bluuebunny/crossref_metadata_2025_split huggingface dataset:
160 CARDIOPULMONARY RESUSCITATION IN MICROGRAVITY
Authors: Li Vigni Myriam Letizia , Satiro Francesco , Vecchiet Arisa 
Published: December 2022

Abstract

Introduction
The increase of human space missions in microgravity conditions has led the scientific community to investigate the potential effects on astronauts' bodies. There is a high incidence of cardiovascular complications, with cardiac arrest being among the most difficult to manage. On earth, guidelines regarding cardiopulmonary resuscitation are constantly updated; however, in microgravity, the literature on the subject is still lacking. The aim of this study is to review the available literature and lay the foundation for further nursing developments in this regard.

Materials and Methods
A literature review was conducted by consulting Pubmed as the database. The research question was, "How is CPR performed on the astronaut suffering from cardiac arrest during space flight?" As inclusion criteria, we considered all relevant studies in the literature in the last 10 years, using MeSH terms.

Results and Discussion
The studies reviewed showed that there are 5 possible methods of cardiopulmonary resuscitation in the space environment (Consensus of 2015) : the Reverse Bear Hug Method; the Side-Straps Method; the Evetts-Russomano Method; the Handstand Method; and the Waist Straddle Method. Mackaill et all, through a simulation on a parabolic flight, a dummy and 10 different operators, demonstrated that the Russomano maneuver is capable of sustaining the cardiac circulation by conferring effective manual chest compressions. Hinkelbein et all, drafted a first guideline regarding resuscitation maneuvers. The results of the study also show that defibrillation and ventilation appear to be techniques that have not yet been investigated. The belief remains that BLSD and ALS protocols can be applied in the same manner as applied on Earth. Schimtz et all, with an RCT study that included 15 volunteers and a simulation dummy placed underwater (an environment similar to space characteristics), studied 2 different resuscitation techniques, comparing the Schimtz-Hinkelbein Method and the Cologne Method. The former method demonstrated a better depth and frequency of repetitions of manual compressions. Subsequently, Forti and his collaborators, highlighted the application of automatic mechanical compression devices generating effective compressions.

Conclusion
To date there is little evidence to state with certainty that exclusively one method of cardiopulmonary resuscitation is effective in the aerospace environment. Since the emergency of cardiac arrest is a major problem there is a need to study these processes more thoroughly and entrust health care professionals with the management, practice and theory of such space dynamics also in view of the arrival of the nursing presence during missions in space.
516 SAFETY OF PCSK9I IN A SINGLE COUNTRY, MULTICENTER, OBSERVATIONAL STUDY: A POST-HOC ANALYSIS OF THE AT-TARGET-IT STUDY
Authors: Buonocore Davide , Basile Christian , Calabro´ Paolo , Marzano Federica , Asile Gaetano , Abbate Vincenza , Vicidomini Francesca , Paolillo Stefania , Catalano Angelo , Merlini Piera Angelica , Iannuzzo Gabriella , Ciccone Marco Matteo , Paloscia Leonardo , Varbella Ferdinando , Brunetti Natale Daniele , Indolfi Ciro , Gargiulo Paola , Filardi Pasquale Perrone 
Published: December 2022

Abstract

Introduction
PCSK9 inhibitors (PCSK9i) significantly decrease LDL cholesterol (LDL-C), either as monotherapy or in addition to the maximally tolerated dose of statin and/or ezetimibe. Yet, few data are available in real-world observations.

Purpose
AT-TARGET-IT is an Italian multicenter registry involving 9 Italian centers, designed to assess efficacy, adherence, and persistence of PCSK9i, as well as prescribing doctors’ behavior in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH). The aim of the present analysis was to assess differences between evolocumab and alirocumab on safety in patients on PCSK9i in a real-world single country observational study.

Methods
From June through November 2021, we enrolled patients with PCSK9i first prescription from 6 months before inclusion through starting of PCSK9i use. Clinical and demographic characteristics, concomitant therapies, blood chemistry, were recorded at the time of first prescription and at the latest observation preceding inclusion in the study.

Results
Of 798 patients enrolled, 566 (70.9%) patients took Evolocumab and 232 (29.1%) Alirocumab (of them, 117 patients Alirocumab 75 mg and 115 Alirocumab 150 mg). The LDL-C values reductions did not significantly differ between Evolocumab and Alirocumab groups (65.1% for Evolocumab; 64.5% for Alirocumab, p=ns). Regarding safety events, after a median observation period of 19.3 months (6; 57), 19 patients (2.4%) had acute coronary syndrome, 18 (2.3%) hospitalization for CV causes, 3 (0.4%) stroke, 6 (0.8%) new-onset heart failure (HF) and 68 (4.9%) the composite endpoints of ACS, CV hospitalization, new onset HF, new onset chronic kidney disease, stroke and cerebrovascular insufficiency. Comparing events between patients in Alirocumab and in Evolocumab, no significant difference was found between the two groups. Combined endpoint of adverse events occurred more frequently in patients in Alirocumab (27; 11.6%), in comparison with those in Evolocumab (41; 7.2%) (p=0.044) (Figure).

Conclusion
AT-TARGET-IT study shows that between evolocumab and alirocumab there was a statistically significant difference on the combined endpoint of adverse events.
380 CARDIAC AND VASCULAR IMPAIRMENT IN PATIENTS WITH MILD PSORIASIS: A LONGITUDINAL STUDY
Authors: Cocuzza Federica , Carciotto Gabriele , Pistelli Lorenzo , Parisi Francesca , De Murtas Elisabetta , Poleggi Cristina , Campanella Francesca , De Sarro Rosalba , Vinciguerra Paolo , Imbalzano Egidio , Di Bella Gianluca , Micari Antonio , Dattilo Giuseppe , Casale Matteo 
Published: December 2022

Abstract

Backgrounds
Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated reaction and hyperproliferation of keratinocytes. It is typically associated with several comorbidities; in particular, there are numerous evidence of a link between this condition and cardiovascular (CV) disease. Nevertheless, little is known about its role as an independent cardiovascular risk factor.

Purpose
The aim of this longitudinal study is to evaluate the role of Psoriasis as an independent CV risk factor, to establish the relationship between severity and duration of Psoriasis and CV damage and to find reliable markers to stratify CV risk in these patients.

Methods
33 patients affected by mild Psoriasis without comorbidities were enrolled in this longitudinal study and were compared with 33 healthy subjects. The severity of Psoriasis was assessed with the PASI (Psoriasis Area and Severity Index) score: a score &lt;10 was used to classify psoriasis as mild. Both groups underwent an echocardiogram, with evaluation of 2-dimensional strain (2D-SE), and a Doppler of carotid-femoral pulse wave velocity (PWV). The same evaluation was performed at 2-year follow-up.

Results
A total of 66 patients was included: 33 (50%) with mild psoriasis without comorbidities and 33 (50%) healthy subjects. Comparable clinical and echocardiographic baseline characteristics were observed between the two groups, except for Global Longitudinal Strain (GLS), which was significantly lower (p=0.002) in the Psoriasis group (22.39 ± 2.28%) than in controls (24.15 ± 2.17%), and PWV, that was significantly lower (p=0.004) in controls (8.06±1.68 m/sec) than in the psoriasis group (9.23 ± 1.53 m/sec). Significant correlations between GLS, disease duration and patient age at diagnosis were found, as in coronary artery disease (CAD) and cardiomyopathies. At 2-year follow-up, no significant changes in demographic or clinical characteristics were found within the Psoriasis group. The PASI score did not change significantly, no patient needed any systemic therapy (6 needed an increase in topical drugs) and none of the patients developed any conventional cardiovascular risk factor. There were no significant differences in echocardiographic parameters and no CV events occurred.

Conclusions
According to our data, mild Psoriasis determines subclinical cardiac and vascular damage. However, at two-year follow-up, no CV changes in initially healthy patients were found.
720 FRAILTY INFLUENCE ON PHYSICAL AND PSYCOLOGICAL OUTCOMES IN POST-CARDIAC SURGERY PATIENTS CARDIAC REHABILITATION, A SINGLE CENTER STUDY
Authors: Villani Giovanni Quinto , Villani Matteo , Corbellini Daniela , Schettino Valentina , Bettinardi Ornella , Rosi Alessandro 
Published: December 2022

Abstract

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 &lt;3, 230 M, 65±3 yrs) and in a Group B (540 frail pts, CIRS &gt;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 shown: 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-frail 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.
1067 TELEMEDICINE FOR LIPID LEVELS FOLLOW UP AFTER ACUTE CORONARY SYNDROME
Authors: Mautone Francesco , Ragnatela Ilaria , Di Nunno Nicola , Corbo Maria Delia , D´alessandro Domenico Antonio , Ieva Riccardo , Casavecchia Grazia , Mele Marco , Santoro Francesco , Brunetti Natale Daniele 
Published: December 2022

Abstract

Background
The implementation of guidelines on LDL cholesterol levels after acute coronary syndrome (ACS) is very poor according to registries and surveys. Telemedicine could improve adherence to guidelines and facilitate clinical follow-up of patients with ACS, even with the limitations of Covid-19 pandemic.

Aim of the study
To evaluate the efficacy of telemedicine follow-up in improving adherence to LDL guidelines and improving rates of prescription of PCSK9-inhibitors.

Design and Methods
650 consecutive patients discharged with diagnosis of ACS or Chronic CS were enrolled in the study and followed after 2 and 4 months. LDL levels and lipid lowering drug prescription were recorded. Data from 300 patients with ACS patients and &lt;80 years were analyzed and LDL values of telemedicine followed-up patients (telephone/smartphone app/pc teleconsultation) were compared with controls.

Results
Baseline mean LDL levels were 120 mg/dl, 55% of patients were naive of lipid lowering therapy. At second follow-up mean LDL levels were 55 mg/dl (p&lt;0.05 vs baseline) and rates of prescription of statins, ezetimibe and PCSK9-inhibitors were 98%, 79%, and 18% respectively. Rates of subjects with LDL levels below recommended threshold were 4% at baseline, 39% at first follow-up, 53% at second follow-up (p&lt;0.05). Patients followed up with telemedicine showed lower LDL levels at second follow-up (55vs72 mg/dl, p=0.08) and higher rates of subjects below recommended LDL levels (63%vs30%, p=0.05).

Conclusions
Telemedicine follow-up may improve the implementation of guideline recommended LDL levels after ACS.
470 MYOCARDIAL FIBROSIS IN ASYMPTOMATIC PATIENTS UNDERGOING SURGERY FOR MITRAL AND AORTIC VALVE REGURGITATION
Authors: Fragasso Gabriele , Sanvito Francesca , Monaca Giuseppe , Ardizzone Valentina , De Bonis Michele , Pappalardo Federico , Smart Chanel , Montanaro Claudia , Lapenna Elisabetta , Calabrese Maria Chiara , Castiglioni Alessandro , Benussi Stefano , Maisano Francesco , Zangrillo Alberto , Ambrosi Alessandro , Doglioni Claudio , Alfieri Ottavio , Margonato Alberto 
Published: December 2022

Abstract

Background
Chronic heart valve regurgitation induces left ventricular (LV) volume overload, leading to the development of hypertrophy and progressive dilatation of the ventricle to maintain physiological cardiac output. In order to prevent potential irreversible LV structural changes, the identification of the best timing for treatment is pivotal.

Objective
To assess the presence and extent of fibrosis in myocardial tissue in asymptomatic patients with valvular heart disease (VHD) and preserved LV dimensions and function undergoing cardiac surgery.

Methods
Thirty-nine patients were enrolled. Sixteen patients were affected by aortic or mitral regurgitation: they were all asymptomatic, undergoing valve surgery according to VHD European Society of Cardiology guidelines. Twentythree patients with end-stage nonischemic dilated cardiomyopathy (DCM) and severe LV dysfunction undergoing cardiac surgery for implantation of a durable left ventricular assist device (LVAD) served as controls. During surgery, VHD patients underwent three myocardial biopsies at the level of the septum, the lateral wall and LV apex, while in LVAD patients the coring of the apex of the LV was used. For both groups, the tissue samples were analyzed on one section corresponding to the apical area. All slides were stained with hematoxylin and eosin and Masson's trichrome staining and further digitalized. The degree of fibrosis was then calculated as a percentage of the total area.

Results
Of 39 patients, 23 met the inclusion criteria: 12 had mitral or aortic insufficiency with a preserved ejection fraction and 11 had idiopathic dilated cardiomyopathy. Quantitative analysis of apical sections revealed a myocardial fibrosis amount of 10±6% in VHD patients, while in LVAD patients the mean apical myocardial fibrosis rate was 38±9%. In VHD patients, fibrosis was also present in the lateral wall (9±4%) and in the septum (9±6%).

Conclusion
Our case series study highlights the presence of tissue remodeling with fibrosis in asymptomatic patients with VHD and preserved LV function. According to our results, myocardial fibrosis is present at an early stage of the disease, well before developing detectable LV dysfunction and symptoms. Since the relationship between the progressive magnitude of myocardial fibrosis and potential prognostic implications are not yet defined, further studies on this topic are warranted.
1066 THE USEFULNESS OF CEREBRAL PROTECTION DURING TAVR: A METANALYSIS
Authors: Boccuto Fabiola , Carabetta Nicole , Cacia Michele Antonio , Panuccio Giuseppe , Critelli Claudia , Indolfi Ciro , De Rosa Salvatore 
Published: December 2022

Abstract

Introduction
although transcatheter aortic valve replacement (TAVR) represents a milestone in the treatment of degenerative aortic stenosis, stroke remains an important complication compared to surgical aortic valve replacement (SAVR). Multiple magnetic resonance imaging (MRI) studies demonstrated a substantial rate of new cerebral ischemic lesions after TAVR. In order to avoid debris passage into the circulation and to prevent procedure-related embolic stroke, cerebral embolic protection (CEP) devices were developed. However, their safety and efficacy remain controversial. Very recently, new studies provided additional evidence on this topic.

Aim
to assess the entire body of evidence from randomized controlled studies about neurological outcomes after TAVR.

Materials and Methods
a systematic meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, Scopus, and Google Scholar for randomized controlled studies. The following keywords were used for the search: “transcatheter aortic valve implantation” or “stroke prevention” or “embolic protection” and “cerebral protection”. Study groups were defined as a the “CEP group” and the “control group”. Non-randomized studies reporting outcomes with cerebral embolic protection (CEP) during TAVR were excluded to reduce the selection and confounding bias of observational pilot studies. The primary outcome was post-procedural stroke. Secondary outcomes included total lesion volume on MRI and new ischemic lesions on MRI.

Results
nine trials including 4077 patients were eligible for analysis and included to the meta-analysis. Of those, 2203 patients were randomized to cerebral embolic protection and 1874 patients to control group. Despite the rate of post-procedural stroke was higher in the CEP arm (2.27%) compared to the control arm (2.87%, p&lt;0.001), the use of cerebral embolic protection was not associated with a significantly lower risk of stroke (OR=0.82, 95% CI 0.59-1.15; p=0.255). Cumulative meta-analysis revealed a trend towards a lower impact on stroke prevention with more recent trials.

Conclusions
use of cerebral embolic protection devices during TAVR is a safe procedure. However, the current outline of results from all randomized controlled trials available does not support its routine use, as no significant reduction of stroke risk was evident. The use of these devices might be considered in selected high-risk patients, such as in the setting of heavy calcified cusps or atherosclerotic aortic lesions.
624 DEALING WITH THE UNKNOWN: A STRANGE CASE OF RECURRENT FEVER
Authors: Brugiatelli Leonardo , Coretti Francesca , Alfieri Michele , Bastianoni Gianmarco , Paolini Federico , Coraducci Francesca , Belleggia Sara , Torselletti Lorenzo , Barbarossa Alessandro , Ciliberti Giuseppe , Principi Samuele , Di Noto Giorgio , Lanari Antonella , Giovagnoli Andrea , Tavio Marcello , Stronati Giulia , Russo Antonio Dello , Guerra Federico 
Published: December 2022

Abstract
Blood culture negative endocarditis (BCNE) accounts for 5-10% of all cases of endocarditis. The most common cause of this outcome is initiation of antibiotics prior to cultures. The second most common etiology of negative blood culture is infection secondary to intracellular organisms, which require specific serological tests to be detected. Less frequently, the cause BCNE is noninfectious endocarditis. In this case, it could be secondary to systemic inflammatory diseases or malignancies.
We present the case of a 64-year-old male who presented to his physician complaining of fever, malaise and generalized weakness. He was treated with oral antibiotics and with evidence of initial improvement, but after a few days the fever recurred. His past medical history was significant for cardiac surgery: he had an aortic bioprosthesis implanted for severe regurgitation secondary to left coronary cusp prolapse. Furthermore, he underwent mitral and tricuspid valve annuloplasty for severe regurgitation secondary to diffuse prolapse of these valves.
After recurrence of the fever, he presented to his local hospital. A CT scan was executed and showed left basal lobe hypoattenuation. Given the context, this finding led to a diagnosis of community-acquired pneumonia. He was then treated accordingly and improved. A few days later, the fever returned, and he went back to his local hospital. This time he was visited by a cardiologist, and a transthoracic echocardiogram showed the presence of a vegetation adherent to the aortic bioprosthetic valve. Revising the initial CT scan, the lobar consolidation initially seen was interpreted retrospectively as an atelectasis. On that same day, due to the presence of a painful red eye, the patient was visited by an ophthalmologist. Retinal examination revealed the presence of lesions strongly suggestive of fungal endophthalmitis.
Considering these results, fungal endocarditis was suspected. In view of the patient's complexity and the need for a cardiac surgery, the patient was transferred to our hospital and, after performing blood cultures to identify the pathogen, immediately started on an empirical broad-spectrum antibiotic and antifungal therapy. On admission a cerebral CT scan showed the presence of asymptomatic cerebral septic emboli. Due to the presence of cerebral lesions deemed at high hemorrhagic risk, no immediate surgical indication was posed, despite the suspicion of fungal endocarditis. Fortunately, the patient responded to medical treatment alone. However, blood cultures never revealed the presence of a defined pathogen. Therefore, the final diagnosis was that of blood culture negative endocarditis.
959 AN UNEXPECTED DIAGNOSIS BY ECHOCARDIOGRAPHY: APPLICATION IN CLINICAL PRACTICE
Authors: De Luca Valeria Maria , Antonelli Giorgio , Cammalleri Valeria , Carpenito Myriam , Mega Simona , Caricato Marco , Andrisani Gianluca , Quattrocchi Carlo Cosimo , Grigioni Francesco , Ussia Gian Paolo 
Published: December 2022

Abstract
A carcinoid tumore is a rare neuroendocrinologic malignancy that commonly origins from enterochromaffin or Kulchitsky cells in the gastrointestinal tract and secretes bioactive molecules in blood. Up to 60% of patients with carcinoid tumors have cardiac involvement, often on the right-sided heart valves (typically the tricuspid valve and the pulmonic valve).
A 66 year old woman was admitted to hospital with congestive heart failure, chronic diarrhea and weight loss. A contrast-enhanced computed tomography scan of the liver showed multiple masses (the largest 70 mm×45mm) compatible with metastases. A transthoracic echocardiogram showed dilatation of right sections of the heart with severe tricuspid regurgitation (RV 64 ml/beat, ERO 1 cmq) and mild pulmonary valve stenosis (Peak gradient 13 mmHg). Patient's aortic and mitral valves were normal in structure and function. The EKG revealed low-voltage QRS complexes of all leads, unspecific ST segment changes and sinusal rhythm. The blood tests showed a significant increase in chromogranin A (17670 ng/ml) and enolase; a 24-hour urine collection showed a total output of 5-hydroxyindoleacetic acid eleveted. A biopsy of the liver with immunostaining for chromogranin and synaptophysin were strongly positive and confirmed the diagnosis of metastatic carcinoid syndrome (grade 1, cells CDX2 positive).
The echocardiographic findings of carcinoid heart disease is drumstick-like, rigid, and shortened leaflets with a visible regurgitant orifice, causing torrential tricuspid regurgitation. The pulmonic valve presents more frequently valvular stenosis.
A combination of biomarkers and cardiac imaging is useful in screening and diagnosis of carcinoid heart involvement in patients with carcinoid syndrome. The management of carcinoid heart disease is hardful and requires a multidisciplinary approach, medical and surgical treatment, for optimized care.