Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state.

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.

An attempt to establish early signals of peripheral arterial disease (PAD): the use of rhythm's parameters of peripheral blood flow (RF).

Rhythm parameters of peripheral arterial rest blood flow (RF) as a potential predictor of peripheral arterial disease (PAD) have been investigated. Three groups of subjects have been studied: a. six apparently healthy subjects; b. seven high risk (hypertension, diabetes, hypercholesterolaemia, hypertriglyceridaemia, erythrocytosis) subjects; c. four occlusive PAD selected patients with one 'pre-symptomatic' leg. RF has been measured by 'strain-gauge plethysmography' every min for 25 min, 4 times/day. Right fore-arm, right leg and left leg have been assessed. Data have been analyzed by 'single and population mean cosinor'. Significant circadian rhythms have been detected in apparently healthy subjects. Mesor and amplitude can differ according to single individual's area. Mesor is higher in upper limb. RF circadian rhythm parameters differ in subjects with various vascular risk load. Sometimes, PAD-symptomatic limb shows higher mesor than pre-symptomatic one, suggesting conditions of reactive post-ischemic hyperemia or a role of RF in PAD. Circadian dyschronia can be detected in PAD limbs but also in high risk subjects, perhaps an example of chronoprotopathology. These results suggest the possibility of a clinical use of RF rhythm parameters as predictors of vascular protopathology.

Toward a medical prolepsis by chronobiology.

Medicine today strongly aims at prevention and optimization of diagnosis and therapy Studies tried staging and standardization of clinical trials in diseases and made search of markers for early diagnosis, prognosis and therapy. Moreover, risk factors and other variables such as predictors are now investigated more often in groups or populations of apparently healthy subjects, especially for such diseases as atherosclerosis and neoplasia. This new aspect of increasing interest may be defined as medical prolepsis (from the Greek pi rho ómicron lambda eta psi iota zeta = anticipated idea). It includes early signals of disease (protopathology) as well as other signals the host shows as defence or alarm reaction. Hence, we suggest a chronobiological approach in this field, which allows to quantify health and reveals more subtle differences in many physiological variables. According to these views, we reported studies concerning humoral markers and other parameters considered as risk factors both in atherosclerosis and in some endocrine tumors.

Systolic time intervals during isometric exercise in supine position should be corrected also for arterial pressure.

In this paper we have studied the relationship between the systolic time intervals (STI) and the heart rate (HR) and systolic arterial pressure (SAP) in a group of 24 healthy subjects at three different effort levels during an isometric exercise in supine position and in basal conditions. We observed a decrease of the non corrected STI values during the exercise. Then we corrected STI using the regression equations obtained by plotting STI values versus the corresponding HR values at rest and during the exercise. We showed an increase of corrected left ventricular ejection time (LVET) during the whole exercise, and an increase of corrected total electromechanical systole (QS2c) at 50% effort level and then a return to the basal values. We also derived the multiple regression equations correlating QS2 and LVET with HR and SAP. Notwithstanding these equations show a significant positive correlation between the two STI considered and SAP only at the maximum effort, we corrected LVET and QS2 values by these equations assuming that the relationship between these parameters exists also in basal conditions and during the remaining stages of the exercise. By this correction we found a decrease of LVETc and QS2c in accordance with hemodynamic data reported by other authors. We may conclude that it seems useful to correct the STI obtained during isometric exercise in supine position both for HR and SAP.

[The normal values of systolic time intervals must be reviewed?]. / I valori normali degli intervalli di tempo sistolici devono essere rivisti?

A study of the relation between left ventricular ejection time (LVET) and arterial blood pressure (BP), was carried out in 26 healthy volunteers divided into 2 groups. A rise in BP was achieved in the first group of 2 subjects by venous infusion of 0.02% methoxamine solution. The heart rate was held constant by right atrial pacing and the arterial blood pressure was measured by catheterization of the right radial artery. A simultaneous recording of the electrocardiogram, the carotid arterial pulse and the arterial blood pressure tracings, was obtained. The relationship between LVET and the corresponding values of BP was examined by plotting LVET against BP. The second group of 24 subjects underwent a session of maximal isometric exercise. When the maximum of the effort was reached, the carotid arterial pulse tracing was recorded and the blood pressure of the arteria dorsalis pedis was measured by doppler technique. In both groups we plotted LVET against BP and HR. Simple and multiple regression equations were obtained. Our data show that LVET correlates with BP during the maximal isometric exercise and during venous infusion of methoxamine, suggesting that the normal values of systolic time intervals (STI) should be revised.