80936 research outputs found
Sort by
Impact of SGLT2 inhibitors on endothelial function and echocardiographic parameters in dilated cardiomyopathy
No full textBackground: Dilated cardiomyopathy (DCM) is a common cause of heart failure with reduced ejection fraction (HFrEF) in industrialized countries and a major contributor to morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in HFrEF management; however, their impact on endothelial function in this patient population remains less explored. This study aims to evaluate the effects of SGLT2i on endothelial function and echocardiographic parameters in patients with DCM. Methods: This observational, longitudinal, monocentric study enrolled patients with DCM and HFrEF. Endothelial function was assessed using peripheral arterial tonometry (EndoPAT) at baseline, 6 months, and 12 months following the initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i). The enrollment period spanned from November 2021 to November 2022. The primary endpoint was the change in reactive hyperemia index (RHI) over time. In addition, a subgroup analysis was conducted to compare the effects of different SGLT2i agents (empagliflozin vs. dapagliflozin) and DCM etiology (ischemic vs. idiopathic) on endothelial function. Results: A total of 102 patients were included, predominantly male (72%), with a median age of 75 years and an average baseline left ventricular ejection fraction (LVEF) of 32.9 ± 7.9%. NYHA class II/III was observed in 76% of participants, and ischemic etiology accounted for 53% of DCM cases. The baseline RHI value was 1.15 ± 0.34. At 6 months, it significantly increased to 1.40 ± 0.34 (P < 0.0001), reflecting an absolute change of 0.25 ± 0.03 (ΔRHI baseline - 6 months). Between 6 and 12 months, the RHI showed a further significant increase to 1.69 ± 0.36 (P < 0.0001), with an additional change of 0.29 ± 0.03 (ΔRHI 6 - 12 months). The overall change in RHI from baseline to 12 months (ΔRHI baseline - 12 months) was 0.54 ± 0.04 (P < 0.0001). No significant differences in RHI were observed between patients treated with dapagliflozin and those receiving empagliflozin (P = 0.589), nor between different DCM etiologies (ischemic vs. idiopathic, P = 0.463). The enhancement in RHI was associated with a reduction in the incidence of hospitalization for heart failure (AUC 0.783, P < 0.001). Progressive improvement in left ventricular function was observed through echocardiographic parameters. Although EDV and ESV showed a decreasing trend (EDV: 176.2 ± 64.9 to 167.6 ± 31.1 ml, P = 0.335; ESV: 124.5 ± 52.7 to 116.8 ± 24.6 ml, P = 0.606), these changes were not statistically significant. LVEF improved significantly from 32.9 ± 7.9% at baseline to 36.8 ± 5.5% at 6 months and 37.1 ± 4.9% at 12 months (P < 0.001). The E/A ratio declined from 1.5 ± 0.5 to 1.1 ± 0.3 (P = 0.023) and the E/E' ratio decreased from 18.1 ± 5.1 to 11.1 ± 2.8 (P = 0.027).Left atrial volume significantly decreased from 108 to 100 ml (P = 0.041), and pulmonary artery systolic pressure dropped from 44 to 39 mmHg at 6 months and 35 mmHg at 12 months (P < 0.001). Conclusion: SGLT2i therapy significantly improves endothelial function in patients with DCM suggesting a potential vascular benefit beyond their well established cardioprotective effects
Towards Distributed Process Discovery in Healthcare: Testing and Proving the Feasibility of the Federated Alpha+ Algorithm
No full textThe crosstalk between immune activation and metabolism in heart failure. A scientific statement of the Heart Failure Association of the ESC
No full textA better understanding of additional mechanisms of heart failure (HF) progression may allow a different and more complete phenotyping of the disease and identification of novel therapeutic targets. Persistent latent myocardial inflammation/immune activation in HF may represent an attempt to restore tissue homeostasis in the failing heart, where cardiomyocytes and immune cells undergo metabolic reprogramming, which allows them to deal with decreased availability of nutrients and oxygen. This status can trigger a metabolic crosstalk between immune cells and cardiomyocytes which, depending on the outcome, can either perpetuate the maladaptive remodelling of the heart, or determine an adaptive response. Therefore, the interplay between immune activation and metabolism is gaining recognition as a potential therapeutic framework. On these premises, future studies addressing novel HF treatments should attempt to evaluate the potential therapeutic role of direct metabolic and immunological crosstalk modulation. The aim of the present scientific statement from the Heart Failure Association of the ESC is to summarize the current evidence for the connection between inflammatory and immune activation and metabolic adaptation in the onset and progression of HF, in order to promote future strategies for the development of targeted-disease preventive and therapeutic measures
Evidence Generation and Implementation of Transcatheter Interventions for Atrioventricular Valvular Heart Disease in Heart Failure: Current Status and Future Directions
No full textMitral regurgitation and tricuspid regurgitation are the most common valvular heart diseases in patients with heart failure and have independent prognostic value. Transcatheter interventions are now available for the treatment of valvular heart disease, and their efficacy and safety have been tested in randomized controlled trials. However, evidence is still limited and sometimes inconclusive because several aspects of these trials limit their interpretation or consistency. These include heterogeneity in the pathogenesis and clinical characteristics of patients, the dynamic nature of secondary atrioventricular valve disease severity, the role of heart failure medications and devices, dependency on procedural results and operators' skills, smaller number of patients enrolled and the power to detect differences in trials, and limitations to use patients' reported outcomes with unblinded study protocols. These specific aspects of trials in patients with atrioventricular valve disease are reviewed in this article with a focus on possible solutions to generate further evidence for the efficacy and safety for transcatheter treatments of atrioventricular valve disease in patients with heart failure
Noise Control of High-Voltage Devices for the Development of Sustainable and Resilient Transmission Lines
No full textLa produzione e il consumo di elettricità misurano lo stato di sviluppo di un Paese. Le industrie e i settori con un fabbisogno energetico più elevato sono più avanzati e producono beni e servizi di maggior valore, contribuendo non solo a un maggiore sviluppo economico, ma anche a un migliore benessere dei residenti che ne beneficiano. È quindi fondamentale che tutte le entità di un Paese, siano esse residenziali, commerciali o industriali, ricevano energia sufficiente per le proprie esigenze. Le linee di trasmissione svolgono un ruolo cruciale nel raggiungimento di questo obiettivo e, pertanto, la loro manutenzione e le misure volte a garantirne la longevità sono di primaria importanza. Non è possibile garantire che la potenza trasferita attraverso le linee di trasmissione sia sempre costante. Questo espone le linee, progettate in base alla loro geometria e ai materiali per determinati carichi massimi, al rischio di surriscaldamento in caso di potenza superiore al limite. Ciò può causare danni, con conseguente interruzione dell'alimentazione ai dispositivi successivi nel circuito, interruzione di tutte le operazioni da parte dei consumatori situati a valle e riduzione della longevità delle linee stesse. Ciò richiede l'installazione di interruttori automatici che aiutino a scollegare temporaneamente il circuito in caso di sovraccarichi di potenza imprevisti a monte. Una volta ripristinata la normalità della potenza a monte, l'interruttore automatico viene utilizzato per completare il circuito e ripristinare il flusso di energia. Ciò consente di evitare potenziali danni al circuito, di ottenere un circuito più duraturo e di ridurre le interruzioni di corrente. Un interruttore automatico installato sulle linee di trasmissione è denominato Organo Manovra su Polo (OMP). Il dispositivo, per carichi di potenza inferiori, in particolare 170 kV, deve essere presente in prossimità di aree residenziali e, a causa del suo funzionamento, è una fonte di rumore. D'altra parte, nelle aree urbane, la necessità di distribuire l'energia a valle dei trasformatori riduttori di tensione verso utenze residenziali, commerciali e industriali ha dato origine ad apparecchiature elettriche denominate Compact Sorter on Pole, abbreviato in SCP, o Compact Sorter Pole in inglese. Oltre alla sua funzione sopra indicata, il dispositivo, a causa del suo funzionamento, è una fonte di calore e rumore. Dissipare il calore è di fondamentale importanza, così come l'attenuazione del rumore per evitare che i residenti in prossimità del dispositivo ne siano influenzati.
A conferma del fatto che l'inquinamento acustico è uno dei fattori che contribuiscono al deterioramento a lungo termine della salute umana in tutto il mondo, esso porta a diversi disturbi come stress elevato, ipertensione, perdita dell'udito, disturbi del sonno, aumento della frequenza cardiaca, vasocostrizione, elevati livelli di adrenalina, alterazioni del sistema immunitario e ansia. La sola esposizione al rumore elevato contribuisce a 48.000 casi di malattie cardiache e 12.000 morti premature ogni anno in Europa. Trattare il rumore e mitigarne la propagazione nell'ambiente è necessario in tutti gli ambiti della vita.
Questo lavoro si propone di approfondire la generazione di rumore da parte di un dispositivo OMP e la caratterizzazione del profilo sonoro, acquisito tramite l'acquisizione del rumore degli interruttori automatici presso le sottostazioni dei fornitori. Successivamente, simula il rumore prodotto da un dispositivo OMP e verifica se il livello di pressione sonora (SPL) a determinate distanze rispetta i limiti di legge italiani sul rumore. Questo lavoro prosegue poi con la simulazione della struttura SCP e conduce simulazioni approfondite per determinare il flusso termico e fluido di energia in entrata e in uscita dal rifugio. Le posizioni ottimali di ingresso e uscita vengono individuate attraverso analisi di sensibilità e i materiali delle struttureElectricity production and consumption measure a country's status of development. Industries and sectors with higher requirements of electricity are more advanced and produce goods and services that are more valuable and contribute not only to greater economic development but also to better well-being of the residents benefitting from those. It is thus important for all the entities - be them residential, commercial, or industrial - in a country to receive ample power for their needs. Transmission lines play a crucial role in satisfying this objective and hence, their maintenance and steps to ensure their longevity are of prime importance.
The power transferred through transmission lines cannot always be ensured to be constant. This puts the lines, which are designed based on their geometry and materials for certain maximum loads, at risk of overheating in case they are subjected to power higher than their limit. This can lead to their damage, which is accompanied by disruption of power to the subsequent devices in the circuit, disruption of all the operations by the consumers that are located downstream, and lower longevity of the lines in themselves. This necessitates the incorporation of circuit breakers that help to disconnect the circuit temporarily in case of unforeseeable power surcharges upstream. Once the upstream power is restored to normalcy, the circuit breaker is used to complete the circuit to resume the flow of power. This leads to the avoidance of any potential damage brought to the circuit, a more durable circuit, and shorter power outages. A circuit breaker installed on transmission lines is named Organo Manovra su Palo (OMP) in Italian. The device, for smaller power loads, namely 170 kV are to be present close to residential areas and due to its operation is a noise source.
On the other hand, in urban areas, the need for distribution of power downstream of step-down transformers to residential, commercial and industrial consumers has given rise to electrical equipment named Smistatore Compatto su Palo, abbreviated to SCP, or Compact Sorter Pole in English. In addition to its purpose stated above, the device, through its operation, is a source of heat and noise. Dissipating its heat is of prime importance, as well as the attenuation of noise for the residents in vicinity of the device to not get affected by it.
To substantiate on noise pollution being one of the factors of the deteriorating long-term health of human beings throughout the world, it leads to various disorders such as high stress, high blood-pressure, hearing loss, disturbance in sleep, increased heart-rate, vasoconstriction, elevated adrenaline levels, changes in the immune system, and anxiety. Exposure to elevated noise alone contributes to 48000 cases of heart disease and 12000 premature deaths every year in Europe. Treating noise and mitigating its propagation in the environment is necessary in all spheres of life.
This work aims to delve deeper into the noise generation of OMP and characterisation of the sound profile, that has been acquired by noise acquisition of the circuit breakers at the substation of suppliers. It then simulates the noise produced by an OMP device and verifies if the sound pressure level (SPL) at certain distances follows the Italian legal limits of noise. This work then progresses to SCP and simulates its structure and conducts extensive simulations to find the thermal and fluid flow of energy in and out of the shelter. Optimum positions of the inlet and outlet are found through sensitivity analyses and materials of the passive structures and their thicknesses are selected to ensure a robust dissipation of heat. The results of the thermo-fluid simulations are experimentally validated, before the acoustic simulations are performed to ensure that the SPLs at certain distances satisfy the Italian legal limits. Further research into investigation of material properties is also performed to find th
Diagnosis and management of tardive dyskinesia: from research to clinical practice
No full textTardive dyskinesia (TD) is a chronic, often disabling hyperkinetic movement disorder associated with prolonged use of dopamine receptor blocking agents (DRBAs), particularly antipsychotics (APs) for psychiatric disorders such as schizophrenia and bipolar disorder. It manifests as abnormal, involuntary movements, often involving the orofacial region, extremities, or trunk, and is associated with significant physical and psychosocial impairment. TD is primarily linked to dopamine receptor hypersensitivity, oxidative stress, and genetic susceptibility, with a higher prevalence in patients treated with first-generation APs. However, second-generation APs (SGAs) have not eliminated the risk entirely, particularly in older adults and those with prolonged exposure. Diagnosis relies on clinical assessments such as the Abnormal Involuntary Movement Scale (AIMS) and comprehensive neurological evaluations. Treatment guidelines emphasize early detection, prevention through minimal effective doses of APs, and the use of VMAT2 inhibitors (vesicular monoamine transporter 2 inhibitors) as a first-line therapy in moderate-to-severe cases. VMAT2 inhibitors reduce dopamine signaling dysregulation without directly blocking D2 receptors, effectively managing symptoms in many patients. For treatment-resistant cases, deep brain stimulation and other non-pharmacological interventions offer promising alternatives. Current research underscores the complexity of TD's pathophysiology and the need for personalized approaches. Future directions include developing biomarkers for risk stratification, refining therapeutic strategies, and optimizing long-term outcomes through multidisciplinary care
Il patrimonio architettonico rurale come strumento per la valorizzazione del paesaggio. Un caso bresciano
No full textIl paesaggio, inteso come intricata rete di elementi naturali e costruiti dall’uomo, trova nell’architettura storica e monumentale una delle sue espressioni più significative. In particolare, l’architettura rurale, profondamente radicata nel territorio, costituisce un elemento cardine per le aree agricole. Questa ricerca si concentra sulla bassa pianura bresciana, dove le cascine storiche, integrate nel contesto naturale e infrastrutturale, definiscono il volto del paesaggio. L’obiettivo è duplice: censire le cascine mediante l’utilizzo di software GIS e sviluppare strumenti efficaci per valutare i rischi che minacciano la conservazione di questo patrimonio. Si sottolinea, infine, l’importanza di valorizzare l’architettura rurale come asset fondamentale per la tutela e la promozione del paesaggio agrario
ICS use trajectories in severe asthma patients on benralizumab: real-life data from 3-years follow-up
Full text linkBackground: Inhaled steroids dose reduction is a relevant goal in severe asthma management. Research question: We aimed to investigate ICS use trajectories and their clinical impact in severe asthma patients on benralizumab over 36 months. Study design and methods: We conducted a retrospective real-life observational study including clinical and inflammatory parameters. Patients were stratified according to ICS dose trends over time: "stable" (same dose at ≥80% of visits), "decreasing" (≥50% of visits with lower ICS dose vs baseline), and "increasing" (≥50% of visits with higher ICS dose vs baseline). Results: 92 patients were included. Post-bronchodilation FEV1 significantly increased over 36 months, while pre-bronchodilation FEV1 remained stable. An overall statistically significant improvement was observed also for ACT, ACQ, AQLQ and annual exacerbation rate. The probability of decreasing ICS dose was 19.0% at 12 months and 37.4% at 36 months. In the decreasing group (30% of the cohort), baseline blood eosinophil count (BEC) was higher than in the stable group, and BEC suppression over time was greater. The decreasing group was also less frequently treated with OCS at baseline. At 24 months, the stable group showed a greater reduction in OCS use compared to the decreasing group. Across all groups, OCS use dropped from 89.8% to 4.9% at 36 months. Interpretation: The findings suggest that ICS tapering is feasible and safe in selected patients under benralizumab therapy. Conclusions: To the best of our knowledge, this is the first real-life study specifically supporting the ICS-sparing effect of benralizumab over a 36-month period
The N-species integrable Volterra system as a maximally superintegrable Hamiltonian system
No full textThe results presented in this paper are a natural development of those described
in the paper The Volterra Integrable case. Novel analytical and numerical results
(OCNMP Vol.4 (2024) pp 188-211), where the authors reconsidered the integrable
case of the Hamiltonian N -species Lotka-Volterra system, introduced by Vito Volterra
in 1937. There, an alternative approach for constructing the integrals of motion has
been proposed, and compared with the old Volterra approach. Here we go beyond,
and show that in fact the model introduced by Volterra and studied by us is not just
integrable, but is maximally superintegrable and reducible to a system with only one
degree of freedom regardless of the number of species considered. We present both
analytical and numerical result