bluuebunny/crossref_metadata_2025 huggingface dataset:
The Surface Topography in Machining of Medical Metallic Materials: A Review
Authors: Xu Ying , Qiao Yang , Guo Pei Quan , Li Yang
Published: July 2016

Biomedical materials are materials that can be implanted in an organism or combined with biological tissue. They are used for the diagnosis, treatment, and replacement of tissues or organs, and enhance their functions. With high strength, good toughness and bending fatigue strength, excellent processing performance which can not be replaced by other medical materials, biological medical metallic materials, such as stainless steel, cobalt based alloy, titanium and titanium alloys and noble metal are widely used in medical field. The surface topography has a great influence on the function of the parts, especially for the wear, vibration, noise, corrosion resistance of the friction surface. And the surface morphology of medical metal is very important in the influence of its corrosion resistance.
High Strength Titanium Rods Produced by Thermomechanical Powder Consolidation
Authors: Yang Fei , Gabbitas Brian , Singh Ajit Pal , Wang Chung Fu
Published: July 2016

In this paper, pure titanium rods, with high strength and ductility, were prepared by vacuum sintering titanium powder compacts at 1300oC for 2h and then hot extruding the as-sintered titanium billets at 900oC in air. The microstructure and property changes, after vacuum sintering and hot extrusion, were investigated. The results showed clear evidence of porosity in the microstructure of as-sintered titanium billet and tensile testing of as-sintered material gave yield strength, ultimate tensile strength and ductility values of 570MPa, 602MPa and 4%, respectively. After extrusion at 900oC, no obvious pores could be seen in the microstructure of as-extruded titanium rod, and the mechanical properties were significantly improved. The yield strength, ultimate tensile strength and the ductility reached 650MPa, 705MPa and 20%, respectively, which are much higher than values for CP titanium (grade 4), with a yield strength of 480MPa, ultimate tensile strength of 550MPa and ductility of 15%. The fracture characteristics of as-sintered and as-extruded titanium rods have also been investigated.
Low-Cost α+β PM Ti Alloys by Fe/Ni Addition to Pure Ti
Authors: Bolzoni Leandro , Ruiz-Navas Elisa Maria , Gordo Elena
Published: July 2016

Ti and its alloys can deliver a very interesting combination of properties such as low density, high strength, corrosion resistance and biocompatibility and, therefore, are very flexible materials which can be adapted to various applications. Nonetheless, Ti and Ti alloys are only employed in critical applications (i.e. aeronautical and aerospace, nautical, medical, etc.) or in products for leisure. In both of these cases the higher fabrication costs of Ti in comparison to its competitors (i.e. steel and aluminium) is not the limiting factor as it is for many structural applications, especially for mass production (i.e. automotive sector). The use of creative techniques and the decrement of the starting price of Ti have been identified as the two main routes to follow to decrease the fabrication costs. In this study, the production of low-cost α+β Ti alloys has been assessed by combining the addition of cheap alloying elements (in particular a Fe/Ni powder) with the classical powder metallurgy route (pressing and sintering). Physical and mechanical properties as well as microstructural analysis of these low-cost alloys were measured and correlated to the processing parameters used to sinter them. It is found that the low-cost Ti alloys show similar behaviour to conventional α+β Ti alloys and, thus, have the potential to be used for non-critical applications.
Material Performance in Laser Cladding of a Laminated Plate with Wavy Bond Interface
Authors: Li Zi Hui , Gao Mei Na , Wang Xu Yue
Published: July 2016

A laminated plate with excellent mechanical properties is commonly used for a bulkhead part in which the interface structure of diffusion bonded is detrimental to the bending quality. In this study, 304 stainless steel and Q235 carbon steel were cladded by laser cladding technique. Microstructure, yield strength, elements diffusion, hardness and tensile fracture morphology of the clad metals were evaluated. The bond interface of the cladded metals demonstrated a wavy morphology in this work. Tensile test results shows that yield strength reaches 400-410MPa and tensile strength reaches 405-419MPa. They are higher than the standard value 235MPa and 370MPa, respectively. In wavy interface region, transition layer of metallurgical bond was formed as a result of mutual diffusion of Fe, Cr and Ni. The hardness is increased in the substrate and cladding plate near the bond interface. The mechanical properties of the low-carbon steels is increased by laser cladding with austenitic stainless steel, which are far beyond the national standard and other bending methods.
Study on Titanized Layer Microstructure of T10 Steel by Double Glow Plasma Surface Alloying Technique
Authors: Hong Xiao Lu , Cui Chong Liang , Sun Ting Fu , Wei Xi Cheng , Ji Cheng Chang
Published: July 2016

The titanized layer was prepared on the surface of T10 steel using a double glow plasma surface alloying (DGPSA) technique. The titanized layer was characterized by SEM and scratch tester. Results showed that the TiC layer with a thickness of 1.5~8.5μm was formed on the sample surface at the range of 900°C to 1100°C for the holding time from 2h to 6h, which was homogeneous, dense, and metallurgically combined with the substrate. The Ti concentration gradually decreased from surface to the matrix. The diffusion activation energy of Ti during double glow plasma titanizing was also estimated.
A Brief Review of Forming Forces in Incremental Sheet Forming
Authors: Li Yan Le , Sun Jie , Li Jian Feng
Published: July 2016

Investigation of forming forces in incremental sheet forming (ISF) is of great importance since it provides understanding of the deformation mechanics, monitoring of the forming process, failure prediction, and future means of on-line control and optimization. This paper provides a review of studies on the contact conditions and the effects of the process parameters on forming forces in ISF, followed by the current status on forming force prediction and its potential role in the improvement of ISF technology.
A Novel Nano-TiO2 Additive Oil-in-Water Lubricant for Hot Steel Rolling
Authors: Xia Wen Zhen , Zhao Jing Wei , Wu Hui , Jiao Si Hai , Zhao Xian Ming , Zhang Xiao Ming , Jiang Zheng Yi
Published: July 2016

To obtain a low cost, environmentally friendly and effective lubricant, a novel nanoTiO2 additive oil-in-water (O/W) lubricant for hot steel rolling has been developed. Based on the contact angle, tribological and hot rolling tests, the performance of the nanoTiO2 additive O/W lubricants was evaluated and discussed. The results show that the strongest adhesion force between the nanoTiO2 additive O/W lubricant and the work roll is obtained after addition of 4% nanoTiO2 additive in the 1% O/W lubricant. The nanoTiO2 nanoparticles can reduce coefficient of friction (COF) and rolling force, and enhance the surface quality of the hot-rolled product. The lubrication mechanism of nanoTiO2 additive O/W-based lubricant has been proposed.
Parametric Study of DIC Technology for Strain Distribution of CuZn30 during Micro-Bending Process
Authors: Wang Li Jie , Kinsey Brad
Published: July 2016

In this paper, digital image correlation (DIC) technology and equipment were applied to research strain distribution of CuZn30 metal sheet throughout thickness during three-point bending process. Especially, a parametric study of DIC technique was conducted. The results show that the subset value and step size has a great impact on the strain distribution date. In order to obtain a lower iterations and confidence of the image, reasonable step size and subset value should be decided.
A Novel Testing System for Mechanics Properties of the Thin-Walled Micro Components in Inertial System
Authors: Che Lin , Wang Bo , Li Guo
Published: July 2016

In this paper, micro tensile method was combined with micro bridge dynamic test method as a new testing method for mechanics performance to be put forward, and a novel testing system for mechanics properties of the thin-walled micro components was established. The micro testing specimen were designed and manufactured. And related mechanics performance tests were carried on to verify the feasibility and reliability of the test system. The experimental results show that displacements of the testing system are measured with 0.01μm resolution and axial loads are measured with 0.005N resolution.
Dispersion of Al2O3 Reinforcements in Al Composites via Friction Stir Processing
Authors: Du Zheng Lin , Tan Ming Jen , Guo Jun Feng , Wei Jun
Published: July 2016

Friction Stir Processing is a solid state process with the ability to modify microstructure and refine grain sizes of the material without melting and uniformly disperse reinforcement particles in the material matrix resulting in further improvements in the mechanical properties. In this study, it was used to disperse Al2O3 reinforcement particles of different sizes. Uniform dispersion of the reinforcements was achieved in the aluminium matrix with significant reduction in grain size were observed via SEM and EBSD. Improvement in Vicker’s micro hardness was observed after FSP.
Effect of Sliding Speed and Loads on Tribological Behaviors of Iron and Cobalt-Based High-Temperature Alloys against Al2O3 Balls
Authors: Huang Chang Ming , Zou Bin , Liu Yan An , Zhang Shuai
Published: July 2016

The dry sliding wear behaviors of iron and cobalt-based high-temperature alloys against Al2O3 with different sliding speed under various loads were investigated using a ball-on-disc tribo-tester. The friction coefficient of both high-temperature alloys decreased with the increasing speed and load. The GH605 exhibited the stronger wear resistance than GH2132 under all test conditions. The adhesion layer and oxides were found on the worn surface of Al2O3, and the high-temperature alloy would react with air and the wear mechanisms might be adhesive wear and oxidative wear.
Microcellular Foaming of Biodegradable PLA/PPC Composite Using Supercritical CO2
Authors: Ma Zhen Guo , Lang Xian Hua , Luo Peng , Xin Zhen Xiang , Zhang Zhen Xiu
Published: July 2016

Poly (lactic acid) (PLA)/poly (propylene carbonate) (PPC) composite foams were microcellular foamed with CO2 through a batch foaming process. The influences of PPC contents, foaming temperature, and saturation pressure on the cell structure and foam density were investigated. The biodegradable PLA/PPC composite foam showed a controlled structure of microcellular and nanocellular. With an increase in saturation temperature and pressure, the cell size was increasing and both the cell density and foam density were decreased simultaneously.
Preparation of MgB2 Films by Directly Electrophoretic Depositing MgB2 Powder on Ti Substrates
Authors: Li Feng Hua , Gao Han , Zhang Bo Wen , Zhu Qing Lian
Published: July 2016

MgB2 powder was fabricated by sintering the mixture of pure Mg and B powder with atomic ratio of Mg : B=1:2. The magnetic property of the powder indicated that it was superconducting and its critical transition temperature was 39K. Titanium based MgB2 films were obtained by electrophoretic deposition method using Ni sheet as anode and titanium tapes as cathode. The films were annealed at 500°C for 2 hours, subjected to argon-hydrogen (95%Ar+5%H2) gas flow. The results of X-ray diffraction (XRD) analysis showed that the composition of the film was mainly MgB2. The observation under scanning electron microscopy (SEM) showed that the film of MgB2 was uniform and dense. The electrical resistivity of double-side MgB2 film was about 5.280×10-8Ω/m.
Experimental Study on the Thermal/Vibration Characteristics for a Plate Structure Made of High-Temperature-Resistant Nickel-Based Stainless Steel
Authors: Shang Lan , Wu Da Fang , Wang Yue Wu , Wang Huai Tao
Published: July 2016

A thermal/vibration test system was established in this paper, using which the key vibration characteristic parameters of a plate structure made of high-temperature-resistant nickel-based stainless steel in a thermal vibration coupled environment up to 1100°C (e.g., the modal frequency and modal vibration shape) were experimentally obtained. A self-developed extension configuration of a high-temperature-resistant ceramic pole was used to transfer the vibration signals of the structure to a non-high temperature zone, and the acceleration sensors were applied to identify the vibration signals. The test data were analyzed using a time-frequency joint analysis technique. The research results can provide an important basis for the dynamic performance analysis and safety design of structure under high-temperature thermal vibration conditions for hypersonic flight vehicles.
A Novel Rotational Insertion Method for Deflection-Free Delivery of a Microelectrode into Deep Brain
Authors: Li Zhe , Ng Khoon Siong , Wu Tie Cheng , Li Xiao Ping
Published: July 2016

Measuring deep brain neural activities with a microelectrode is of greatest importance in uncovering the mechanism of various brain disorders. In this operation, a microelectrode needs to be accurately inserted into deep the brain. However, a microelectrode of high flexibility would bend at encountering a layer of tough tissue during insertion, which would lead to deflection and impaired targeting accuracy. To deal with this problem, a rotational insertion method has been developed in this paper for deflection-free insertion. Rotation helps generate a dynamic anti-bending force to prevent buckling, and this force becomes larger with the increase of rotational speed. Thus, by controlling the rotational speed at which insertion is carried out, deflection-free insertion of a microelectrode deep into brain can be realized. The effectiveness of this method has been experimentally confirmed.
Computer Simulation of AUV Navigation System Using Fish Lateral Line Sensing Mechanism
Authors: Liu Gui Jie , Gong Hua Yao , Leng Ding Xin , Xu Lei , Liu Zhan Wen
Published: July 2016

Based on the study of fish lateral line sensing mechanism, integrated fluid dynamics, boundary layer theory, coupling theory and so on. To establish a neural network model similar to the fish neuromas model. After the numerical calculation and simulation analysis to simulate fish lateral line system, we can get the conclusions to apply to autonomous underwater vehicle (AUV) navigation and target recognition. Provided a new method for AUV navigation and environment perception. Computer simulation results presented that based on the fish lateral line sensing mechanism to build a perception model, AUV can identify a new water condition distinguishably. This discovery can be used in navigation and positioning of AUV.
An Investigation of Forces and Tool Wear in Milling of Ni3Al-Base Superalloy
Authors: Liu Gao Qun , Zhao Zheng Cai , Fu Yu Can , Yan Zhi Liang
Published: July 2016

This article studies the forces and tool wear behavior in the milling process of Ni3Al-base superalloys with cemented carbide cutting tools. The effects of cutting parameters on the machinability of these superalloys are experimentally discussed. The results indicate that the forces increase with the increase of the axial depth of cut, the radial depth of cut and the feedrate per tooth. The cutting tools wear rapidly in the milling process of Ni/Al superalloys. The cemented carbide cutting tool with TX coating is more suitable for machining Ni/Al superalloys when compared with the tool with TiCN coating.
High Speed Machining of Hardened AISI 1045 Steel
Authors: Zhang Xue Ping , Wu Shu Biao , Yao Zhen Qiang , Xi Li Feng
Published: July 2016

Hardened AISI 1045 steel implemented in machine tool spindle was previously ground using grinding operation. This research aims to address the feasibility of hard turning AISI 1045 using PCBN tool with chip breaker under dry condition. Chip morphology, cutting force and temperature were measured, analyzed and correlated with machining parameters. Experimental results demonstrate that serrated chips are generated at high speeds, high feed rate is an assistant to promote serrated chips, and chip breaker can help break chip into acceptable lengths. Cutting forces were characterized with periodic fluctuation along three directions as chips are serrated. Temperature at machined zone can reach as high as 1200°C, which indicates that adiabatic shear bands can be successfully achieved during the machining of hardened AISI 1045 steel without applying lubricants.
A New Technology to Machine Bimetal Band Saw
Authors: Dong Hong Jian , Zhang Qin He , Tan Lei , Liu Guo Wei , Guo Tuo Dang
Published: July 2016

As a kind of commonly used tools, junior hacksaw plays an important role in our daily life. A new kind of bimetal band saw taken low carbon medium alloy steel X32 as the backing material and the high-speed steel M42 as the saw tooth material is developed. In this paper, a new method to machine the bimetal band saw with wire electrical discharge machining (WEDM) is introduced. The processing route for common tooth profile is calculated. The fixture with specific angles is designed with CAD software (proe5.0) and machined with 3D printing technology. The experiments show that bimetal band saw machined with WEDM method has better surface quality compared with that machined through the traditional grinding process. Without any burrs, the new bimetal band saw is more resistant to wear and has a longer service life.
Research on the Preparation and Cutting Experiment of Magnesium-Calcium Alloy
Authors: Wei Yu Kun , Zhang Hao Bo , Qiao Yang , Guo Pei Quan
Published: July 2016

Compared to conventional metallic materials, biodegradable material magnesium and calcium (Mg-Ca) alloys are attractive to be new participants as implants. It can avoid stress shielding and provide sufficient mechanical strength as the similar mechanical properties to human bone. In this study, Mg-0.8wt%Ca and Mg-1.6wt%Ca are prepared and Mg-0.8wt%Ca is dry milled. Overall carbide tool is used in the process and the roughness generated by different combination of cutting parameters, i.e. cutting speed, feed, and depth of cut are studied.
A Rare Association of Hepatitis a Virus Infection with Type-1 Diabetes
Authors: Hasosah Mohammed , Bokhari Alaa , Alsahafi Ashraf , Sukkar Ghassan , Alzaben Abdullah
Published: July 2016

Patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases, which includes fatty liver, steatohepatitis and cirrhosis. The association of hepatitis A infection with type-1 diabetes is extremely rare. To the best of our knowledge, our case is the first case report in children. We described a nine year-old girl who had type-1 diabetes and developed hepatitis A virus infection without complications. A review of the literature is also provided.
Editor’s Note
Authors: Griffo Raffaele
Published: July 2016

-
Cardiac Rehabilitation and resuming sexual activity
Authors: Tuniz Duilio , Petri Enzo , Carone Maurizio , Bernardi Guglielmo , Fioretti Paolo M.
Published: July 2016

patients’ quality of life and subjective well being. Patients, however, are often uninformed regarding the question of resuming sexual activity after a cardiac event. Recent epidemiologic data reveal that sexual problems are widespread and adversely affect mood, well-being, and interpersonal functioning Erectile dysfunction (ED) is the most commonly recognized and treated sexual dysfunction. It affects > 30% of men 40 to 70 years of age and its prevalence in patients with cardiovascular disease is higher than in the general population. International Guidelines has faced the problem of resuming sexual activity after a cardiac event and of the eventual suitability to the use of sildenafil or other selective inhibitor of cGMP-specific phosphodiesterase type 5 (5-PDE) for the therapy of ED in these patients. The clinical judgment should be based on the integration of clinical and instrumental data, on the evaluation of the compatibility with the foreseen energetic cost of the effort connected to sexual activity and, in case of prescription of 5-PDE inhibitors, on the eventual incompatibility with the therapy undertaken (in particular with nitrates). In the review the main reference points of literature are supplied in order to have the chance of giving motivated technical advice. Finally it is extremely important to face the problem of resuming sexual activity systematically within the cardiac rehabilitation program, with educational sessions, individual or couple conversations, and with the aid of information pamphlets.
Documento di consenso La Prevenzione Secondaria
Authors: Griffo Raffaele , Temporelli Pier Luigi , Abrignani Maurizio G. , Colivicchi Furio
Published: July 2016

-
ESC Congress 2004: highlight on exercise and cardiac rehabilitation
Authors: Piepoli Massimo F.
Published: July 2016

-
Postoperative atrial fibrillation: etiopathogenesis, prevention and therapy
Authors: Calisi Pasqualina , Griffo Raffaele
Published: July 2016

Atrial fibrillation is the most frequent complication after cardiac surgery. Its onset leads to a threefold higher risk for stroke compared with patients in sinus rhythm and other adverse events such as thromboembolic events and heart failure. The direct consequence is an increased length of hospital stays with obvious economic implications. These reasons have led the attention of many investigators to point out the rule of possible predisposing factors and underlining mechanisms in order to establish an effective preventive treatment. The present paper is aimed to review the state-ofthe- art knowledge about post-operative atrial fibrillation and its complex etiopathogenesis which is in turn responsible for the lack of consensus regarding routine prophylaxis.
Cardiovascular Prevention and Coronary Heart Disease mortality decrease
Authors: Griffo Raffaele
Published: July 2016

-
Le ricette salvacuore
Authors: Scardi Sabino
Published: July 2016

-
Physiological effects of intravenous fructose 1.6-diphosphate on diaphragmatic function in malnourished patients with COPD
Authors: Nava S. , Fuccella L.M. , Viglianti B.
Published: July 2016

Background. A low body mass index is one of the strongest predictors of mortality in Chronic Obstructive Pulmonary Disease (COPD) patients. Under-nutrition is often associated with skeletal muscle wasting and hypophosphatemia. Aim and Methods. In a pilot, randomised, doubleblind placebo-controlled study, we assessed the physiological effects of phosphorous administration in 17 stable undernourished COPD patients, on diaphragmatic function, breathing pattern, neuromuscular drive (P0.1) and dyspnea score. Fructose 1.6-diphosphate (FDP) or placebo was administered i.v. for 7 consecutive days. Results. FDP administration was associated with a marked increase in inspiratory time (Ti) that induced a significant rise (p<0.05) in the Pressure Time Product of the diaphragm per breath (PTPdi/b). However, since breathing frequency also decreased, the Pressure Time Product per minute of the diaphragm (PTPdi/min), index of diaphragmatic energy expenditure was markedly reduced. The efficiency of the respiratory pump in clearing CO2 was also improved, although not significantly, in the FDP group (p=0.09) as well as the maximal transdiaphragmatic pressure during the sniff manoeuvre (Pdi,sniff). Conclusions. This pilot physiological study showed that phosphorus replacement in undernourished, stable COPD patients, may be associated with a complex modification in respiratory pattern and diaphragmatic functions, leading to a marked although not significant reduction in PTPdi/min.
Evaluation of co-morbidity indices in patients admitted for Chronic Obstructive Pulmonary Disease
Authors: Pinckney R.G. , O’Brien R. , Piccirillo J.F. , Littenberg B.
Published: July 2016

Background. There is limited and conflicting information on the use of co-morbidity instruments to predict mortality in patients with chronic obstructive pulmonary disease (COPD). Methods. We sought to test the validity of the Charlson Index and another co-morbidity instrument, the Adult co-morbidity evaluation 27 (ACE-27), in patients admitted with COPD exacerbations. Co-morbidity scores were obtained by chart review. Information on mortality was retrieved from the Social Security Death Index. We examined the predictive validity of the Charlson and the ACE- 27 using survival analysis. Results. There were 112 patients eligible for the study. The ACE-27 but not the Charlson predicted survival, after adjusting for age, gender, and smoking history in Cox regression, hazard ratio (95% CI) of 1.99 (1.17-3.39). Conclusions. This study confirms earlier findings that the Charlson Index is not a reliable predictor of mortality in patients with COPD. However, the ACE-27 appears to be useful for predicting survival in this study.
The mechanics of the lung parenchyma and airway responsiveness to metacholine
Authors: Salerno F.G. , Resta O. , Foschino-Barbaro M.P. , Spanevello A.
Published: July 2016

The lung parenchyma is anatomically and mechanically connected to the intraparenchymal airways. Due to forces of interdependence the lung parenchyma represents a mechanical load that opposes bronchial narrowing during airway smooth muscle activation. The mechanical load caused by the parenchyma is a function of the number of the alveolar attachments to the airways, and of the mechanical properties of the parenchyma. The extracellular matrix is a major component of the lung parenchyma responsible of most of its mechanical properties. The excessive airway narrowing observed in the asthmatic population may be the consequence of the altered mechanical properties of the extracellular matrix reducing the mechanical load that opposes airway smooth muscle contraction.
Primary angiosarcoma of the lung and pleura
Authors: Maglaras G.C. , Katsenos S. , Kakadelis J. , Katsanos C. , Metafratzi Z. , Stefanou D.G. , Vassiliou M.P. , Constantopoulos S.H.
Published: July 2016

A 46 year old male smoker was admitted for severe continuing hemoptysis. Chest-X-rays and chest computed tomography revealed nodular infiltrates and bilateral hemothorax. Fiberoptic bronchoscopy resulted to non-diagnostic cytological and microbiological findings. Open lung and pleural biopsies after right thoracotomy revealed epithelioid angiosarcoma and further staging assessment showed secondary brain and liver foci. The patient received several courses of chemotherapy but he died one month later. The clinical, radiological, pathological, histochemical and therapeutic aspects of the disease are discussed. Angiosarcoma, a rare tumour with poor prognosis should be taken into consideration in the differential diagnosis of hemoptysis.
Primary multi-drug resistant tuberculosis presented as lymphadenitis in a patient without HIV infection
Authors: Mirsaeidi S.M. , Tabarsi P. , Edrissian M.O. , Amiri M. , Farnia P. , Mansouri S.D. , Masjedi M.R. , Velayati A.A.
Published: July 2016

Primary multi-drug resistant extrapulmonary tuberculosis is an uncommon form of the disease, but it seems that by increasing the number drug resistant tuberculosis around the world, the number of cases of primary multidrug resistant tuberculosis with extrapulmonary presentation also is going to rise. In this report, we describe a 19- year old, HIV negative man with primary multi-drug resistant TB lymphadenitis, presented with cervical lymphadenopathy and sinus discharge at the site of involved lymph nodes. The Acid Fast Bacilli (AFB) smear of sputum was negative but the AFB smear of discharged fluid as well as the excisional biopsy of the lymph nodes confirmed the M. tuberculosis infection. The patient underwent the treatment with a combination of isoniazide, clofazimine, pyrazinamide, ofloxacin and amikacin with promising results. By increasing the number of drug resistant tuberculosis patients around the world, appropriate diagnosis and treatment of different presentations of the disease need a special attention.
Sleep disordered breathing following stroke
Authors: Turkington P.M. , Elliott M.W.
Published: July 2016

In recent years there has been increasing interest in the relationship between obstructive sleep apnoea and stroke. It is clear that many patients who have had a stroke have marked obstructive sleep apnoea. This is seen during recovery but also during the acute phase when transient hypoxaemia and the blood pressure swings associated with upper airway obstruction, may worsen the ischaemic penumbra of the area of the brain which is compromised, leading to a worse outcome. There is some evidence to support this hypothesis. This article explores these issues.
Rehabilitation of COPD patients: which training modality
Authors: Clini E. , Costi S. , Romagnoli M. , Florini F.
Published: July 2016

Non pharmacological therapy has been gaining more interest and has been evolving rapidly over the last decade as an essential part of therapy for COPD patients. Pulmonary Rehabilitation (PR), the most important non pharmacological treatment in patients with COPD, has a primary goal: to achieve the highest possible level of individual exercise tolerance, thus reducing the primary and/or secondary health care utilisation. The aim of the present review is to focus the role of exercise training in these patients as well as to address the question on which training methods are the most beneficial. We have therefore undertaken a MEDLINE-based search including the terms: pulmonary rehabilitation, exercise, lung disease/obstructive. Several strategies based on endurance or strength training are nowadays implemented during PR programmes in order to maximise the benefits for each patient. The impaired function of ambulation muscles causing breathlessness as one of the more frequent symptoms in many COPD, suggests that training the lower extremities is the most important goal to achieve during pulmonary rehabilitation of these patients. On the other hand, as muscle strength appears to be an independent contributor to survival and utilisation of health care resources, it seems largely justified also to include this further modality in the PR program of these patients. In conclusion, both modalities are effective and useful for COPD patients. However, whether resistance training should be administered to all COPD and which is the optimal length of strength training still needs to be elucidated.
Recurrent catamenial hemothorax
Authors: Charokopos N. , Tsiamita M. , Karkoulias K. , Panagiota R. , Dougenis D. , Spiropoulos K.
Published: July 2016

Endometriosis is a common cause of chronic pelvic pain and infertility affecting women of reproductive age, but the disease in rare conditions may be extragenital so may be present with a variety of symptoms. This is a report of an unusual case of pelvic endometriosis that presented with a recurrent hemothorax.
Water and sodium imbalance in COPD patients
Authors: Valli G. , Fedeli A. , Antonucci R. , Paoletti P. , Palange P.
Published: July 2016

Water retention and hyponatraemia are typically observed in the final stages of Chronic Obstructive Pulmonary Disease (COPD) and the onset of edema is a poor prognostic factor. For several years the pathogenesis of edema in COPD patients was attributed to heart impairment because of pulmonary hypertension, but the evidence that cardiac output is often adequate for the metabolic demands has suggested, since 1960, that the pathogenesis of edema in these patients would be correlated with gas exchange impairment and in particular with carbon dioxide (CO2) retention. The gas exchange impairment induces, in these patients several hormonal abnormalities: renin (Rn), angiotensin II (AnII), aldosterone (Ald), atrial natriuretic peptide (ANP), vasopressin (ADH) and endothelial factors are some of the factors involved. The systemic response to hypercapnia has the effect of reducing the renal blood flow and, as a result, increasing water and sodium retention with the final effect of edema and hyponatraemia. The aim of this brief review is to highlight the current knowledge on renal/hormonal abnormalities in COPD and their therapeutic implications.
Endoscopic removal of a right main bronchus glomus tumor
Authors: Vailati P. , Bigliazzi C. , Casoni G. , Gurioli C. , Saragoni L. , Poletti V.
Published: July 2016

Glomus tumours in the respiratory tract are very rare. The majority of the reported cases have been surgically treated. An approach with rigid bronchoscopy to endobronchial lesions suspected to be carcinoid or other well vascularized tumours, as glomus tumor is, should be considered because it can allow a safe diagnosis and eventually be therapeutic avoiding more invasive and surgical procedures.
Simultaneous pulmonary and intrathoracic lymph nodal granulomatosis of unknown significance (GLUS)
Authors: Katsenos S. , Kostikas K. , Lachanis S. , Sabaziotis D. , Psathakis K. , Loukides S.
Published: July 2016

A case of a 30-year-old male with a fever, dry cough and associated abnormal findings in imaging modalities (bilateral hilar lymphadenopathy and nodular parenchymal opacities) is described. After a further and scrutinized work-up, the diagnosis of GLUS syndrome was made. Clinical, etiological, pathological and therapeutical aspects of the disease are discussed, demonstrating the paramount importance of the use of the immunohistochemical methods in the diagnosis of this disorder.
Physical activity for coronary heart disease: cardioprotective mechanisms and effects on prognosis
Authors: Scrutinio Domenico , Bellotto Fabio , Lagioia Rocco , Passantino Andrea
Published: July 2016

A sedentary lifestyle is one of the five major risk factors for coronary heart disease (CHD) along with hypertension, abnormal values of blood lipids, smoking and obesity. After an acute myocardial infarction, risk factors continue to contribute synergically to the clinical progression and prognosis of CHD. Regular physical exercise has been shown to improve exercise capacity and quality of life, to reduce symptoms and to decrease the risk of new coronary events in patients with CHD. Regular physical activity with its favourable effects on coronary risk factors, endothelial dysfunction, inflammation, tendency to thrombosis, on autonomic tone and myocardial ischemia, may play a role in reducing the risk of new coronary events and death. In view of the clinical benefits yielded and its well-documented cardioprotective mechanisms, regular physical activity should be regarded, by general practitioners and cardiologists, as a true and effective form of therapy for patients with CHD.
Exercise Rehabilitation in Heart Disease: the real “polypill” for primary and secondary prevention
Authors: Piepoli Massimo F.
Published: July 2016

Our society is currently at war against the ominous enemy of chronic disease. Chronic disease presents a heavy burden to society, in terms of both medical costs and human suffering. It is our perception that: 1) much of the medical community underpractises primary prevention as regards appropriate levels of physical activity for health, and 2) much of the research community undervalues the importance of understanding the physiological, genetic and clinical bases of diseases caused by physical inactivity. For many, exercise is viewed solely as a research or diagnostic tool and not as a true weapon against chronic disease. In reality, however, exercise attacks the roots of chronic disease, i.e. physical inactivity. The first step in a common “battle plan” is to convince the medical community that chronic disease is rooted in physical inactivity. In this review, we focus on the biological evidence to date showing how physical inactivity leads to chronic disease. One purpose of this review is to demonstrate that exercise, such as treadmill testing of humans for cardiac dysfunctions, is more than a diagnostic tool but part of disease management itself.
Cardiac Rehabilitation in the Region of Veneto
Authors: Carlon Roberto
Published: July 2016

In Italy there has been a progressive shifting of the legislative and fiscal activity from a national level to a regional one. In the Venetian district a series of documents, also concerning the cardiac rehabilitation, has been produced. A document elaborated in 1999 contains a detailed account of eligibility criteria for cardiac rehabilitation as well as of structural and organizational requirements. Other documents contain the updated price lists for admission episode (DRG 462) or days of stay in hospital and diurnal hospital activity, according to the type of structure which supplies the service. For outpatients, cardiac rehabilitation is identified by the code 93.36 and the ticket fare is 19,50€. In the enclosure no.6 of the Sanitary Regional Plan, still under definitive approval, it is stated that for each Intensive Therapy there will be a functional connector with a cardiac rehabilitation service which, except for few Centers, will carry on its activity with outpatients. At present the regional Cardiac Rehabilitation includes 3 complex units (for in- and outpatients) and 13 simple units (for outpatients only), with a total of 3031 patients rehabilitated in 2004.
Epidemiology of Acute Coronary Syndrome in Campania
Authors: Gregorio Giovanni , Citro Rodolfo , Chieffo Carmine , Corsini Fabrizio , Riccio Carmine , Iacomino Maria , Serafino Maria
Published: July 2016

Recent observational studies have pointed out many problems regarding the pre-hospital and in-hospital management of patients with acute coronary syndrome (ACS). The present study analyses the epidemiology of ACS in Campania Region. It has enrolled the 92.3% of coronary care units (CCU) of the Campania. The results indicate that 77% of patients admitted in CCU have ACS and the time of admission in CCU is still too long. Moreover the vast majority of patients arrive at the hospital without emergency ambulance and 48% of patients admitted in CCU for ACS with elevated ST segment do not receive any reperfusion therapy; compared with the 35.1% of patients included in the BLITZ study. The challenge of the SSN in the next future is to improve the “decision making” in the management of patients with ACS. This goal could be reached by an optimal organization of the hospital and out-of-hospital emergency services creating an integrated network of cardiological assistance.
A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery
Authors: Calsamiglia Giuseppe , Camera Federica , Mazza Antonio , Villa Paola , Gigli Berzolari Francesca , Tramarin Roberto , Cobelli Franco
Published: July 2016

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs.
What’s the best assessment of preload after cardiac surgery?
Authors: Piccirillo Maria Rosario , Natale Armando , Trosino Giovanni , Sebastopoli Marianna , Vivona Giovanni , De Martino Giovanni , Ismeno Gennaro , Piazza Luigi , Belloni Luigi
Published: July 2016

Objective: The assessment of the role of transesophageal echocardiography and invasive tests with pulmonary modified catheter to monitor the preload indexes in patients in intensive- care-unit after cardiac coronary surgery. Materials and Methods: Between January and December 2004 24 patients (14 male, 10 female) with coronary artery disease were prospectively enrolled for preload assessment during off-pump myocardial revascularization. Pulmonary Capillary Wedge Pressure (PCWP), Left Ventricular End Diastolic Indexed Area (LVEDAI), Δ Aortic Velocity (ΔVAo), Right Ventricular End Diastolic Volume (RVEDVI) as preload indexes were evaluated. Transesophageal echocardiography and pulmonary modified catheter monitoring were performed during the preoperative period at T1 and after fluid infusion (T2). Patients were considered Responders (R) or No Responders (NR) if the Stroke Volume Index increase at T2 was >20% with respect to T1. Results: Mean T1 PCWP was similar in both groups (12.8±2.2 in R vs. 11.4±3 mmHg in NR; p=NS) and mean increase of PCWP at T2 was similar in both groups (1.5±0.3% in R vs. 1.2±3% in NR; p=NS). Mean T1 RVEDVI was similar in both groups (97.33±34 in R vs. 101±21 ml/m2 in NR; p=NS); T2 RVEDVI was similar in R and NR Groups (122.11±49 vs. 138.54±30 ml/m2; p=NS); mean T1 and T2 LVEDAI was similar in R and NR (11.2±3.5 vs. 10.2±2.3 at T1 and 14.04±3.35 vs. 14.67±2.1 cm2/m2 at T2 respectively; p=NS). Higher mean value of T1 ΔVAo (20±7% in R vs. 10±2% in NR; p=0.006) were recorded while similar mean value of T2 ΔVAo were observed (11±3% in R vs. 5±2% in NR; p=0.743). Correlation index between T1 and T2 ΔVAo (R=0.82) in R was significant (p=0.0002), while correlation index between T1 and T2 ΔVAo (R=0.11) in NR was not significant. Conclusions: Our study showed in patients soon after coronary cardiac surgery ΔVAo is the only predictor of “fluid responsiveness” and of ventricular compliance.
Heart failure, oxidative stress and allopurinol
Authors: Biagi Paolo , Abate Luigi
Published: July 2016

Oxidative stress is one of the new and most intriguing pathogenetic hypotheses of heart failure; it involves various mechanisms such as endothelial dysfunction, mechanoenergetic uncoupling and apoptosis. Xanthine oxidase, a key enzyme in purine catabolism, is overexpressed in patients with heart failure, and it is also an important source of oxidizing activity molecules (free radicals, superoxide anion, oxygen peroxide, etc…). Allopurinol competitively inhibits the action of xanthine oxidase and effectively counters oxidative stress. It could thus prove useful in the treatment of heart failure: in fact it is the only drug that has been proven able to lower O2 consumption of dysfunctioning myocardium. The Authors briefly review the xanthine oxido-reductase enzyme system and in particular analyse the latest evidence reported in the literature on allopurinol in the treatment of heart failure.
COPD and tobacco smoke
Authors: Bartal M.
Published: July 2016

Chronic obstructive pulmonary disease (COPD) is a chronic inflammation of the airways, including the parenchyma and the pulmonary vasculature. The burden of COPD is increasing around the world in terms of morbidity and mortality in adult population. Active smoking is a major risk factor for COPD, although there is individual susceptibility to the effects of tobacco smoke. This variability could result from host as well as environmental factors. Even passive smoking in early childhood as well as intrauterine exposure could pave the way for COPD. Tobacco smoke induces a specific, persistent inflammation, different from that of asthma. Three other processes accompany and interact with inflammation: imbalance of both the proteases- antiproteases, the oxidants-antioxidants, and improper repair mechanisms. These processes respectively lead to mucus hypersecretion and alveol wall destruction, dysfunction and death of biological molecules, damage to the extracellular matrix and pulmonary fibrosis with adventitial, submucosal and smooth muscle thickening. The earlier the smoke exposure, the greater the level of decline in lung function. Combined mucus hypersecretion, reduced clearance, and impairment of the lung defence mechanisms explain why COPD patients even with stable condition, carry potential respiratory pathogens in significant concentration, paving the way for infection and acute exacerbations of COPD. Every additional exacerbation in a smoker deteriorate more the lung function. Fortunately, smoking cessation, which is a part of the respiratory rehabilitation could reduce the number of hospitalisations and the decline of lung function, and thus reduce the management cost of the disease and improve the quality of life. The earlier the quitting, the better the improvement of FEV1. “Smoking cessation is the single effective and cost effective way to reduce exposure to COPD risk factors” (GOLD, evidence A).
Different outcomes of pulmonary rehabilitation in patients with COPD with or without exacerbations
Authors: Riario-Sforza G.G. , Incorvaia C. , Paterniti F. , Dugnani N. , Fumagalli M.
Published: July 2016

Background. Pulmonary rehabilitation is recognised as an effective treatment in reducing disability and improving the quality of life in patients with COPD. We evaluated the effects of a course of pulmonary rehabilitation in improving the physical performance and lung function in patients with or without COPD exacerbations. Methods. 74 patients with COPD were enrolled, 37 (24 males and 13 females, mean age 74.6 years) without exacerbations (group A), and 37 (23 males, 14 females, mean age 73.9 years) with exacerbations (group B). The latter must have had the latest exacerbation at least one month before the inclusion. All patients underwent to a rehabilitation programme of 8 visits in 4 weeks in a day-hospital setting, with exercise training, respiratory muscle training and education on COPD. The changes in physical performance and lung function in respect to baseline were measured by a 6-minute walking test, using phethysmography, and by an analogic manometer measuring maximal inspiratory and expiratory pressures (MIP, MEP). Results. Patients of group A showed a mean increase in timed walk distance of 58.38 ± 57.46 m, compared to a mean increase of 31.38 ± 44.78 m in group B patients (p = 0.028). As to lung function, a mean increase of 178.92 ± 132.28 ml in FEV1 in group A versus 67.84 ± 102.04 ml in group B (p < 0.0001) and a mean increase of 22.36 ± 25.06 cm H2O in MEP in group A versus 7.70 ± 12.28 cm H2O in group B (p = 0.002) was found. Conclusions. These findings indicate that patients with COPD with exacerbations achieve a less favourable outcome of pulmonary rehabilitation, with a significantly lower improvement of physical performance, respiratory muscle strength and lung function in respect to subjects without exacerbations.