bluuebunny/crossref_metadata_2025_split huggingface dataset:
92 Eligibility and reimbursement of SGLT2 inhibitors in a heart failure outpatient cohort
Authors: Tarantini Roberto , Vecchi Andrea Lorenzo , Matteo Federica , Guerci Marco , Ponti Roberto De 
Published: December 2021

Abstract

Aims
In patients affected by heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction, sodium–glucose cotransporter type 2 inhibitor drugs (SGLT2i) have shown unexpected and extraordinary results, regardless of the co-presence of diabetes mellitus (DM). The results of the clinical trials have recently allowed the national drug agency (AIFA) to summarize and simplify SGLT2i indications for treatment; however, the reimbursement of these drugs is currently only ensured to diabetic patients, who represent a small subgroup of heart failure (HF) population. The study aims to determine eligibility for SGLT2i in HF outpatients, according to the inclusion criteria of the main clinical trials, comparing the drug label proposed by EMA/AIFA with the current reimbursement criteria.

Methods and results
In this retrospective, observational study, 206 HF outpatients were enrolled from September 2018 to September 2019. The percentages of eligible patients according to the DECLARE-TIMI 58, EMPA-REG OUTCOME, DAPA-HF, EMPEROR REDUCED, and EMPEROR PRESERVED inclusion criteria were analysed, comparing the indications proposed by the EMA/AIFA label and the current reimbursement criteria. Among the 206 patients enrolled, the mean age was 71 ± 12 years, 24% were diabetic, the mean MDRD eGFR was 61 ± 22 ml/min/1.73m2, the mean ejection fraction (LVEF) was 38 ± 11% (LVEF &lt;40 in 65% of the whole cohort). According to EMA/AIFA indications, eligible patients for SGLT2i in this cohort are 66%, representing almost the entire HFrEF population. This percentage, which is far higher than the eligibility of the main clinical trials, is motivated by the more stringent inclusion criteria proposed by the latter, in which the prevailing limiting factors were NYHA class and NTproBNP values. The reimbursement of these drugs is currently only ensured for diabetic patients with eGFR &gt; 60 ml/min/1.73 m2; in our study only 8% of patients met these criteria. Assuming soon to extend the EMA/AIFA indication to HFpEF patients, wider eligibility for SGLT2i is expected for most patients with HF, irrespective of DM and LVEF.

Conclusions
Two-thirds of our HF population is currently eligible for SGLT2i prescription, according to the drug label proposed by EMA/AIFA; this eligible cohort includes almost all HFrEF patients. When the indications will be updated according to the results of HFpEF trials on SGLT2i, eligibility will be extended almost to the entire cohort of HF outpatients. Most eligible patients are not diabetic, however, they have not currently access to drug reimbursement. The constant updating of the SGLT2i label and reimbursement criteria is the main limiting factor in current clinical practice.
691 Distribution of wall motion abnormalities in young patients presenting with acute coronary syndrome
Authors: De Santis Giulia , Pistelli Lorenzo , Franzino Marco , Nicolo Claudio , Parisi Francesca , Cusma Maurizio , Trio Olimpia , Manganaro Roberta , Zito Concetta , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Costa Francesco 
Published: December 2021

Abstract

Aims
Distribution of wall motion abnormalities (WMA) in young patients presenting with acute coronary syndrome (ACS) is not well described.

Methods and results
We included 91 consecutive young patients (≤45 years at presentation) with ACS with obstructive or without obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Wall motion abnormalities, wall motion score index (WMSI) and left ventricle ejection fraction (LVEF) were evaluated. A wall motion abnormality in at least one segment was present in 78.7% of patients. Mean LVEF was 50.9 ± 8.8% and mean WMSI was 1.38 ± 0.37%. Akinesia of at least one segment was present in 49.4%, dyskinesia and aneurysm were rare (1.1%, respectively). Ventricular thrombus was observed in 4.7%. Distribution of wall motion abnormalities is presented in Figure A. Most frequently WMA affected the apex and the basal inferior wall. The severity of WMA for each segment is presented in Figure B. The mean highest severity of WMA affected the apex, and the inferior and infero-septal wall. In the subgroup of patients presenting without obstructive coronary artery disease, WMA were less prevalent (37.5%), LVEF was higher (57.1% vs. 50.4% P = 0.032), and WMSI was lower (1.16% vs. 1.40% P = 0.07), but similarly affected with higher frequency the apex area.

Conclusions
In conclusion, WMA are frequent in young patients presenting with ACS, mostly affecting the apex. More severe abnormalities of wall kinesis affect the apex and the inferior and infero-septal wall.
752 Acute coronary syndrome in young patients: long-term follow-up and quality of life assessment
Authors: Parisi Francesca , Nicolò Claudio , Franzino Marco , De Santis Giualia , Pistelli Lorenzo , Recupero Antonino , Pugliatti Pietro , Dattilo Giuseppe , Cimino Claudia , De Gregorio Cesare , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Costa Francesco 
Published: December 2021

Abstract

Aims
Early onset acute coronary syndrome (ACS) is associated with a more aggressive evolution and its consequences can be devastating to the quality of life (QOL), affecting the patient’s psychology, ability to work, and the socioeconomic burden. In the last decade, the incidence of ACS in young patients (≤45 years old) is increased but unfortunately, little is known about long-term follow-up and impact on quality of life. The aim of this study was to analyse the clinical evolutions and the QOL in this specific group of patients.

Methods and results
We included 91 consecutive young patients (≤45 years at the time of presentation) with ACS referred from October 2013 until March 2021 to our clinic. All enrolled patients underwent angiography. We analysed the clinical presentation, echocardiography, and therapy at the time of discharge. Furthermore, patients underwent telephone follow-up after 40 months: new hospitalizations, cardiovascular events, bleeding, and relevant changes in medical therapy were investigated. In addition, patients were also invited to participate to a survey to investigate QOL, sexual, and socioeconomic changes after ACS. QOL was explored through the EQ-5D scale using the time trade-off (TTO) and visual analogue scale (VAS) technique based on European values. Mean age was 40.6 ± 3.6 years and 17.6% were women. Most patients had obstructive coronary artery disease at angiography (90.1%) and 85.7% underwent PCI. At a median follow-up of 40 months, major adverse cardiovascular events (MACE) a composite of death, myocardial infarction, stroke and definite stent thrombosis, occurred in 12% of patients (Figure 1). Patient reported bleeding occurred in 29.8%, while bleeding requiring hospitalization in 3.6%. Univariate predictors of MACE were previous stroke, Killip class at presentation, current drug use, left ventricle ejection fraction, wall motion score index (WMSI), and haemoglobin at admission. Young patients showed reduced levels of QOL (TTO: 0.85 ± 0.17—VAD: 0.79 ± 0.17), with higher levels among individuals without obstructive coronary artery disease (Figure 2). Predictors of lower quality of life were WMSI, left anterior descending (LAD) stenting, left ventricular aneurysm and ventricular thrombus (Figure 3). After 12 months from the index event, 31.5% of patients were still on dual antiplatelet therapy, and the mean number of medications was 4.65 ± 2.3.

Conclusions
In conclusion, young patients have a high residual risk of ischaemic and bleeding events and impaired QOL. Optimization of medical therapy and better patient information is of upmost importance to mitigate residual risk of adverse events.
373 Utility of the early phase of DPD scintigraphy in the diagnosis of correlated TT-R cardiac amyloidosis
Authors: Graziani Tiziano , Cidda Carla , Serra Walter , Mattioli Maria , Sammartano A. , Migliari S. , Ruffini Livia 
Published: December 2021

Abstract

Aims
The importance of cardiac scan with phosphonate-based radiotracers in the diagnosis of cardiac amyloidosis is now well established. Standard imaging is performed 3 h after tracer injection with a planar view on the cardiac region. This study sought to evaluate the predictive role of early-phase myocardial uptake (10 min after injection) of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) compared compared with standard late acquisition, in patients with suspected hereditary transthyretin-related cardiac amyloidosis (TTR-CA).

Methods and results
Fifty five patients with suspected of TTR-CA with typical aspects of the relative apical sparing at two-dimensional speckle-tracking echocardiography, reported as a specific pattern for cardiac amyloidosis, were enrolled after having signed informed written consent. They have been subjected to a 99mTc-DPD cardiac scintigraphy with planar acquisition at 10 min and 3 h after tracer injection (13 Mbq/Kg). Patients with cardiac uptake on the planar images concluded the examination with a SPECT-CT (cardiac protocol) to assess the affected myocardial segments. On planar images the heart-to-mediastinum-ratio was measured. Subsequently, the diagnosis of amyloidosis has to be confirmed with morphologic examinations such as biopsy and genetic tests. Of the enrolled patients with clinical and echocardiographic aspect of TTR-CA, 22 were positive for cardiac amyloidosis. All of them showed tracer uptake in both early and late images. In patients with positive results, the early-phase showed a Heart-to-mediastinum-ratio &gt;1.2. SPECT/CT showed involvement of almost two myocardial segments: in all patients the ventricular septum showed significant tracer uptake.

Conclusions
Our small group of patients showed that 99mTc-DPD myocardial uptake intensity on early-phase scintigraphy can be used to anticipate the results of late images in diagnosis of TTR cardiac amyloidosis.
753 Facilitators and barriers in adherence to infection prevention and control recommendations among healthcare providers in cardiac settings
Authors: Chialà Oronzo , Chiaretti Ludovica , Ruggiero Antonio , Carnevale Angelica , Fiorini Jacopo , Esposito Giuseppe , Mongardi Maria 
Published: December 2021

Abstract

Aims
The infection prevention and control (IPC) represents a global issue. In cardiac settings, it is a fundamental aspect, mostly in interventional procedures (PMK and valves implantation, angiography procedures), even if with different levels of incidence, mortality, and morbidity. Different guidelines and recommendations have been published to reduce complications related to cardiac procedures infections. Although there are several recommendations, the presence of specific protocols and the adherence to them in medical treatment facilities are controversial. The aim is to identify facilitators and barriers to IPC guidelines in health care providers of cardiac settings.

Methods and results
The research will be conducted in three phases: (1) an integrative review, to identify the main IPC recommendations related to the most common invasive procedures in cardiac interventional settings and the most cited facilitator and barriers; (2) the information collected by the review will help to conduct an explorative survey, involving health care providers from cardiac settings, to better understand what are the most helpful facilitators and the hardest barriers to face; and (3) a qualitative study, using explorative interviews will be held to analyze the experiences of health care providers in their professional action.

Conclusions
Generally, the adherence to IPC recommendations results difficult and time-consuming. For example, even if healthcare workers may value the use of IPC guidelines, such as wearing PPE, these are not always available, adequate for purpose, or comfortable. Identifying which factors could be considered facilitators or barriers will help authorities and healthcare facilities in developing effective strategies to support health care providers to undertake IPC measures.
567 Wolff–Parkinson–White syndrome and sport activity: a peculiar case in a young athlete
Authors: Licciardello Claudio , Golino Michele , Seganfreddo Francesca , Matteo Federica , Giovenzana Fulvio Lorenzo Francesco , Franzosi Cinzia , Genoni Paola , Marazzato Jacopo , De Ponti Roberto 
Published: December 2021

Abstract

Aims
Wolff–Parkinson–White (WPW) is a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles. Palpitations, presyncope, or syncope that result from supraventricular tachycardia represent classic symptoms; however, especially in young athletes, the syndrome can occur with sudden cardiac death. As result, the presence of an accessory pathway (AP) and tachycardia induced by physical activity contraindicates agonist physical activity and represents an indication to perform an electrophysiology (EP) study to stratify the arrhythmic risk, also allowing an eventual transcatheter ablation (TCA) of the AP.

Methods and results
An agonist football player, known since the age of 6 years for Wolff–Parkinson–White syndrome from an intermittent right midseptal parahissian AP, underwent a transesophageal EP study and subsequently ineffective TCA with radiofrequency when he was 13 years old. For evidence of intermittent ventricular preexcitation (VPE), at the age of 15 he underwent a further endocavitary EP study with documentation of poor conductive abilities of the AP. Subsequently, at the age of 17, he had a resumption of palpitation and lipotimie during effort; during another sport medical examination with an exercise stress test (EST), a persistent VPE with the start of an orthodromic atrioventricular reentrant tachycardia during the recovery phase was documented. A new EP study with isoprenaline infusion confermed the precence of the parahissian AP and the inducibility of an orthodromic atrioventricular reentrant tachycardia (Picture 1-2B); therefore, after mapping the arrhythmia, a cryoablation of AP was performed (Picture 1c-1d). Nevertheless, 12 h after the procedure, there was still evidence of intermittent VPE. The patient was then discharged and, after a month, he repeated the EST with documentation of persistent VPE which suddenly disappeared at the peak of the exercise and reappeared during the recovery phase. At the 1-year follow-up, no arrhythmic recurrence but persistence of VPE was reported and a successive EST confirmed abrupt interruption of VPE at the peak of the exercise. Due to the low arrhythmic risk, sport activity was not more restricted.

Conclusions
This represents an original clinical case, as it raises the question of what practical criteria should be defined as an effective TCA of AP in a competitive athlete with unfavorable anatomy. The current guidelines (Sport Cardiology and Exercise 2020) provide useful indications in linear and common cases, but may be a source of doubts in particular cases. Therefore, only the experience and the careful evaluation of the individual patient can provide the key to a correct management of the cases like this.
Non-linear particle reacceleration by multiple shocks
Authors: Vieu T , Gabici S , Tatischeff V 
Published: December 2021

ABSTRACT
When the pressure of particles accelerated at shock waves is no longer negligible compared to the kinetic pressure of the gas, the linear theory of diffusive shock acceleration breaks down. This is expected in particular when the shock sweeps up pre-existing cosmic rays, or when multiple shocks reaccelerate successively the same particles. To describe these systems, one has to account for the non-linear backreaction of the particles on the magnetohydrodynamic flow. Using an up-to-date semi-analytical model of particle reacceleration at non-linear shocks, we show that the presence of pre-existing energetic particles strongly affects the shock profile, in such a way that the reacceleration of non-thermal particles or the acceleration of particles from the thermal bath becomes less efficient. We further describe the evolution of the distribution of particles after several shocks and study the properties of the asymptotic solution. We detail the case of identical shocks as well as more realistic scenarios, including the heating of the medium or superbubble environments. When the particles are efficiently confined in the acceleration region, it is generally found that the spectrum converges toward a concave solution after a few tens of shocks, with a spectral index around 3.5 at the highest energy. The post-shock cosmic ray pressure reaches an asymptotic value of about 4–5 per cent of the ram pressure of one shock. Most of the shock pressure is transferred to escaping particles.
Daytime napping is associated with retinal microcirculation: a large population-based study in China
Authors: Liu Xin , Wang Guowei , Wang Xiaoyan , Wang Yueye , Min Yan , Zhang Janice , Chang Robert T , Zhao Xueyin , He Wei , Moshfeghi Darius M , Lu Ying , Hsing Ann W , Yao Ke , Zhu Shankuan 
Published: December 2021

Abstract

Study Objectives
To investigate the association between daytime napping and retinal microcirculation.

Methods
This is a cross-sectional study from a prospective population-based cohort. 2,662 participants were recruited after quota sampling. Information on napping was collected through face-to-face interviews. Retinal vascular calibers (RVCs), including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arterio-to-venous ratio (AVR), were obtained from fundus photography. Multivariate regression and restricted cubic spline curve were performed to determine the association between RVCs and daytime napping duration.

Results
56.4% participants reported daytime napping regularly. Compared to no nap, daytime nap was related to higher CRAE, with nap duration of 0.5–1 h showing the most significant association. 0.5–1 h daytime nappers displayed an average of 4.18 µm (95% confidence interval [CI] 2.45–5.91, p &lt; 0.001) wider CRAE than non-nappers after adjustment. No significant association was found between CRVE and daytime napping. Moreover, individuals with 0.5–1 h daytime napping had a lower risk for AVR reduction (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.56–0.86, p = 0.001) than non-nappers. Similar association persisted in non-hypertensive population. Restricted cubic spline indicated a J-shaped relationship between AVR reduction and nap duration.

Conclusion
Retinal microcirculation was positively associated with self-reported 0.5–1 h daytime napping. Better indicators of retinal microcirculation were probably related to nap duration in a J-shaped manner. Also, the possibly beneficial role of 0.5–1 h daytime napping on retinal microcirculation might be independent of clinically diagnosed vascular diseases.
The possible thyroid disruptive effect of di-(2-ethyl hexyl) phthalate and the potential protective role of selenium and curcumin nanoparticles: a toxicological and histological study
Authors: Sherif Naima Abd El-Halim , El-Banna Asmaa , Abdel-Moneim Rehab Ahmed , Sobh Zahraa Khalifa , Balah Manal Ibrahim Fathy 
Published: December 2021

Abstract
Di-(2-ethylhexyl) phthalate (DEHP) is one of the ubiquitous pollutants worldwide. This study aimed to clarify the potential thyroid disrupting effect of DEHP and explore the probable ameliorative effects of selenium nanoparticles (Se-NPs) and curcumin nanoparticles (CUR-NPs). Forty-two male albino rats were divided into seven groups (n = 6): Group I (negative control); group (II) orally received DEHP (500 mg/kg BW, dissolved in corn oil); Group (III) orally received Se-NPs (.2 mg/kg BW) in combination with DEHP; Group (IV) orally received CUR-NPs (15 mg/kg BW) alongside with DEHP; Group V (corn oil); Group VI (Se-NPs) and Group VII (CUR-NPs). The duration of the experiment was 30 days. DEHP administration significantly decreased serum free T4 and significantly increased serum free T3 as compared to control group, whereas thyroid-stimulating hormone showed no significant change. DEHP disrupted redox status leading to accumulation of malondialdehyde and depletion of reduced glutathione. Histologically, the effect of DEHP on thyroid follicles was confirmed by light and electron microscopic examination and morphometric analysis. Se-NPs slightly improved thyroid parameters as well as redox status. CUR-NPS reinstated the values of all studied thyroid parameters to nearly control levels. This research provides Se-NPs and CUR-NPs as novel protective agents against DEHP-thyroid disrupting effects.
RAPIDO
Authors: Castro Alejandra , Leal Andrea Ancer , Montiel Tahani Casameni , Sharrief Anjail , Denny Mary Carter , Beauchamp Jennifer E.S. 
Published: December 2021

Abstract:
The mnemonic BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) has been developed for the public to better remember and identify the warning signs of stroke. However, discrepancies may arise when translating stroke educational materials from English to Spanish. This article discusses the use of a culturally tailored tool, RAPIDO, to raise stroke awareness in Spanish-speaking populations.
Anesthesia for tracheal and carinal resection and reconstruction
Authors: Schieren Mark , Wappler Frank , Defosse Jerome 
Published: December 2021

Purpose of review
The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction.

Recent findings
In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal mask airways appear to be an advantageous alternative to tracheal intubation.
Extracorporeal support can ensure adequate gas exchange and/or perfusion during complex resections and reconstructions without interference of airway devices with the operative field. It also serves as an effective rescue technique in case other approaches fail.

Summary
The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.