Intrahospital organizational model of remote monitoring data sharing, for a global management of patients with cardiac implantable electronic devices: a document of the Italian Association of Arrhythmology and Cardiac Pacing.

: In recent years, the increasing number of patients with a cardiac implantable electronic device (CIED) has required different approaches in terms of the device's control and surveillance. It is increasingly difficult to keep the traditional in-office protocol device's control: we must think of a different organization dedicated to the activity of remote control and monitoring (RC/RM) of devices and patients.A CIED team structured with nurses, technicians and physicians should be organized inside the hospital, with the aim of CIED patients' managing and of creating a network between the various departments.Small hospitals may not be able to manage independently the CIEDs RC/RM and it is possible to hypothesize the creation of a collaborative network between neighbouring structures.This activity must combine the use of technology with the ability to take care of patients and to maintain adequate and meaningful relationships.

Pacemaker dependency after transcatheter aortic valve implantation: incidence, predictors and long-term outcomes.

AIMS: The aims of this study were to determine the appropriateness of permanent pacemaker implantation (PPI) after TAVI through an analysis of PM dependency at follow-up, and to assess long-term outcomes of patients undergoing PPI after TAVI. METHODS AND RESULTS: From June 2007 to February 2018, 1,116 consecutive patients without prior PM underwent TAVI in our institution. We assessed the incidence and predictors of PM dependency of patients who underwent PPI within 30 days, and also the six-year outcomes among patients who did not undergo PPI at 30 days. At 30 days, PPI was reported in 145 patients (13.0%). Rates of PM dependency were 35.7%, 35.8% and 33.3% at 1, 6 and 12 months, respectively. Analysing PPI timing, implantation on day 1 was found to be a predictor of PM dependency at six months (OR 20.7 [95% CI: 3.4-126.7]; p=0.001) and 12 months (OR 7.5 [95% CI: 1.4-40.2]; p=0.019). An interaction between PM dependency and the presence of baseline right bundle branch block (RBBB) at six months (pinteraction=0.024) and 12 months (pinteraction=0.028) was reported when PPI was performed on the same day as TAVI. At six years, patients who received a PM at 30 days showed a higher all-cause death rate (KM estimate 41.7% vs 57%; plog-rank=0.034). CONCLUSIONS: Among patients receiving PPI after TAVI, PM dependency rates were about 33-36% at one year. Patients with a baseline RBBB undergoing PPI at day 0 or at day 1 when severe CDs persisted for 24 hours after TAVI, irrespective of baseline CDs, had a higher chance of being PM-dependent at follow-ups. Finally, PPI after TAVI was associated with increased six-year mortality.

[Monitoring of heavy metals and trace elements in the air, fruits and vegetables and soil in the province of Catania (Italy)]. / Monitoraggio di metalli pesanti ed oligoelementi in aria, ortofrutta e terreno nella provincia di Catania.

Contamination of fruits and vegetables with heavy metals can result from anthropogenic events (car or factory emissions, poor management of sewage and industrial waste) or from natural events (volcanic activity and geological soil matrix). The chemical and toxicological characteristics of heavy metals can have an impact on human health through several mechanisms. Other metals, on the other hand, are essential for maintenance of physiological and biochemical human processes, are protective against many diseases and must be present in the diet because they cannot be synthesized by the human body. The purpose of this study was to assess the presence of heavy metals and trace elements both in fruit and vegetable products widely consumed in the province of Catania (Sicily, Italy) and in various environmental matrices (air, water and land), and to investigate possible sources of contamination. Fruit and vegetable products (tomatoes, lettuce, spinach, eggplants, potatoes, zucchini, grapes, apples and pears) were sampled (n = 60) from the towns of Adrano, Biancavilla and Mazzarrone. These locations were selected for their geomorphology, climate and cultivation characteristics. Levels of lead, cadmium, nickel, copper, zinc, vanadium and selenium in fruit, vegetables, air and water samples were determined using atomic absorption spectrometer with graphite furnace Perkin-Elmer AAnalyst 800 while soil samples were evaluated by the atomic emission spectrometer Optima 2000 DV Perkin-Elmer. The presence of mercury was evaluated by atomic absorption spectrometry with cold vapor technique. Study results revealed widespread contamination of fruit and vegetables and mainly due to use of fertilizers and to volcanic activity. A strategy targeting the entire food chain is essential for ensuring food safety and consumer protection and maintaining contaminants at levels which are not hazardous to health.

[The prevention of Ochratossina A (OTA A) in the wine]. / La Prevenzione di Ochratossina A (OTA A) nel vino.

The expansion of global market has recalled more and more the attention of the researchers on the presence of mycotoxins in the foodstuff. Trying to limit the damages to the health and the correlated economic losses the European Community has legislated fixing more restrictive limits for the presence of mycotoxins in the single food products; and, specifically the limits of presence of Ochratoxin A (OTA A) in the wines have been established by the rule EEC 123 / 2005. With the purpose to prevent the formation of OTA á in the wine (from the grape to the bottled product), has been conducted, a study to compare the different techniques currently used, as the Good Agricultural Practices (BPA), the Good Practices of Manufacture (BPF) and the Good Practices of storage (BPS) with the system of Hazard Analysis Critical Control Points (HACCP), nowadays used only from the begin of the phase of processing of the agricultural products. It results that, concerning the BPAs, the application of the System HACCP on the primary production would bring neither some innovation nor qualitative improvement. The comparison among BPF, BPS and HACCP, confirms, instead, as the HACCP allows to individualize a series of additional critical points worth of attention during the process and maintenance of the grapes. Such result is in agreement with the new community rule 852/2004, which, also because the difficulties in the application of the HACCP to the primary production, confirm the necessity to follow, on the field, the hygienic respect of the sanitary measures (see attached one artt. 5- 6). This involves the necessity of an increasing integration and cooperation among different professional workers (as hygienist and agronomist). That kind of cooperation is already in use (from year 2003), within the "progetto fito", started by the AUSL 3 of Catania, with the coordination of the Service Hygiene Food stuff and Nutrition (SIAN).