vs 7,8%) with a higher rate of cardiac surgery (80% vs 35,5%), cardiac valves complications such as abscesses, perforations and pseudo–aneurysms (20% vs 18,4%) and a higher rate of intra–hospital mortality (40% vs 18,4%). Streptococcus and Enterococcus were most involved in the late–diagnosed group.Several trials demonstrated that presence of ET reduces 1–year mortality from 18.5% to 8.2% 2 and in–hospital mortality from 28% to 13% 3. Our preliminary study confirms the importance of ET application to improve early diagnosis (88.4%) and to reduce mortality. Bibliography:1.Kouijzer et al., Native valve, prosthetic valve, and cardiac device–related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies(2022). 2.Botelho–Nevers et al. Dramatic reduction in infective endocarditis–related mortality with a management–based approach(2009). 3.Chirillo,F.et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis(2013).
P486 ALIROCUMAB EFFECTIVENESS AND RAPIDITY IN ACHIEVING AND MAINTAINING TARGET LDL CHOLESTEROL VALUES IN PATIENTS AT VERY HIGH CARDIOVASCULAR RISK, ALSO ASSESSING ITS EFFECTS ON TRIGLYCERIDE AND HDL CHOLESTEROL VALUES
Authors: Cavarra M , Salerno E , Chiaranda‘ M , Chiaranda‘ G , Tamburino C
Published: May 2023

Introduction

Still too few patients (pts)after an acute cardiocerebrovascular(CeVD) event reach LDL–C values recommended by guidelines even in therapy with statins and Ezetimibe(Eze),thus maintaining a high risk of new cardiovascular(CV)episodesPurpose: To evaluate in a long follow–up the effectiveness and the rapidity of Alirocumab(Ali)in the attainment and maintenance of LD–C target values in pts at very high risk in therapy with only Eze because they are intolerant to statins

Methods

Our case studies consist of 72 pts of which 80% are male(58)and 20% female(14),with an average age of 61.9 y,90.2% of pts were hypertensive,34.7% diabetic and 15.2% with peripheral arteriopathy;5.5% had chronic kidney disease (CKD stage III) In the case history the 65.2% had an ACS and the 34.7% had CeVD.84.7% were in therapy only with Eze while 15.3% in association with PUFA N–3. The average value of LDL–C was 169.2 mg/dl. The follow up was 24 months (mths) with clinical checks and value of LDL–C at 3,6,12 and 24. The dosage of Ali varied from 150 to 75 mg in relation to the value of basal LDL–C to achieve a rapid reduction of at least 50%.Triglyceride (Tg) and HDL–C values were also evaluated

Results

At 3 mths the reduction of LDL–C was 52.24%, recording in 34,7% of cases a greater reduction of 65%; at 6 mths of 51.18%; at 12 mths of 51.36% and at 24 mths of 52.47%. The 37 pts who had started with 150 mg, had a very high average LDL–C base 183.0 mg/dl, and showed a reduction of C–LDL to 3 mths of 59.04%, to 6 mths of 58.45%, to 12 mths of 65.05%, to 24 mths of 55.76%. The target value of C–LDL recommended by the ESC guidelines was reached for 42.10% at 3 mths; for 52.63% at 6; for 63.15% at 12 and for 73.68% at 24. 5.5% of pts with a CKD showed a 73.68% reduction in LDL–C values to 3 mths, 65.22% to 6, 57.49% to 12 and 53.95% to 24. The follow–up to the Tg study showed a reduction of 3.55% to 3 mths, an increase of 8.75% to 6, a reduction of 1.65% to 12 and 7.95% to 24. HDL–C values showed an increase of 4.55% at 3 mths, 3.69% at 6, 10.97% at 12 and 7.82% at 24

Conclusions

Our case studies have confirmed the effectiveness of Ali in reducing LDL–C values in pts at very high CV risk and the rapidity in reaching the target value set by guidelines for the management of CV risk. Our study also confirmed the effectiveness of Ali in increasing the values of HDL–C, in accordance with the guidelines ESC 2019 while it was not possible to confirm the reduction of Tg values.
P490 MANAGEMENT OF SEVERE HYPERCHOLESTEROLEMIA IN ITALY: EVIDENCE FROM SANTORINI STUDY
Authors: Arca M , Solini A , Calabrò P , Gambacurta R , Catapano A
Published: May 2023

The management of severe hypercholesterolemia (sHC) (LDL–C >160 mg/dL) represents a clinical challenge in routine practice, mainly in the setting of high cardiovascular (CV) risk. The aim of the present analysis was to assess the characteristics and management at baseline examination of patients with sHC enrolled in the Italian cohort of SANTORINI study. The SANTORINI study (NCT04271280) is a multinational, observational, prospective study evaluating the use of lipid–lowering therapies (LLTs) in 9044 adult patients with high– and very–high CV risk enrolled from 14 European countries between March 2020 and February 2021, with a 12–month follow–up period per patient. The Italian cohort comprised 1977 patients, 229 (11.6%) of whom were classified with sHC. Their mean age was 59.4 years, 56% were male, BMI was 27.2 kg/m2 and mean LDL–C levels were 196.7 mg/dL. In 7% of cases sHC was reported to be associated with a clinical diagnosis of familial hypercholesterolemia. By investigators, 150 (65.5%) patients were classified at very–high and 79 (34.5%) at high CV risk, mainly (74.2%) based upon ESC/EAS European guidelines criteria. Atherosclerotic cardiovascular disease was actually present in 68.4% of patients, while 40.6% were on primary prevention. Despite sHC was associated with high CV risk, 64.6% of patients had no documented LLTs at baseline, 15.3% was receiving lipid–lowering monotherapy including 9.2% on statins (6.1 % moderate and 2.6% high–intensity), 1.7% were on ezetimibe, 1.6% on PCSK9i and 0.5% on other oral LLTs, and 20.1% was receiving combination therapy (10.9% were on statin + ezetimibe, 4.8% on PCSK9i + oral LLT, and 4.4% other oral combination therapy). Based on present findings, it is therefore concluded that, although the clinicians mostly follow current guidelines to determine CV risk in hypercholesterolemia, there is a low utilisation of LLTs, especially combination therapies, in the subgroup of patients with sHC at high and very–high CV risk. This means that further measures are needed to improve the therapeutic management of these patients in order to minimise the risk of adverse cardiovascular events.
P494 FRAILTY INFLUENCE ON PHYSICAL AND PSYCHOLOGICAL OUTCOMES IN POST–CARDIAC SURGERY PATIENTS CARDIAC REHABILITATION, A SINGLE CENTER STUDY
Authors: Villani G , Aschieri D , Bolognesi G , Ferraro S , Pisati M , Rusticali G , Rosi A
Published: May 2023

Cardiac rehabilitation (CR) is a clinically and cost–effective intervention in post–cardiac surgery patients (PCSp). However the influence of patients frailty on clinical and psychological outcomes in these patients are not well–known. The aim of our work was to evaluate the effectiveness of a personalized rehabilitative therapy in PCSp divided using the Cumulative Illness Rating Scale (CIRS) in group A (393 low–frail pts, CIRS <3, 230 M, 65±3 yrs) and in a Group B (540 frail pts, CIRS >4, 379 M, 67±10) ) evaluating pre and post–treatment the degree of autonomy recovery (Six–minute walking test SMWT, Barthel Index, BI) and the psychological behaviour (State–Trait Anxiety Inventory STAI–X1, Depression Questionaire QD–R). At admission the comparison between Group A vs B has show: a greater loss autonomy in frail patients (BI scale A 51.7±1 vs B 28.7±14, p 0.005; SMWT A 245±25 m vs B 155±18 m, p 0.005) a greater impairment in psychological characteristics in frail patients (STAI–X1 A 18±9 vs B 20±4 p 0.028, QD/R A 3.6±2 vs B4.4±3 p0.001) At discharge after a similar period of rehabilitation (A 24.7±11.8 days vs B 25.6±10 days, p ns) we observed: a more evident improvement of degree of autonomy recovery in low–frai group ((BI scale A 77.7±18 vs B 67.7±19, p 0.001; SMWT A 485±18 m vs B 341±25m, p 0.001) a similar improvement in anxiety and depression characteristic in both groups (STAI–X1 A 17.8±2 vs B 17.4±4 p ns, QD/R A 3.1±2 vs B 3.4±2 p ns)

Conclusions

In our experience the frailty status does not affect the cardiac rehabilitation in post–cardiac surgery patients in term of ensuring adequate functional recovery (although reduced compared to low–frail patients) but with similar improvement in psychological behaviours.
Problems identification and performance analysis in small hydropower plants in Nepal
Authors: Pandey Roshan , Shrestha Rajendra , Bhattarai Nawraj , Dhakal Rabin
Published: May 2023

Hydropower is powered by water, making it a clean source of energy. It contributes about 17% of worldwide annual energy generation and 90% of national energy generation, out of which 25% of its generation is contributed by small hydropower plants (SHPs). Thus, Nepal is predominantly dependent on a clean source of energy for power generation. In quantitative terms, approximately 70% of hydropower plants in Nepal are SHPs. Unfortunately, there are several bottlenecks to the smooth operation of these plants, viz. run-off-river hydropower with low water flow in dry season, insufficiency of proper guidance monitoring, regularization and inadequate and unfriendly policies. The study is based on primary and secondary data considering the SHPs spreading from eastern to western Nepal. Furthermore, the study follows the multicriteria decision analysis method to generalize the major issues at the sites. Inadequate water flow in the dry season is not the only issue for reduction in power generation; mechanical failure due to lack of monitoring and periodical maintenance is the predominant reason for the reduction in power output. This study discusses the role of reduction in water flow, unavailability of a trained workforce in rural hydropower areas, absence of appropriate equipment monitoring guidelines and inconsistent maintenance in the equipment failure and power production of hydropower plants. Every one in three SHPs has issues with smooth operation in terms of generation capacity, and overall, 50% of SHPs have mechanical issues as the major problem, which concludes the findings of the research.
Analytical Validation of a Laboratory-Developed Lung Nodule Risk Reclassifier Assay
Authors: Vuong Doris Q , Yu Heng , Seger Adam , Carbonell Luis , Wu Alan H B
Published: May 2023

Background

Lung cancer is the second leading cause of death in the United States. Lung cancer is often diagnosed in its late stage leading to a poor prognosis. Lung nodules are often described as indeterminate from CT scans resulting in lung biopsies that are invasive and may lead to complications. The need for noninvasive methods to assess malignancy risk in lung nodules is great.

Methods

The lung nodule risk reclassifier assay consists of 7 protein biomarkers: Carcinoembryonic Antigen (CEA), C-X-C Motif Chemokine Ligand 10 (CXCL10), Epidermal Growth Factor Receptor (EGFR), Neutrophil Activating Protein-2 (NAP2), Pro-surfactant Protein B (ProSB), Receptor for Advanced Glycation Endproducts (RAGE), and Tissue Inhibitor of Metalloproteinase Inhibitor 1 (TIMP1) and 6 clinical factors (subject age, smoking pack years, and sex, and lung nodule size, location, and spiculated appearance). The protein biomarker assays comprise a multiplex immunoassay panel printed on giant magnetoresistance (GMR) sensor chips as components of a printed circuit board (PCB) run on the MagArray MR-813 instrument system. The analytical validation consisted of imprecision, accuracy, linearity, limits of blank, and limits of detection studies for each biomarker. Several reagents, as well as PCBs, were used in these studies. The entire validation study also assessed multiple users.

Results

This laboratory-developed test (LDT), using the MagArray platform, meets the manufacturer's specifications for imprecision, analytical sensitivity, linearity, and recovery. Common biological interferents are known to interfere with the detection of each biomarker.

Conclusions

The lung nodule risk reclassifier assay performed as required to be offered as an LDT in the MagArray CLIA-certified laboratory.
Stable potassium isotope distribution in mouse organs and red blood cells: implication for biomarker development
Authors: Cui Meng-Meng , Moynier Frédéric , Su Ben-Xun , Dai Wei , Hu Yan , Rigoussen Dimitri , Mahan Brandon , Le Borgne Marie
Published: May 2023

Potassium (K) is an essential electrolyte for cellular functions in living organisms, and disturbances in K+ homeostasis could lead to various chronic diseases (e.g. hypertension, cardiac disease, diabetes, and bone health). However, little is known about the natural distribution of stable K isotopes in mammals and their application to investigate bodily homeostasis and/or as biomarkers for diseases. Here, we measured K isotopic compositions (δ41K, per mil deviation of 41K/39K from the NIST SRM 3141a standard) of brain, liver, kidney, and red blood cells (RBCs) from 10 mice (five females and five males) with three different genetic backgrounds. Our results reveal that different organs and RBCs have distinct K isotopic signatures. Specifically, the RBCs have heavy K isotopes enrichment with δ41K ranging from 0.67 to 0.08‰, while the brains show lighter K isotopic compositions with δ41K ranging from −1.13 to −0.09‰ compared to the livers (δ41K = −0.12 ± 0.58‰) and kidneys (δ41K = −0.24 ± 0.57‰). We found that the K isotopic and concentration variability is mostly controlled by the organs, with a minor effect of the genetic background and sex. Our study suggests that the K isotopic composition could be used as a biomarker for changes in K+ homeostasis and related diseases such as hypertension, cardiovascular, and neurodegenerative diseases.
A Bandleader’s Beginnings
Authors: Crease Stephanie Stein
Published: May 2023

Duke Ellington helped Webb get his first job as a bandleader, at a speakeasy in midtown, which led to other similar short-term jobs, as many of these clubs were raided and closed down. In February 1927, Chick Webb and His Harlem Stompers played at the Savoy Ballroom for the first time. Fess Williams and His Royal Flush Orchestra had been the Savoy’s leading resident band since it opened in March 1926. Webb’s band included saxophonist Johnny Hodges, who would go on to become one of Duke Ellington’s star soloists. In May 1927, the Savoy presented its first “Band Battle,” featuring bands led by Fletcher Henderson, King Oliver, Fess Williams, and Chick Webb, and Webb’s band got its first rave review in the Black press. Webb joined Local 802, the largest musicians’ local union in the world, and was soon called out by Local 802’s Governing Board for failing to file weekly reports. Though the Harlem Stompers were gaining a following in Harlem, Webb and his bandmates still scuffled for every dollar, while Henderson’s was among the best-paid Black band in New York City. In summer and fall of 1927, Chick Webb and His Harlem Stompers were a hit whenever they appeared at the Savoy.
A Bandleader’s Rise
Authors: Crease Stephanie Stein
Published: May 2023

Webb’s band had a full calendar through the early months of 1933, at the Lafayette, Connie’s Inn, and the Savoy Ballroom, where they were now the resident band. Webb expanded the band and hired important sidemen, including saxophonist/arranger Edgar Sampson, trumpet player Mario Bauza, and bassist John Kirby. Sampson crafted scores for Webb’s band, including “Let’s Get Together,” “Savoy,” and “Don’t Be That Way” that became classic Swing Era anthems. Later on Bauza became a pioneer in Afro-Cuban jazz. Webb and other bands started playing for many Depression-era and political benefits at the Savoy, for hunger and unemployment relief, and for the Scottsboro Boys Dense Fund. Webb landed a recording contract with a new label, Decca, and a radio contract with NBC. The band’s steady radio presence in New York expanded Webb’s visibility and popularity. In spring 1934, Moe Gale and Charles Buchanan hired two people to make Webb’s band more of a show business attraction: comedian and showman Bardu Ali as M.C. and conductor, and Charles Linton, a suave handsome vocalist.
The Last Grooves
Authors: Crease Stephanie Stein
Published: May 2023

In 1938 though spring of 1939, Webb’s band was on the road almost constantly, on one-nighters through the South and Midwest. In New York in August 1938, Webb’s band debuted at the Paramount Theater, a breakthrough engagement even for top Black bands. “Chick Webb and His Famous Orchestra, Featuring Ella Fitzgerald” was lit up on the theater’s huge marquis in Times Square. By this time, Webb and saxophonist/vocalist Louis Jordan did not get along, and Jordan left in early summer. Mario Bauza left after demanding more money for himself and the sidemen, knowing that Moe Gale’s agency was taking a good percentage of the band’s box office earnings. Webb was admitted to Johns Hopkins Hospital a few times for rest and treatment, with Dr. Ralph J. Young still his personal physician. Meanwhile, Webb and his band kept breaking through the “color line” at prestigious venues, including a long engagement at Manhattan’s Park Central Hotel. In March 1939, they were back at the Paramount, and attended the groundbreaking ceremony for the Savoy Pavilion for the 1939 World’s Fair. In April and May, the band went back and forth to Boston to play at the Southland Cafe, where the band’s radio broadcasts show how powerfully Webb still played, even as his health was failing. In New York City in late May 1939, the band gave what would be their last performances at the Savoy Ballroom and the Apollo Theater.
Overview of the Journal Article
Authors: Robinson Marin S. , Stoller Fredricka L
Published: May 2023

This chapter presents an overview of the journal article, a paper suitable for submission to a refereed chemistry journal. It describes some defining characteristics of journal articles while emphasizing concise writing and organization. The major purpose for writing a chemistry journal article is to share the results of original research with other chemists. The primary audience for a journal article is an expert one; readers are typically well educated and highly experienced in the subfield of chemistry addressed in the article. Chemistry readers (experts and non-experts alike) want crisp, clean sentences that say what needs to be said and no more. As such, concise writing is important in every section of the journal article. In general, journal articles are divided into four major sections. These sections have the familiar names: Introduction, Methods, Results, and Discussion. Collectively, this organizational structure is referred to as the IMRD format, which promotes targeted reading.
Writing the Outcomes and Impacts Section
Authors: Robinson Marin S. , Stoller Fredricka L
Published: May 2023

This chapter highlights the Outcomes and Impacts section of the research proposal. Proposal guidelines generally instruct authors to conclude with expected outcomes and statements that describe the significance and relevance of these outcomes. Some National Science Foundation (NSF) proposals specifically ask applicants to address the intellectual merit and broader impacts of the proposed work. The chapter considers examples of expected outcomes and related project timelines. When authors are writing their expected outcomes, it is important to be careful not to promise something they cannot deliver. Hedging language can be quite useful in some instances. The intellectual merit of a proposal is often judged by three Cs: Is it creative? Is it credible? Does it contribute to new knowledge?
Rewriting Scripture
Authors: Elledge C.D.
Published: May 2023

The study of noncanonical literature opens expansive perspectives into the arts and agendas of ancient scriptural interpreters. Throughout the Apocrypha (Deuterocanonical Books), Pseudepigrapha, Dead Sea Scrolls, and other writings, Israel’s earlier traditions were intensively reinterpreted and given new expression. In the process of reinterpreting earlier tradition, entirely new “rewritten scriptures” were also produced, including Jubilees and the Book of Biblical Antiquities. These two writings reveal the extensive interpretive lore that guided scriptural interpretation during the era of Christian origins. As illustrated in the scriptural argumentation of Paul, the book of Hebrews, and other writings, the authors of the New Testament were strongly influenced by the techniques and popular interpretive traditions of their early Jewish contexts.
Introduction
Authors: Dutton William H.
Published: May 2023

The introduction focuses on how the internet and related digital media, information, and communication technologies can lead to power shifts. It explains how technological change in networking can reconfigure access to information and people in ways they affect such critical factors as what people know as well as whom they know. By reconfiguring access to information and people, digital media create the potential for shifts in the informational or communicative power of networked individuals. The chapter describes these conceptions of power and associated power shifts and approaches to their study over the history of computing and the internet. These power shifts occur within a larger ecosystem of hybrid socio-technical media or assemblages that are behind network power shifts. The introduction provides an overview of related literature on the Fifth Estate, introduces the big questions that surround power shifts and the rise of the Fifth Estate, and outlines the chapters that follow.
The Idea and Evidence of a Fifth Estate
Authors: Dutton William H.
Published: May 2023

The idea and evidence of a Fifth Estate emerged from field research and a wide range of examples from everyday life as well as once-in-a-lifetime events. It is an inherently realistic perspective as it is a theory based on inductive reasoning rather than a hopeful vision. To convey the potential of networked individuals and the Fifth Estate, this chapter presents selected examples ranging from a climate activist to a whistleblower along with cases from everyday life. The chapter explains the differences between networked individuals and networked institutions and the strategies that enable individuals to source and network in ways that enhance their communicative and informational power. Examples make the concept of a Fifth Estate more concrete and demonstrate how it is likely to be as significant as the Fourth Estate of the press by enhancing pluralistic accountability in liberal democratic states. The networked individual of the Fifth Estate provides an ideal type that helps delineate Fifth Estate actors from other actors in cyberspace, from institutions to malicious users.
Fifth Estate Theories of Distributed and Network Power
Authors: Dutton William H.
Published: May 2023

Fifth Estate theories of distributed and network power contribute to traditional theories of the estates as well as more contemporary political perspectives on the separation of powers, distribution of powers, and pluralism. A description of the origins of early theoretical conceptions of the Fourth Estate of the press provides a foundation for differentiating the Fifth Estate and seeing its role in contemporary pluralist theories of democracy. The origins of these estates are from the perspective of a preindustrial society, but they can be theoretically transported into the digital age to offer an innovative perspective on the network power shifts of the digital age. A discussion of the critics of the Fifth Estate, including those tied to the other four estates, illuminates how it is distinct from, and not part of, other estates, institutions, and actors in the internet realm.