Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration.

PURPOSE: Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance. METHODS: This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure. RESULTS: LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038). CONCLUSIONS: Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.

Heart and Coronary Artery Dose Sparing in Left-sided Breast Cancer: 3D-Conformal Radiotherapy vs. Helical Tomotherapy.

BACKGROUND/AIM: To compare heart, left ventricle (LV) and coronary artery dose-sparing with three-dimensional conformal radiotherapy (3D-CRT) vs. helical tomotherapy (HT) in left-sided breast cancer (BC). PATIENTS AND METHODS: 3D-CRT and HT treatments were planned for 20 patients (pts). Computed tomography (CT) scans without and with intravenous contrast (ic) were performed and co-registered. Left breast and organs at risk (OARs) were contoured. Dose-volume histograms (DVHs) for 3D-CRT and HT treatment plans were evaluated in terms of planning target volume for evaluation (PTVeval) coverage and dose to the OARs. RESULTS: HT provided the best target coverage and significantly reduced D2% and mean dose to the left anterior descending artery (LADA) and to the LADA-planning organ at risk volume (PRV), D2%, V5 and mean dose to the LV and D2% and V25 to the heart. As expected, due to the rotational delivery, the dose to all other coronary arteries and their PRV, contralateral breast and lungs was higher with HT. CONCLUSION: In left-sided BC, HT provided the best target coverage and significantly reduced LV and LADA doses. Moreover D2% and V25 to the heart were significantly reduced. Further studies are needed to correlate dosimetric findings with in-depth cardiac monitoring.

Flow Dynamic Pattern in Liver and Renal Transplantation under Exercise Prescription Program.

BACKGROUND: Cardiovascular diseases in the context of renal and liver transplants remain the leading cause of morbidity and mortality. Physical exercise at a moderate intensity is allowed to contrast the risk profile. Echocardiographic evaluation is essential to stratifying potential cardiotoxicity by the standard and, more recently, the deformation and dynamic study of the intracardiac vortex. This study aims to investigate the vortex echo parameters of solid-organ-transplanted subjects who are physically active compared to a control group of healthy subjects. METHODS: A group of 33 transplanted subjects (16 kidneys and 17 livers) was studied via a transthoracic echocardiography exam, comprehending the myocardial deformation parameters of global longitudinal strain (GLS), twisting of the left ventricle (LV) chamber, and HyperDoppler image acquisition. RESULTS: The subjects enrolled in this study were 50 in total: there were 33 transplanted and 17 healthy subjects. The transplanted subjects presented higher values of interventricular septum in diastole (IVSd p = 0.001), posterior wall diastolic (PWd p = 0.05), and left ventricle mass index (LVMI p = 0.029); ejection fraction (EF) was found to be higher in athletes (p < 0.001). Transplanted subjects presented mild diastolic dysfunction, emerging only from septal E values (p = 0.001). The 4DStrain (p = 0.018) and GLS2c (p = 0.017) were significantly better in the athletes. All of the geometrical and energetical vortex data were in the normal range and no significant differences were found. An interesting positive correlation was evident for the diastolic parameter, particularly the E/A ratio (p = 0.023) and E' septal value (p = 0.049), along with the vorticity fluctuation. This behavior was present for all subjects, particularly those that were transplanted (p = 0.005). CONCLUSIONS: In the vortex investigation, especially in cases of normal EF, the positive correlation of some diastolic parameters with the flow dynamic patterns corroborates this hypothesis. The HyperDoppler analysis could be helpful to detecting potential damage earlier in the diastolic time before a systolic deficiency.

Effect of internal port on dose distribution in post-mastectomy radiotherapy for breast cancer patients after expander breast reconstruction.

Background: In patients with expander-based reconstruction a few dosimetric analyses detected radiation therapy dose perturbation due to the internal port of an expander, potentially leading to toxicity or loss of local control. This study aimed at adding data on this field. Materials and methods: A dosimetric analysis was conducted in 30 chest wall treatment planning without and with correction for port artifact. In plans with artifact correction density was overwritten as 1 g/cm3. Medium, minimum and maximum chest wall doses were compared in the two plans. Both plans, with and without correction, were compared on an anthropomorphic phantom with a tissue expander on the chest covered by a bolus simulating the skin. Ex vivo dosimetry was carried out on the phantom and in vivo dosimetry in three patients by using film strips during one treatment fraction. Estimated doses and measured film doses were compared. Results: No significant differences emerged in the minimum, medium and maximum doses in the two plans, without and with correction for port artifacts. Ex vivo and in vivo analyses showed a good correspondence between detected and calculated doses without and with correction. Conclusions: The port did not significantly affect dose distribution in patients who will receive post-mastectomy radiation therapy.

Multiparametric autoantibody analysis: a new paradigm for the diagnosis of connective tissue diseases.

BACKGROUND: In patients affected by connective tissue diseases (CTDs), the identification of wide autoantibody profiles may prove useful in early diagnosis, in the evaluation of prognosis (risk stratification), and in predicting response to therapy. The aim of the present study was to evaluate the utility of multiparametric autoantibody analysis performed by a new fully automated particle-based multi-analyte technology (PMAT) digital system in a large multicenter cohort of CTD patients and controls. METHODS: Serum samples from 787 patients with CTD (166 systemic lupus erythematosus; 133 systemic sclerosis; 279 Sjögren's syndrome; 106 idiopathic inflammatory myopathies; 103 undifferentiated CTD), 339 patients with other disorders (disease controls) (118 infectious diseases, 110 organ-specific autoimmune diseases, 111 other rheumatic diseases), and 121 healthy subjects were collected in 13 rheumatologic centers of the FIRMA group. Sera were analyzed with the Aptiva-PMAT instrument (Inova Diagnostics) for a panel of 29 autoantibodies. RESULTS: Multiparametric logistic regression showed that enlarged antibody profiles have a higher diagnostic efficiency than that of individual antibodies or of antibodies that constitute classification criteria for a given disease and that probability of disease increases with multiple positive autoantibodies. CONCLUSIONS: This is the first study that analyzes the clinical and diagnostic impact of autoantibody profiling in CTD. The results obtained with the new Aptiva-PMAT method may open interesting perspectives in the diagnosis and sub-classification of patients with autoimmune rheumatic diseases.

Impact of total marrow/lymphoid irradiation dose to the intestine on graft-versus-host disease in allogeneic hematopoietic stem cell transplantation for hematologic malignancies.

Background and purpose: Graft-versus-host disease (GvHD) is a leading cause of non-relapse mortality in patients undergoing allogeneic hematopoietic stem cell transplantation. The Perugia Bone Marrow Transplantation Unit designed a new conditioning regimen with total marrow/lymphoid irradiation (TMLI) and adaptive immunotherapy. The present study investigated the impact of radiotherapy (RT) doses on the intestine on the incidence of acute GvHD (aGvHD) in transplant recipients, analyzing the main dosimetric parameters. Materials and methods: Between August 2015 and April 2021, 50 patients with hematologic malignancies were enrolled. All patients underwent conditioning with TMLI. Dosimetric parameters (for the whole intestine and its segments) were assessed as risk factors for aGvHD. The RT dose that was received by each intestinal area with aGvHD was extrapolated from the treatment plan for each patient. Doses were compared with those of the whole intestine minus the affected area. Results: Eighteen patients (36%) developed grade ≥2 aGvHD (G2 in 5, G3 in 11, and G4 in 2). Median time to onset was 41 days (range 23-69 days). The skin was involved in 11 patients, the intestine in 16, and the liver in 5. In all 50 TMLI patients, the mean dose to the whole intestine was 7.1 Gy (range 5.07-10.92 Gy). No patient developed chronic GvHD (cGvHD). No dosimetric variable emerged as a significant risk factor for aGvHD. No dosimetric parameter of the intestinal areas with aGvHD was associated with the disease. Conclusion: In our clinical setting and data sample, we have found no clear evidence that current TMLI dosages to the intestine were linked to the development of aGvHD. However, due to some study limitations, this investigation should be considered as a preliminary assessment. Findings need to be confirmed in a larger cohort and in preclinical models.

Florentine Normative Values for Physical Fitness in Adolescents Aged 14-15 Years.

Physical fitness during youth is linked to the health of today's young people and future adults. Therefore, fitness evaluation can direct any physical exercise interventions and verify improvements. The study aims to provide normative values of the physical fitness of the Florentine adolescent population. This cross-sectional study enrolled 1915 subjects aged 14 and 15 from the first and second high school classes. Tests were performed to assess cardiovascular endurance, upper and lower limb strength, running speed and agility, and lower limb muscle flexibility. Sex and age-related percentiles were elaborated. The study included 1028 subjects in the first class (aged 14.3 ± 0.8 years; 54.5% females) and 887 in the second class (aged 15.3 ± 0.7 years; 53.4% females). Males showed higher values than females except for flexibility. Furthermore, both genders show increased results in transitioning from the first to the second class, except for muscle flexibility and running speed. The percentiles of the present study provide normative values of the physical fitness of the 14-15-year-old Florentine adolescent population. These results, characterized by a sociocultural specificity linked to the territory from which they were collected, can contribute to the assessment and improvement of the physical status of young people, promoting current and future health.

Supervised Exercise in Water: Is It a Viable Alternative in Overweight/Obese People with or without Type 2 Diabetes? A Pilot Study.

The study of the effects of a water-based exercise program in overweight/obese people with or without type 2 diabetes is a topic of relatively recent interest. This type of exercise presents some advantages in reducing the risk of injury or trauma, and it can be a valuable therapeutic card to play for sedentary or physically inactive patients who have chronic metabolic diseases. This work aims to make a contribution showing the effects of a water-based exercise intervention, supervised by graduates in sports sciences, in a group of overweight/obese people with or without type 2 diabetes. In total, 93 adults (age 60.59 ± 10.44 years), including 72 women (age 60.19 ± 10.97 years) and 21 men (age 61.95 ± 8.48 years), were recruited to follow a water-based exercise program (2 sessions/week, for 12 weeks) at the C.U.R.I.A.Mo. Healthy Lifestyle Institute of Perugia University. Results showed an improvement in body mass index (−0.90 ± 1.56, p = 0.001), waist circumference (−4.32 ± 6.03, p < 0.001), and systolic (−7.78 ± 13.37, p = 0.001) and diastolic (−6.30 ± 10.91, p = 0.001) blood pressure. The supervised water-based intervention was useful in managing patients with metabolic diseases who often present with other health impairments, such as musculoskeletal problems or cardiovascular or rheumatic disease that could contraindicate gym-based exercise.

Side Bioimpedance Analysis in Menopausal Post-Oncological Breast Cancer.

BACKGROUND: Post-oncological BC (breast cancer) has an increased cardiovascular risk due to the variation of some anthropometric parameters. This study investigates the differences between a quadrantectomy and a mastectomy on the body composition over time in presence of a breast prothesis. METHODS: A group of BC patients (n = 41 aged 56.6 ± 9.5 years; 15 mastectomy patients; and 26 quadrantectomy patients) were compared to controls (C) (n = 22 aged 46.5 ± 13.44 years). Through bioimpedance analysis (Akern-BIA 101), the body mass index (BMI), total body water (TBW), extracellular water (ECW), body cell mass (BCM), fat mass (FM), free fat mass (FFM), and angle phase (PA) were compared within each group and between different groups using the Student's Test T. RESULTS: The BC group showed lower values of FFM and TBW compared to C. The FFM was significantly (p = 0.04) lower in those with quadrantectomy. The right hemisome of the quadrantectomy has increased values of FFM, BCM (p = 0.04) and TBW compared to the counter-lateral hemisome, and FM values (p = 0.0008) lower than the counter-lateral. The hemisome with intervention has increased values of FM and ECW compared to the counter lateral, as well the FFM, BCM, TBW, and PA. CONCLUSIONS: The results support the hypothesis that non-conservative surgical treatment (mastectomy) is associated with a better BIA profile without any substantial impact of breast implants in the body composition analysis. The awareness of a severe diseases could play a role to ameliorate lifestyle; however, further studies will be necessary to support this theory.

Effects of a Mixed Exercise Program on Overweight and Obese Children and Adolescents: A Pilot, Uncontrolled Study.

Pediatric excess weight has reached severity worldwide, affecting physical health. Decreasing weight and body mass index (BMI) after exercise intervention reduces the cardiometabolic consequences; the role of age and gender on the effectiveness of exercise in overweight youth was debated in this study. A total of 138 overweight/obese young (75 girls, 63 boys) were recruited at Perugia (Italy) University to follow an exercise program. Participants were allocated into two groups (children, n = 88 and adolescents, n = 50). The study aimed to verify the efficacy of a mixed resistance-endurance exercise program in anthropometric and physical performance measures, evaluating the influence of gender and age on two groups of young overweight/obese participants. In children, we observed a statistically significant improvement in fat mass percentage, fat-free mass, waist circumference (WC), fat mass, as well as in strength, endurance, speed, and flexibility measures. We also observed reduced WC and waist-to-height ratio (WHtR) values in girls. In the adolescents' subgroup, results showed a statistically significant variation in fat mass percentage, BMI, WC, and WHtR, and strength of the upper and lower limbs; we also observed a weight reduction in girls. A clinical approach, with the combination of strength and dynamometric tests plus the body composition study using air plethysmography methodology, is health-effective and allows for the monitoring of the efficacy of an exercise program in overweight/obese young people.

Prospective Cross-Sectional Evaluation of Penile Helicine Circulation by Power Doppler During Dynamic Ultrasound in Veno-Occlusive Erectile Dysfunction.

OBJECTIVE: To evaluate the usefulness of Power Doppler to improve the diagnostic work up of veno-occlusive erectile dysfunction patients. MATERIALS AND METHODS: Patients affected by erectile dysfunction, mean IIEF 5 = 13.5 (12-17) for at least 6 months, were enrolled in a prospective cross-sectional study. All patients underwent Dynamic Power Doppler after intracavernous injection of vasoactive drugs (PGE1 20 mcg and Papaverine 6 mg). Poor responders' patients subsequently underwent to cavernosometry to get a full assessment of the vascular framework. RESULTS: 202 patients (mean age 46 years), were included in the study. 96 subjects (47.5%) who did not adequately respond to the intracavernous injection -test, subsequently underwent to cavernosometry. In 42 of 96 patients (43.7%) cavernosometry was positive for veno-occlusive dysfunction. In a total of 160 patients who did not have veno-occlusive dysfunction (54 with negative cavernosometry + 106 intracavernous injection-test responders), the Power Doppler was normal in 126 (78.8%) and pathological in 34 (21.3%) in terms of steric conformation of "low flow" vessels corresponding to the Cavernosal Terminal Unit. The diagnostic sensitivity of Power Doppler towards veno-occlusive dysfunction was found to be 52.4% (Positive Predictive Value: 39.3%), the specificity was 78.8% (Negative Predictive Value: 86.3%) and the total diagnostic accuracy was equal to 73.3%. CONCLUSION: Collected data evidenced that patients who reported altered morphological features of the Cavernosal Terminal Unit had an approximately 4-fold greater risk of having veno-occlusive dysfunction compared to patients who had normal Power Doppler features (OR = 4.076; 95% CI: 1.996-8.327).

Integrated Sports Medicine: A First Investigation of Heart Performance in Opera Singers.

INTRODUCTION: Opera singers are continuously subjected to cardiopulmonary exercise. The impact on cardiac performance has not been studied. Our aim was to verify the impact of singing on heart performance, particularly by the evaluation of ECG and deformation parameters as strain, rotation and twist. METHODS: A population of 17 OS (opera singers) underwent a 12-lead ECG and 2D echocardiographic evaluation. A post-processing analysis of the images to obtain the deformation parameters was included. The data expressed as mean as SD were compared to a group of 15 high-level athletes (A). RESULTS: In both groups, the ECG parameters, 2D standard systodiastolic parameters and pulmonary pressure were normal, and in the OS group-LVDd: 47 ± 2.75 mm, LVSd: 31 ± 3.38 mm, E/A: 1.08 ± 0.23, RV: 27.63 ± 3.38 mm; in the A group-LVDd: 51 ± 1.50 mm, LVSd: 32 ± 2.50 mm, E/A: 2.37 ± 0.73, RV: 25.00 ± 3.00 mm. Indexed LV mass was significantly greater in athletes, while ejection fraction (EF) results were higher in OS. Deformation parameters did not differ among the two groups, with the exclusion of GLS expressing a major value in athletes. Rotational parameters resulted in the OS group similar to the athletes. CONCLUSIONS: OS show myocardial performance as high as the athletes. The data obtained suggest a positive impact of regular training as an opera singer. Deformation parameters highlight the fitness status in this group with a specific remodeling in RV in the presence of normal PP. Classic music singing appears to have a training effect on the heart. Further studies are necessary to confirm this hypothesis.

Myocardial Fitness of Bicuspid Aortic Valve Athletes during COVID 19 Pandemic.

COVID 19 pandemic has induced a large sedentarism in several kinds of sports. Some peculiar categories of athletes could particularly suffer from a prolonged inactivity as those affected by minimal cardiopathies as bicuspid aortic valve (BAV) athletes. This study aims to verify the myocardial performance in a restricted group of BAV athletes compared to a control group of agonistic athletes evaluated by traditional echocardiography and deformation parameters. 2D standard and deformations parameters were measured at rest conditions in BAV athletes and controls. Particularly EF, LVDD/LVS diameters, GLS rotation and twisting were considered as myocardial performance data; E/A, E1 and A1 as diastolic ones. All the 2D standard parameters measured were within the normal range in both groups, especially the EF value. Significant differences were found in the diastolic function with reduced values of E and E1 waves in BAV vs. controls. The strain analysis showed a significant reduction in GLS measured in 2C, 3C, 4C in BAV if compared to controls, while no significant differences were found in torsional and rotational parameters. These results are suggestive for a potential long term negative impact of inactivity on cardiac performance more evident in BAV athletes, if compared to athletes with normal aortic valve. GLS of LV and RV can be considered as a predictive parameter of this mild dysfunction and assumed as follow-up parameter to restore a progressive training.

Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis.

Background: To date, few studies have been published on image-guided helical tomotherapy (HT) in a moderate hypofractionation of localized PCa. We report outcome and toxicity of localized PCa patients treated with HT-based moderate hypofractionated radiotherapy. Materials and methods: 76 patients were retrospectively analyzed. A total dose of 60 Gy (20 × 3 Gy) or 67.5 Gy (25 × 2.7 Gy) was prescribed. The χ2 test was used to analyze associations between toxicity and dosimetric and clinical parameters. The Cox proportional hazard regression model was used for multivariate analysis. Kaplan-Meier method was used for survival analysis. Results: median follow-up was 42.26 months [interquartile (IQR), 23-76). At 4-year, overall survival (OS) and metastasis-free survival (MFS) were 91% and 89%, respectively. At multivariate analysis, smoking habitude was associated with MFS [hazard ratio (HR) 7.32, 95% CI: 1.57-34.16, p = 0.011]. Acute and late grade ≥ 2 gastro-intestinal (GI) toxicity was observed in 6.5% and 2.6% of patients, respectively. Acute and late grade ≥ 2 genito-urinary (GU) toxicity were 31.5% and 3.9%. Four-year late GI and GU grade ≥ 2 toxicity were 3% and 7%, respectively. Acute GI toxicity was associated with statins medication (p = 0.04) and androgen deprivation therapy (p = 0.013). Acute GU toxicity was associated with the use of anticoagulants (p = 0.029) and antiaggregants (p = 0.013). Conclusions: HT-based moderate hypofractionation shows very low rates of toxicity. Smoking habitude is associated with the risk of developing metastases after radical treatment for localized PCa.

Impact of BMI, Physical Activity, and Sitting Time Levels on Health-Related Outcomes in a Group of Overweight and Obese Adults with and without Type 2 Diabetes.

Physical activity level and sedentary behaviors affect health status in people with obesity and type 2 diabetes (DM2); their assessment is mandatory to properly prescribe exercise programs. From January 2011 to February 2014, 293 overweight/obese adults (165 women and 128 men, mean age of 51.9 ± 9.5 years and 54.6 ± 8.3 years, respectively), with and without DM2, participated in a three-month intensive exercise program. Before starting, participants were allocated into three subgroups (overweight, body mass index or BMI = 25-29.9; class 1 of obesity, BMI = 30-34.4; or class 2 (or superior) of obesity, BMI > 35). The international physical activity questionnaire (IPAQ-it) was used to evaluate participants' baseline sitting time (SIT) and physical activity level (PAL). Stratified multiple analyses were performed using four subgroups of SIT level according to Ekelund et al., 2016 (low, 8 h/day of SIT) and three subgroups for PAL (high, moderate, and low). Health-related measures such as anthropometric variables, body composition, hematic parameters, blood pressure values, and functional capacities were studied at the beginning and at the end of the training period. An overall improvement of PAL was observed in the entire sample following the three-month intensive exercise program together with a general improvement in several health-related measures. The BMI group factor influenced the VO2 max variations, leg press values, triglycerides, and anthropometric variables, while the SIT group factor impacted the sitting time, VO2 max, glycemic profile, and fat mass. In this study, baseline PAL and SIT did not seem to influence the effects of an exercise intervention. The characteristics of our educational program, which also included a physical exercise protocol, allowed us to obtain positive results.

Modulation of Human Hydrogen Sulfide Metabolism by Micronutrients, Preliminary Data.

BACKGROUND: Hydrogen sulfide (H2S) is a pivotal gasotransmitter networking with nitric oxide (NO) and carbon monoxide (CO) to regulate basic homeostatic functions. It is released by the alternative pathways of transulfuration by the enzymes Cystathionine Beta Synthase (CBS) and Cystathionine Gamma Lyase (CSE), and by Cysteine AminoTransferase (CAT)/ 3-Mercaptopyruvate Sulfur Transferase (3MPST). A non-enzymatic, intravascular release is also in place. We retrospectively investigated the possibility to modulate the endogenous H2S release and signaling in humans by a dietary manipulation with supplemented micronutrients (L-cystine, Taurine and pyridoxal 5-phopsphate/P5P). METHODS: Patients referring for antiaging purposes underwent a 10-day supplementation. Blood was collected at baseline and after treatment and the metabolome was investigated by mass spectrometry to monitor the changes in the metabolites reporting on H2S metabolism and related pathways. RESULTS: Data were available from 6 middle aged subjects (2 women). Micronutrients increased 3-mercaptopyruvate (P = .03), reporting on the activity of CAT that provides the substrate for H2S release within mitochondria by 3MPST, decreased lanthionine (P = .024), reporting the release of H2S from CBS, and had no significant effect of H2S release from CSE. This is compatible with a homeostatic balancing. We also recorded a strong increase of reporters of H2S-induced pathways including 5-MethylTHF (P = .001) and SAME (P = .022), reporting on methylation capacity, and of BH4 (P = .021) and BH2 (P = .028) reporting on nitric oxide metabolism. These activations may be explained by the concomitant induction of non-enzymatic release of H2S. CONCLUSIONS: Although the current evidences are weak and will need to be confirmed, the effect of micronutrients was compatible with an increase of the H2S endogenous release and signaling within the control of homeostatic mechanisms, further endorsing the role of feeding in health and disease. These effects might result in a H2S boosting effect in case of defective activity of pathologic origin, which should be checked in duly designed clinical trials.

Does epidural analgesia influence labor progress in women aged 35 or more?

BACKGROUND: During the last decades, the age of pregnant women significantly increased. The incidence of maternal and labor complications is higher among older women, but conclusive data have not been delivered whether labor epidural analgesia (EA) may affect the duration of labor and delivery outcomes in this population of patients. The aim of this study is to evaluate the effect of EA among women aged over 35 years. METHODS: We retrospectively reviewed medical records of all, singleton, at term deliveries, laboring with EA, between December 2011 and October 2017. Women aged ≥35 years (study group) were compared with women aged <35 years (control group) to evaluate EA effects on the duration of labor and neonatal outcome. RESULTS: The study enrolled 459 women with EA: 122 women were included in the study group and 337 in the control group. The multiple regression analysis showed that parity was an independent variable for a shorter dilation period (p = .002), second stage length (p = .0001) and for the total labor duration (p = .0001); neonatal weight was significant for a shorter dilation period (p = .005) and for the total labor duration (p = .002); maternal age and cervical dilatation at the beginning of EA did not influence neither the period of the labor stages nor the total labor duration (p > .05). CONCLUSIONS: Results of this study indicate that women aged ≥35 with EA may have labor duration and neonatal short-term outcomes similar to younger women with EA.

IncobotulinumtoxinA versus onabotulinumtoxinA intradetrusor injections in patients with neurogenic detrusor overactivity incontinence: a double-blind, randomized, non-inferiority trial.

BACKGROUND: A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA (Incobot/A) vs. OnabotulinumtoxinA (OnabotA) intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization. METHODS: Sixty-four patients with spinal cord injury (SCI) or multiple sclerosis were randomized to receive 30 intradetrusor injections of Incobot/A or OnabotA 200 U; 28 patients in incobotulinumtoxinA group and 29 in onabotulinumtoxinA group completed the study. Primary outcome measure was the non-inferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Secondary outcomes measures were changes in Incontinence- Quality of Life questionnaire, Visual Analog Scale Score (bother of symptoms on Quality of Life), urodynamic parameters, occurrence of adverse effects and related costs (week 12). RESULTS: At week 12, mean value of difference in urinary incontinence episodes/day between the two groups was -0.2 (95% two-sided CI: -1; 0.7); the difference in incontinence episodes/day between the two groups was -0.4 with a higher limit of one-sided 95% CI of 0.2 episodes/day which was much lower than the non-inferiority margin of one episode/day. Total score and subscores of Incontinence- Quality of Life questionnaire, Visual Analog Scale scores and urodynamics did not show differences between the two groups. Adverse effects were similar for both treatments, with urinary tract infection being the most frequent, localised effect. Minor costs were observed following Incobot/A. CONCLUSIONS: In patients with refractory neurogenic incontinence due to SCI or multiple sclerosis, incobotulinumtoxinA was not inferior to onabotulinumtoxinA in improving clinical and urodynamic findings in the short-term follow-up, with comparable adverse effects but minor costs.

Home-based exercise program improves normal right ventricle function in renal transplant recipients.

BACKGROUND: Right ventricular function is strongly associated with clinical outcomes in populations at high cardiovascular risk. Renal Transplant Recipients have multiple coexisting comorbidities potentially involved in the biventricular dysfunction including the right ventricular chamber. Speckle tracking echocardiography is recently used to investigate the normal function of this chamber. The study aims to verify whether global longitudinal strain carries clinical and prognosis implications in the renal transplant recipients during 1 year of regular unsupervised physical activity and compared to a control group. METHODS: A group of 50 transplant recipients, aged 49.6±11.5 was submitted for 1 year to a moderate intensity of mixed exercise. All the subjects were followed by echocardiographic exam every 6 months, only 25 subjects with a high quality of image were investigated by 2D Speckle tracking strain analysis with the measurement calculated at T0, T6, and T12 months. RESULTS: Renal transplant recipients started with low values of right ventricle global longitudinal strain compared to health controls; it increased significantly (P<0.01) after 12 months of exercise, restoring the normal range. CONCLUSIONS: Moderate intensity of physical exercise, despite unsupervised, support a normal RV ventricular performance in renal transplant recipients' strain analysis contribute to plan a correct follow-up, with prognostic impact in these patients practicing physical exercise.

Impact of blood sampling technique on reproducibility of viscoelastic coagulation monitor (VCM™) system test results in the neonate.

Purpose: To evaluate the reproducibility of the results of the viscoelastic coagulation test (VCT) performed with a new viscoelastic coagulation monitor (VCM™ - Entegrion) on native blood obtained by heel prick blood sampling with two different techniques compared to the standard blood collection in the newborn.Methods: Three blood samples were tested with the VCM analyzer in each of the 67 study subjects admitted to our level 3 neonatal intensive care unit. Standard blood collection (S) was performed by direct puncture of a peripheral vessel or by drawing of blood in a syringe connected to an arterial or venous catheter. Then, two more blood samples were drawn through a single heel prick. The first heel prick blood sample (HP1) was collected in the sample well through the attached metal capillary while the second (HP2) was poured directly into the sample well. Blood samples were automatically drawn into their pre-warmed cartridges and inserted into the VCM analyzers set up for analyses, which ran for one hour. VCT blood variables included clotting time (CT), clot formation time (CFT), angle alpha (α), amplitude at 10 and 20 min (A10 and A20), maximum clot firmness (MCF), and lysis indexes at 30 and 45 min (LY30 - LY45). Agreement was quantified by calculating the mean difference and SD between measurements of VCT blood variables from S, HP1 and HP2 blood samples. The 95% limits of agreement were calculated by the Bland & Altman method, using the upper or lower limit of agreement to interpret the variability of the measurements. The Kendall's τ correlation coefficient evaluated the interdependence between SD and intra-measurement mean.Results: S blood samples were easily obtained in all the study subjects, while mild difficulties were recorded in 3/67 infants (4.5%) with the HP1 blood sampling and in 5/67 infants (7%) with the HP2 blood sampling. Pairwise comparison of test results performed on blood samples drawn with HP1 and HP2 techniques showed moderate agreement for CT and α-angle, strong agreement for CFT, LY30 and LY45 and almost perfect agreement for A10, A20 and MCF. In pairwise comparison of VCM analyses performed on blood samples drawn with S technique vs HP1 and HP2 techniques, Kendall's τ correlation coefficient was significant for CT (S vs HP1 and HP1 vs HP2), CFT (S vs HP1 and S vs HP2), α-angle (S vs HP1) and MCF (S vs HP1). This suggests that the measurement error depends on the extent of the measurement. The overall ICC for blood sampling techniques ranged from 0.289 to 0.879 with best agreement observed for CFT (strong) and for A10, A20 and MCF (almost perfect). The LY30 index was the least repeatable measurement (poor agreement). The VCM analysis performed on the blood sample drawn with the HP1 technique showed the best repeatability compared with that performed with the S blood-sampling technique.Conclusion. VCT test results performed with the VCM analyzer on native blood drawn by heel prick in neonates are comparable to those obtained from standard blood samples. This could allow for a widespread, real-time assessment of the overall bedside haemostasis of these small patients.