Predictors of infection after "de novo" cardiac electronic device implantation.

BACKGROUND: Cardiac implantable electronic device (CIED) infection is a major complication that increases morbidity and mortality after the procedure. Several infection risk scores have been suggested to identify patients at higher pre-procedural risk of infection OBJECTIVE: this study sought to evaluate rates of infection, potential risk factors and the role of a modified "Shariff" score as predictor of infection in high-risk patients undergoing de novo CIED implantation. METHODS AND RESULTS: We retrospectively analysed 1391 patients underwent a de novo CIED procedure during the study period. At the median follow-up of 48 months, 20 patients of 1391 (1.4%) developed a CIED-related infective event. In our population, we studied a modified version of the "Shariff" score for only first-time implant patients. At multivariate regression analysis, three factors were independent predictors of infection: previous pocket hematoma [RR 27.2 (8.30-54.02), p = 10-10], a Shariff Score ≥ 4 [RR 3.20 (1.29-12.59), p= 0.029]. and reintervention for catheter malfunction or dislocation [RR 3.57 (1.2-37.4), p= 0.048]. CONCLUSIONS: a "Shariff" score > 4 is suggested as a predictor of higher risk of infection in patients after de novo device implantation. The use of an infection risk score may help to improve tailored pre-operatory strategies to prevent infection.

Predictors of cardiac arrhythmic events in non coronary artery disease patients.

Arrhythmic sudden cardiac death (SCD) represents a major worldwide public health problem accounting for 15-20% of deaths. Risk stratification to identify patients at risk of SCD is crucial in order to implement preventive measures in the general population. Several biomarkers have been tested exploring different pathophysiological mechanisms of cardiac conditions. Conflicting results have been described limiting so far their use in clinical practice. The use of new biomarkers such as microRNAs and sex hormones and the emerging role of genetic on risk prediction of SCD is a current research topic showing promising results.This review outlines the role of plasma biomarkers to predict ventricular arrhythmias and SCD in non coronary artery disease with a special focus on their relationship with the genetic biomarkers.

Lights and shadows about health claims: analysis of food labels in a field survey in Florence.

BACKGROUND: Health claims (HC) are those statements on food labels that state, suggest, or imply that a relationship exists between a food category, a food product, or one of its constituents, and health of consumer. The European legislation on the use of HC aims to encourage responsible consumption by people. The aim of this study is to assess the adherence of HC to EU norms in foodstuffs sold in the large-scale retail distribution in Florence. METHODS: Two independent researchers have separately selected and assessed the foodstuffs with HC sold in at least two of four supermarkets identified randomly in Florence. Each selected product was assessed by a checklist with seven macro-criteria, extrapolated from the 'Specific Conditions' and 'Restrictions of Use' provided by EU regulations, rating the adherence of the chosen foods to the legislation. RESULTS: Seventy-seven products were assessed. Only a limited number of products show full compliance to all the criteria. Specifically, noncompliance related to Criterion 3 ("the amount of the food and pattern of consumption required to obtain the claimed beneficial effect are reported") is the most significant: the absence of indications about the maximum amount to be consumed or the modality of consumption could represent a risk of overconsumption and, consequently, a risk for health. CONCLUSION: According to the results, we hypothesize a lack of knowledge of the EU norms on the part of the manufacturer. A great deal of work is still to be done to assess and manage these products in the right way, as well as to communicate the right messages to the consumers.

Use of robotic colonoscopy in patients with previous incomplete colonoscopy.

OBJECTIVE: Conventional colonoscopy (CC) is the gold standard to diagnostic and therapeutic approach to colon. However, in few cases, cecal intubation could fail due to colon anatomy, patient compliance and physician expertise. Endotics robotic colonoscopy is a novel, safe, mini-invasive modality to explore the entire colon. Our aim was to assess, in a retrospective study, Endotics ability of cecal intubation in all cases in which CC failed. PATIENTS AND METHODS: Between January 2008 and December 2012, 276 Endotics robotic colonscopy examinations were performed at the Gastroenterology and Metabolic Diseases Unit of Pisa University Hospital, Pisa, Italy, in a series of consecutive patients who had undergone CC and failed cecal intubation. RESULTS: We assessed the cecal intubation rate in 102 patients addressed to Endotics after previous incomplete CC. Overall, endotics system was successful in 93.1% of the incomplete conventional colonoscopy cases (95% performance). CONCLUSIONS: Whenever the intended exploration of the entire colon with CC failed, the endotics robotic endoscopy represented a useful tool as it helped examine the entire colon in almost all cases.

Public green areas and urban environmental quality of the city of São Carlos, São Paulo, Brazil / Áreas verdes públicas e a qualidade ambiental urbana do Município de São Carlos, Estado de São Paulo, Brasil

Abstract Assess the state of public green areas, their importance and influence on environmental quality and living in urban centers is an arduous task considering the conceptual and scientific regarding quantification and data analysis methods divergence. In this study, we aimed to determine two indicators of public green areas relative to the percentage of public green areas (PPGA) and the public green areas index (PGAI) in the urban area of São Carlos, SP. The study area was organized into administrative regions (ARs), using satellite images, topographical maps of 1:10,000 Geographic and Cartographic Institute (1990) and data provided by the Municipality of São Carlos. The results show that public green areas comprise 6.55% of the municipality, with a public green areas index (PGAI) of 18.85 m2/inhabitant, indicating good urban environmental quality when compared to rates of 15 m2/capita for public green areas for recreation, suggested by the Brazilian Society of Urban Forestry. The differences between the administrative regions are concern with situations from 4.16 to 36.30 m2/inhabitant. In this context, it is recommend specific public policies and popular participation in the process of continuous improvement for increasing public green areas in the less favored regions. The Genebrino method applied to indicators of public green areas (GPGA – amount of public green areas divided by population density), showed a commendable goal above 40% for urban environmental quality.

Resumo Diagnosticar a situação das áreas verdes públicas, sua importância e influência na qualidade ambiental e de vida nos centros urbanos é uma tarefa árdua, considerando a divergência conceitual e de métodos científicos no que tange a quantificação e a análise dos dados. Neste estudo, objetivou-se determinar dois indicadores de áreas verdes públicas, referentes ao percentual de áreas verdes públicas (PAVP) e ao índice de áreas verdes públicas (IAVP) no perímetro urbano do Município de São Carlos, SP. A área de estudo foi organizada em regiões administrativas (RAs), utilizando imagens de satélite, cartas topográficas 1:10.000 do Instituto Geográfico e Cartográfico (1990) e dados fornecidos pela Prefeitura Municipal de São Carlos. Os resultados demonstram que as áreas verdes públicas compreendem 6,55% do território do município, com um índice de áreas verdes públicas (IAVP) de 18,85 m2/habitante, indicando uma boa qualidade ambiental urbana quando comparado aos índices de 15 m2/habitante para áreas verdes públicas destinadas à recreação, sugerido pela Sociedade Brasileira de Arborização Urbana. As diferenças entre as regiões administrativas são preocupantes, com situações de 4,16 a 36,30 m2/habitantes. Neste contexto, recomendam-se políticas públicas específicas e a participação popular no processo de melhoria contínua para o incremento das áreas verdes públicas nas regiões menos favorecidas. O método genebrino, aplicado aos indicadores de áreas verdes públicas (IAVP – somatório das áreas verdes públicas dividido pela densidade populacional), apontou uma meta recomendável acima de 40% para a qualidade ambiental urbana.

Public green areas and urban environmental quality of the city of São Carlos, São Paulo, Brazil.

Assess the state of public green areas, their importance and influence on environmental quality and living in urban centers is an arduous task considering the conceptual and scientific regarding quantification and data analysis methods divergence. In this study, we aimed to determine two indicators of public green areas relative to the percentage of public green areas (PPGA) and the public green areas index (PGAI) in the urban area of São Carlos, SP. The study area was organized into administrative regions (ARs), using satellite images, topographical maps of 1:10,000 Geographic and Cartographic Institute (1990) and data provided by the Municipality of São Carlos. The results show that public green areas comprise 6.55% of the municipality, with a public green areas index (PGAI) of 18.85 m2/inhabitant, indicating good urban environmental quality when compared to rates of 15 m2/capita for public green areas for recreation, suggested by the Brazilian Society of Urban Forestry. The differences between the administrative regions are concern with situations from 4.16 to 36.30 m2/inhabitant. In this context, it is recommend specific public policies and popular participation in the process of continuous improvement for increasing public green areas in the less favored regions. The Genebrino method applied to indicators of public green areas (GPGA - amount of public green areas divided by population density), showed a commendable goal above 40% for urban environmental quality.

An update on atrial fibrillation in 2014: From pathophysiology to treatment.

Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia. The trigger for initiation of AF is generally an enhanced vulnerability of pulmonary vein cardiomyocyte sleeves to either focal or re-entrant activity. The maintenance of AF is based on a "driver" mechanism in a vulnerable substrate. Cardiac mapping technology is providing further insight into these extremely dynamic processes. AF can lead to electrophysiological and structural remodelling, thereby promoting the condition. The management includes prevention of stroke by oral anticoagulation or left atrial appendage (LAA) occlusion, upstream therapy of concomitant conditions, and symptomatic improvement using rate control and/or rhythm control. Nonpharmacological strategies include electrical cardioversion and catheter ablation. There are substantial geographical variations in the management of AF, though European data indicate that 80% of patients receive adequate anticoagulation and 79% adequate rate control. High rates of morbidity and mortality weigh against perceived difficulties in management. Clinical research and growing experience are helping refine clinical indications and provide better technical approaches. Active research in cardiac electrophysiology is producing new antiarrhythmic agents that are reaching the experimental clinical arena, inhibiting novel ion channels. Future research should give better understanding of the underlying aetiology of AF and identification of drug targets, to help the move toward patient-specific therapy.

Vegetation coverage in hydrographic basins in the central region of the State of São Paulo, Brazil.

Vegetation coverage can be inappropriately used, especially in the absence of proper planning, and can result in a reduction of the occupied area. Demographic and economic alterations are factors that contribute to the degradation of vegetation coverage in landscape units. In addition, because vegetation is essential for protection of recharge areas in aquifers, the fragmentation of habitats in hydrographic basins causes changes in climate temperature, soil erosion, eutrophication, and siltation of watercourses. This study analyzed the vegetation coverage from the municipality of São Carlos, State of São Paulo (SP) to assess the environmental quality of water resources in the hydrographic basins and sub-basins, in the Guarani Aquifer System. The vegetation coverage was analyzed in three scales: municipality, Hydric Resource Management Units (UGRHIs), and hydrographic sub-basins based on map overlapping from the LAPA/UFSCar Digital Cartographic Collection and visual interpretation of LANDSAT 5, TM sensor, Path 220, row 075 on satellite images. The municipality of São Carlos has vegetation coverage of 31,776.4 hectares, in which 57% is classified as preserved vegetation typology, and 58% is over the Guarani aquifer recharge area. The vegetation coverage with savannas, riparian forests, and mesophyll forests represented 28% of the total studied area and is located over 28.3% of the Guarani aquifer recharge area extension. The Permanent preservation areas (PPAs) represent 21.6% of the total vegetation coverage with 51% of it being vegetated. The municipality has a total of 686 springs (Topographic maps of IBGE, escale 1:50,000) distributed on an average of 60 springs per km2; 40% of these are protected by vegetation.

Psychoneuroimmunology and health psychology: inflammation and protective factors.

A common clinical observation is the adverse relationship between stress and human diseases. The attention of scientific research on health has been disproportionately focused on risk factors that predict the onset of certain health outcomes, in particular there has been an increasing interest in the role of inflammation as a common mechanism of disease in a number of medical and neuropsychiatric diseases. Despite the importance of such research being undisputed, it is necessary to emphasize what the protective factors are that promote psychosocial recovery processes and increased survival rates in a biopsychosocial perspective. This article aims to understand the relationship between psychosocial factors and immune system in the interests of health psychology, highlighting the protective factors that promote recovery, resiliency and resistance to disease.

Aminaphtone in the treatment of pseudophakic cystoid macular edema: a case report.

PURPOSE: Cystoid macular edema (CME) following cataract surgery has been recognized for over 50 years as an important cause of suboptimal post-operative vision. The incidence of CME varies widely, but is likely in the range of 1-2% using modern cataract extraction techniques. We report the case of resolution of post-operative CME after treatment with aminaphtone 75 mg three time a day for one month. METHODS: A 74-year-old causasian woman presented with reduced vision in the left eye after one month from uneventful cataract phacoemulsification. She underwent a complete ophthalmological examination comprehensive of spectral domain optical coherence tomography (SD-OCT) which showed CME and a central foveal thickness (CFT) of 703 micron. The patient was treated with aminaphtone for one month. RESULTS: CME disappeared, the CFT was within normal limits when aminaphtone was ceased, and best corrected visual acuity was 20/20 at the end of the treatment. CONCLUSION: Aminaphtone is a novel proposal in the treatment of pseudophakic cystoid macular edema.

Echocardiography and non-invasive imaging in cardiac resynchronization therapy.

The beneficial effects of cardiac resynchronization therapy (CRT) on morbidity and mortality in advanced heart failure patients have been extensively demonstrated. However, previous single- and multicenter studies demonstrated that approximately 30-40% of CRT patients do not show significant clinical improvement or LV reverse remodeling despite fulfilling current inclusion criteria. In search of novel indices that may help to improve the selection of responders to CRT, non-invasive multimodality imaging has provided further insight into the mechanisms underlying CRT response. LV dyssynchrony, extent and location of myocardial scar and LV lead position have shown to be independent determinants of CRT response. An integrated evaluation of these three pathophysiological mechanisms may provide a more accurate selection of heart failure patients who will benefit from CRT and may maximize the cost-effectiveness of this therapy. The present review article provides a critical appraisal of the role of multimodality imaging in the selection of heart failure patients who are candidates for CRT with special focus on the assessment of LV mechanical dyssynchrony, LV myocardial scar tissue extent and LV lead position.

Advanced applications of 3-dimensional echocardiography.

Over the last few decades, advancements in ultrasound, electronic and computing technologies have permitted current second generation 3-dimensional (3D) echocardiography to display on-line 3D rendered images of the heart. Since various studies demonstrated its superiority over 2-dimensional echocardiography, there is growing enthusiasm to embrace this new 3D echocardiographic technology. With its increasing widespread clinical availability, 3D echocardiography is getting closer to routine clinical use. However, as with any new emerging technologies, clinical applications of 3D echocardiography should be based on current evidence. This review will focus on the evidence from clinical studies that form the scientific basis for the advanced applications of 3D echocardiography, from cardiac chamber volume assessments, left ventricular dyssynchrony assessments, quantifications of valvular abnormalities, to the role of 3D echocardiography during cardiac interventions.

Expenditure and value for money: the challenge of implantable cardioverter defibrillators.

Many technology-driven interventions entail considerable financial cost, raising affordability issues. The implantable cardioverter defibrillator (ICD) is a case of an effective primary prevention intervention with high initial costs that is capable of delivering long-term population benefits. At first glance, such interventions may provoke diffidence, if not active resistance, due to the financial burdens which inevitably accompany their widespread adoption. In this article, we review the available economic tools that can help address the ICD cost issue. We think awareness of such knowledge may facilitate dialogues between physicians, administrators and policymakers, and help foster rational decision-making.

[Measuring the positive dimensions among health care workers: a contribution to the Italian validation of the UWES--Utrecht Work Engagement Scale]. / Misurare le dimensioni positive nel lavoro in sanità: un contribute all'adattamento italiano della UWES--Utrecht Work Engagement Scale.

Engagement is defined as a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption. The main purpose of this study was to examine the psychometric properties of the Utrecht Work Engagement Scale (UWES). Data from a sample of health care workers (N=948) were used to test four propositions concerning dimensionality, internal consistency and construct validity. The UWES Italian version and the Multidimensional Organizational Health Questionnaire (MOHQ) were administered to the subjects (a subsample of 225 health care workers also completed the Maslach Burnout Inventory). The factorial structure has been examined through a series of Explorative Factor Analysis (AFE) and Confirmatory Factor Analysis (CFA). As in the original version, we found a three factor solution. Internal consistency indexes were satisfactory. In addition, the correlations between UWES, MOHQ and MBI revealed a good construct validity. It is concluded that the Italian Version of the UWES has acceptable psychometric properties and that the instrument can be used in studies on positive organizational behavior.

Psychomotor performance is not influenced by brief repeated exposures to mobile phones.

The present study investigated the presence of a cumulative effect of brief and repeated exposures to a GSM mobile phone (902.40 MHz, 217 Hz modulated; peak power of 2 W; average power of 0.25 W; SAR = 0.5 W/kg) on psychomotor functions. To this end, after each of 3 15-min exposures, both an acoustic simple reaction time task (SRTT) and a sequential finger tapping task (SFTT) were administered to 24 subjects. The present study was unable to detect the cumulative effects of brief and repeated EMF exposure on human psychomotor performance, although there was a non-statistical trend to shorter reaction times. In summary, these data show an absence of effects with these particular exposure conditions; however, possible cognitive effects induced by different signal characteristics cannot be excluded.

Neurophysiological effects of mobile phone electromagnetic fields on humans: a comprehensive review.

In recent years a growing number of people have begun to use mobile phone technology. This phenomenon has raised questions and doubts about possible effects on users' brains. This literature review focuses on the human electrophysiological and neuro-metabolic effects of mobile phone (MP)-related electromagnetic fields (EMFs) published in the last 10 years. To this end, all relevant papers have been reported and, subsequently, a literature selection has been carried out by taking several criteria into account, such as: blind techniques, randomization or counter-balancing of conditions and subjects, detail of exposure characteristics and the statistical analyses used. As a result, only the studies meeting the selection criteria have been described, evaluated and discussed further. The main goal of this review is to provide a clear scenario of the most reliable experiments carried out over the last decade and to offer a critical point of view in their evaluation. It is concluded that MP-EMFs may influence normal physiology through changes in cortical excitability and that in future research particular care should be dedicated to both methodological and statistical control, the most relevant criteria in this research field.

Long term results of a randomized study performed by Intergruppo Italiano Linfomi comparing Mini-CEOP vs P-VEBEC in elderly patients with diffuse large B-cell lymphoma.

The Intergruppo Italiano Linfomi started, in 1996, a randomized trial for the initial treatment of elderly patients (older than 65 years) with Diffuse Large B-Cell Lymphoma (B-DLCL) comparing 6 courses of Mini-CEOP vs 8 weeks of P-VEBEC chemotherapy. Study objectives were survival, response and Quality of Life (QoL). Two hundred and thirty-two patients were evaluable for final analysis. Complete Response (CR) and Overall Response Rates (ORR) were 54% vs 66% (p = 0.107) and 90% vs 78% (p = 0.021) for P-VEBEC and Mini-CEOP, respectively. With a median follow-up of 72 months, the 5-year Overall Survival (OS), Relapse Free Survival (RFS), and Failure Free Survival (FFS) were 32%, 52%, and 21%, respectively. Subjects achieving a CR showed improvement of QoL regardless of treatment arm. Both Mini-CEOP and P-VEBEC determined a similar outcome for elderly patients with B-DLCL, with a third of patients alive after more than 6 years of follow-up. Both regimens can be considered equally for combination treatment with anti-CD20 monoclonal antibody.

Is the brain influenced by a phone call? An EEG study of resting wakefulness.

We recorded the resting electroencephalogram of 20 healthy subjects in order to investigate the effect of electromagnetic field (EMF) exposure on EEG waking activity and its temporal development. The subjects were randomly assigned to two groups and exposed, in double-blind conditions, to a typical mobile phone signal (902.40 MHz, modulated at 217 Hz, with an average power of 0.25 W) before or during the EEG recording session. The results show that, under real exposure as compared to baseline and sham conditions, EEG spectral power was influenced in some bins of the alpha band. This effect was greater when the EMF was on during the EEG recording session than before it. The present data lend further support to the idea that pulsed high-frequency electromagnetic fields can affect normal brain functioning, also if no conclusions can be drawn about the possible health effects.

Time-course of electromagnetic field effects on human performance and tympanic temperature.

The study aimed to investigate the time-course of electromagnetic field (EMF)-induced effects on human cognitive and behavioral performance and on tympanic temperature. Subjects were randomly assigned to two groups, exposed to a 902.40 MHz EMF before the testing session, or to the same signal during the data collecting session. Following a double-blind paradigm, subjects were tested on four performance tasks: an acoustic simple-reaction time task, a visual search task, an arithmetic descending subtraction task and an acoustic choice-reaction time task. Moreover, tympanic temperature was collected five times during each session. Results indicated an improvement of both simple- and choice-reaction times and an increase of local temperature on the exposed region under the active exposure. There was a clear time-course of the reaction time and temperature data, indicating that performance and physiological measures need a minimum of 25 min of EMF exposure to show appreciable changes.