199 research outputs found
Subclinical Vascular Damage: Current Insights and Future Potential
No full textAnna Vittoria Mattioli,1 Francesca Coppi,2 Antonio Manenti,1 Alberto Farinetti3 1Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy; 2Cardiology Division, Policlinico di Modena, Modena, Italy; 3Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, ItalyCorrespondence: Anna Vittoria MattioliSurgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia, Via del pozzo, 71, Modena, 41100, ItalyEmail [email protected]: The cardiovascular risk assessment must be carried out during all the different phases of life because the cardiovascular risk and the related prevention actions are dynamic and constantly evolving. As patients age, they change their exposure to various risk factors and accumulate comorbidities by changing their subjective cardiovascular risk, so it is necessary to undertake personalized early and preventive diagnostic actions. The main approach to asymptomatic vascular disease is based on primary prevention with the adoption of a healthy lifestyle. Indeed, lifestyle influences most of the traditional risk factors. In recent years, important differences between the sexes regarding cardiovascular risk factors have emerged and in particular, risk factors specific for female sex have been identified. Women are more likely to be categorized into lower risk categories for cardiovascular disease and, as a result, receive less lifestyle counseling than men, as well as less intensive prevention. This narrative review aims to analyze CVD risk prevention in asymptomatic atherosclerosis with a look at new emerging factors. In the end, we quickly analyzed the effects of the recent pandemic on lifestyle and cardiovascular risk and the potential negative effects in the long term.Keywords: prevention, risk factors, women, lifestyle, microbiota, pandemi
An efficient decomposition approach for surgical planning
No full textThis talk presents an efficient decomposition approach to surgical planning. Given a set of surgical waiting lists (one for each discipline) and an operating theater, the problem is to decide the room-to-discipline assignment for the next planning period (Master Surgical Schedule), and the surgical cases to be performed (Surgical Case Assignment), with the objective of optimizing a score related to priority and current waiting time of the cases. While in general MSS and SCA may be concurrently found by solving a complex integer programming problem, we propose an effective decomposition algorithm which does not require expensive or sophisticated computational resources, and is therefore suitable for implementation in any real-life setting.
Our decomposition approach consists in first producing a number of subsets of surgical cases for each discipline (potential OR sessions), and select a subset of them. The surgical cases in the selected potential sessions are then discarded, and only the structure of the MSS is retained. A detailed surgical case assignment is then devised filling the MSS obtained with cases from the waiting lists, via an exact optimization model.
The quality of the plan obtained is assessed by comparing it with the plan obtained by solving the exact integrated formulation for MSS and SCA. Nine different scenarios are considered, for various operating theater sizes and management policies. The results on instances concerning a medium-size hospital show that the decomposition method produces comparable solutions with the exact method in much smaller computation time
A planning and routing model for patient transportation in health care
No full textIn this paper, a problem concerning both the planning of health care services and the routing of vehicles, for patients transportation is addressed. An integrated approach, based on the column generation technique, is proposed to solve the planning and routing problem. Preliminary results on real data show the effectiveness of the proposed approach
The Exposome, Social Determinants, and Environmental Pollution: Comprehensive Cardiovascular Risk in Women
No full textCardiovascular disease (CVD) remains a significant global health concern for women, influenced by a complex interplay of social, economic, and environmental factors. This article examines cardiovascular risk through the lens of the exposome, which encompasses all environmental exposures from conception onward, including pollution, diet, and chronic stress. Social determinants such as socioeconomic status (SES), education, and stress management play crucial roles in shaping women’s cardiovascular health. Lower SES and education are associated with greater exposure to adverse living conditions, poor nutrition, and limited access to healthcare, increasing the risk of CVD. Environmental pollution, particularly air pollution and climate-related changes, further exacerbates cardiovascular risk by promoting oxidative stress and inflammation. Additionally, gender-specific factors, such as pregnancy and menopause, interact with the exposome, heightening the vulnerability of women to cardiovascular risks over their lifetime. Addressing these risk factors requires a comprehensive approach, incorporating public health strategies that focus on reducing pollution, improving food security, and mitigating social inequalities. By addressing the cumulative and interacting exposures that contribute to cardiovascular disease, especially in women, more effective prevention strategies can be developed to improve long-term health outcomes
Macrophage-secreted factors enhance the in vitro expansion of DMD muscle precursor cells while preserving their myogenic potential
No full textObjective: Autologous cell transplantation has been proposed as a possible therapeutic approach for Duchenne dystrophy. In this approach, patients' muscle precursor cells (mpcs) obtained from muscle biopsies would be expanded ex vivo, genetically modified to restore dystrophin expression and then reimplanted in the original donor. Such strategy would have the advantage of bypassing the immune response problem, but on the other hand, it would require a large number of cells because of the poor viability and mobility of transplanted myoblasts. Besides, extensive multiplication of mpcs is difficult and can affect their myogenic ability. Given the key role of inflammation in muscle regeneration, we set out to verify if factors secreted by inflammatory cells could be used to improve in vitro expansion of DMD-mpcs. Methods: We have previously shown that a murine macrophage conditioned medium (mMCM) could increase the in vitro proliferation rate of rat and mouse mpcs. Here we tested the effect of mMCM on cultures of human, dystrophin-deficient mpcs (DMD-mpcs). Results: In the presence of mMCM, DMD-mpcs displayed an increased proliferation rate, while at the same time, maintaining their myogenicity after many in vitro passages. Expanded cells were also injected in muscles of immuno-deficient mice, showing that they were also able to participate in muscle regeneration within recipient muscles. Discussion: Using macrophagic factors, we were able to increase the amount of DMD-mpcs obtainable after 38 days of culture by >7×10 3-fold. These findings indicate that macrophagic factors hold great potential for future use in cell transplantation protocol
Night shifts and consumption of energy drinks by healthcare personnel
No full textThe consumption of drinks with a high caffeine content is a growing phenomenon not only among young people but also among individuals who work night shifts, including healthcare workers. In young people, the motivations that lead to taking energy drinks are linked to performance in studies and recreational activities. In healthcare workers, the motivations are linked to work performance and the need to maintain a high level of wakefulness during the night. This review analyzes the studies published on the consumption of energy drinks in healthcare personnel and the changes that have occurred in recent years also following the stress caused by the recent pandemic on healthcare
Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women.
No full textAbstract Background and aims: The Mediterranean Diet (MedD) is considered a very healthy
diet useful in the prevention of cardiovascular disease. The present study aims to evaluate adherence
to MedD in unselected premenopausal women and its relation with ankle-brachial index
(ABI), an index of preclinical atherosclerosis.
Methods and results: A group of 425 patients (age range 45e54 years) was investigated. They
were enrolled only if they were asymptomatic for cardiovascular disease. Nutritional parameters
were assessed by a self-administered food frequency validated questionnaire (116 items)
completed by an interviewer administered 24 h diet recall. They all underwent ABI measurement.
The mean MedD Score was 32.2 6.1 (Q1eQ3 range 26e37) comparing with data from
Italian population (46 8.3) was significantly lower. Intake of food categories sources of antioxidants
was higher in patients with a greater adherence to Med D and was mainly related to fruit
and vegetables. Patients were categorized in quartile according to MedD Score and we evaluate
the distribution of ABI index within quartile. 31.4% of women in Q1 (lower adherence to MedD)
had an ABI lower than 0.9 compared to 18.3% of women in Q4 (higher adherence to MedD):
p < 0.01. Obesity was more frequent in Q1 compared to Q4 and in women with lower ABI.
Conclusions: Women with a low MedD Score were more obese and showed instrumental sign of
preclinical peripheral atherosclerosis. MedD rich in antioxidants from fruit, vegetables and nuts
influenced the development of atherosclerosis and was associated with a lower incidence of
asymptomatic atherosclerosis
Pharmacological and toxicological evaluation of a new series of thymidylate synthase inhibitors as anticancer agents
No full textThymidylate synthase (TS) is responsible for catalysing the de novo biosynthesis of doexythymidine monophosphate and is a target for many anticancer drugs. A series of thymidylate synthase inhibitors (TSIs), synthesised in our laboratory, were submitted to primary anticancer screening by the National Cancer Institute (NCI). Four compounds, 3,3bis(4-methoxyphenyl)-1H, 3H-naphtho[1,8-cd]pyran-1-one (MR7), 6-chloro-3,3-bis(4-hydroxyphenyl)-]H,3H-naphtho[1,8cdjpyran-1-one (MR21), 3,3-bis(3-fluoro-4-hydroxyphenyl)IH,3H-naphtho[1,8-cd]pyran-l-one (MR35) and 6-bromo-3,3bis(3-chloro-4-hydro.xyphenyl)-1H,3H-naphtho[1,8-cd]pyran-l- one (MR36), passed the criteria and were automatically scheduled for evaluation against the full panel of 60 human tumour cell lines. In this study, the antiproliferative activity of the substances against SK-MEL-2 cells (from metastatic tissue) and SK-MEL-28 cells (from primary malignant melanoma cells) was investigated. Neutral Red uptake and the MTT test were performed to confirm the results of the NCI, and [H-3]thymidine incorporation was performed as a test of the proliferation rate. Our results indicated that compounds MR21 and MR36 were the most active agents and the [H-3]-thymidine test was the best in predicting toxicity against melanoma cells
A decomposition approach for the combined master surgical schedule and surgical case assignment problems
No full textThis research aims at supporting hospital management in making prompt Operating Room (OR) planning decisions, when either unpredicted events occur or alternative scenarios or configurations need to be rapidly evaluated. We design and test a planning tool enabling managers to efficiently analyse several alternatives to the current OR planning and scheduling. To this aim, we propose a decomposition approach. More specifically, we first focus on determining the Master Surgical Schedule (MSS) on a weekly basis, by assigning the different surgical disciplines to the available sessions. Next, we allocate surgeries to each session, focusing on elective patients only. Patients are selected from the waiting lists according to several parameters, including surgery duration, waiting time and priority class of the operations. We performed computational experiments to compare the performance of our decomposition approach with an (exact) integrated approach. The case study selected for our simulations is based on the characteristics of the operating theatre (OT) of a medium-size public Italian hospital. Scalability of the method is tested for different OT sizes. A pilot example is also proposed to highlight the usefulness of our approach for decision support. The proposed decomposition approach finds satisfactory solutions with significant savings in computation time
Analgesia during abdominal aortic aneurysm endovascular repair: remifentanil vs fentanyl-midazolam - a randomized controlled trial
No full textBACKGROUND AND OBJECTIVE: Endovascular repair offers a less surgically invasive procedure for abdominal aortic aneurysms but nevertheless, still requires analgesic sedative cover to ensure an acceptable level of patient comfort and cardiorespiratory stability. The peculiarity of this kind of operation is that painful stimuli are concentrated in specific moments separated by intervals devoid of pain, so the insurgence of pain can be predicted and prevented with a bolus of analgesic, making a continuous infusion not essential, but potentially useful in achieving a better analgesic stability. The primary objective of the study was pain control measured by Visual Analogue Scale; secondary endpoints were cardiorespiratory stability and an acceptable level of sedation. METHODS: The sedative analgesic protocols of two groups of randomly allocated patients, undergoing abdominal aortic aneurysm endovascular repair, were compared. The experimental group received remifentanil infusion (0.03-0.1 microg kg min) and the control group received intravenous doses of fentanyl and midazolam (1-3 microg kg and 0.05-0.1 mg kg, respectively). RESULTS: Fifty patients were investigated out of 60 enrolled. There were no relevant differences concerning cardiorespiratory stability and level of sedation, but pain levels were significantly lower in the experimental group: mean Visual Analogue Scale 0.35+/-0.40 vs. 1.49+/-0.62 (P<0.001) and area under the curve 17.48+/-5.09 vs. 33.05+/-8.19 (P<0.001). CONCLUSION: Both techniques were shown to be safe and most importantly effective in offering cardiovascular stability and analgesia for American Society of Anaesthesiologists III-IV patients undergoing endovascular abdominal aortic aneurysm repair. However, remifentanil continuous infusion proved to offer significantly more stable pain control compared with the currently used combination fentanyl-midazolam
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