Search Results for: Le cause della polmonite nei bambini

‘Non per la morte ma per la miglior vita possibile’. Nessun hospice per i bambini in 11 regioni

Stroke, Ahead of Print. Stroke remains a predominant cause of death and long-term disability among adults worldwide. Emerging evidence suggests that proteinopathies, characterized by the aggregation and accumulation of misfolded proteins, may play a significant role in the aftermath of stroke and the progression of neurodegenerative disorders. In this review, we explore preclinical and clinical research on key proteinopathies associated with stroke, including tau, Aβ (amyloid-β), TDP-43 (TAR DNA-binding protein 43), α-synuclein, and UCH-L1 (ubiquitin C-terminal hydrolase-L1). We focus on their potential as biomarkers for recovery management and as novel treatment targets that may enhance neuronal repair and mitigate secondary neurodegeneration. The involvement of these proteinopathies in various aspects of stroke, including neuroinflammation, oxidative stress, neuronal damage, and vascular dysfunction, underscores their potential. However, further investigations are essential to validate the clinical utility of these biomarkers, elucidate the mechanisms connecting proteinopathies to poststroke neurodegeneration, and develop targeted interventions. Identifying specific protein signatures associated with stroke outcomes could facilitate the advancement of precision medicine tailored to individual patient needs, significantly enhancing the quality of life for stroke survivors.

Al Don Gnocchi Firenze il Computer assisted rehabilitation lab

Objectives
A previous cohort study of male Norwegian Navy submariners showed higher overall cancer incidence and lower all-cause mortality than the general Norwegian population. We have extended the follow-up and show more precise estimates through seven decades.

Design
Historical cohort study using outcome data from Norwegian cancer incidence and cause-of-death registries.

Setting
Linkage with the outcome registries was performed by means of unique national identification numbers given to all Norwegian citizens.

Participants
2663 military men who ever served aboard a Navy submarine between 1942 and 2005.

Outcome measures
Standardised incidence ratios for cancer and mortality ratios were calculated from national period-specific, gender-specific and age-specific rates. Poisson regression was used to compare cancer incidence in groups with different length of submarine service ( >2 years vs ≤2 years).

Results
The overall cancer incidence was 15% higher than expected from the national rates, with colon, lung, skin (melanoma and non-melanoma) and urinary tract contributing 90% of the excess number of cases. Most of the excess was confined to those with shorter-time service, who also showed elevated risk of alcohol-related cancers. Excess non-melanoma skin cancer was most clearly seen among submariners with >2 years of service. Mortality from all causes combined was lower among submariners than in the general population, due to a markedly low mortality from non-neoplastic diseases and external causes.

Conclusions
Increased risk of non-melanoma skin cancer was found among submariners with long-term service, and skin exposure to carcinogens in petroleum products was hypothesised as an explanation. Less support for occupational risks was found for other cancers, although the lack of specific exposure data and limited statistical power reduced the possibility of identifying such associations. A ‘healthy soldier effect’ appeared in the mortality data, mainly restricted to low mortality from non-neoplastic diseases and external causes.

Background
ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality. Primary percutaneous coronary intervention (PPCI) is the preferred treatment, yet some patients experience major adverse cardiac events (MACE) within a year despite successful recanalisation. Identifying predictors of futile recanalisation—defined as achieving thrombolysis in myocardial infarction grade III flow after PPCI but still developing MACE—is essential for improving outcomes.

Research design and methods
This single-centre, retrospective study included patients with STEMI treated with PPCI from January 2019 to January 2023. The primary outcome was futile recanalisation. Least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used to identify independent predictors of futile recanalisation.

Results
Of the 489 consecutive patients who achieved successful recanalisation, 20.9% met the criteria for futile recanalisation within 1 year. Multivariable analysis identified several independent predictors: heart rate at admission (OR 1.32, 95% CI 1.02 to 1.71), reduced left ventricular ejection fraction (LVEF; OR 0.30, 95% CI 0.22 to 0.41), advanced left ventricular diastolic dysfunction (OR 1.44, 95% CI 1.02 to 2.15), elevated cardiac troponin I (CTnI) levels (OR 1.42, 95% CI 1.08 to 1.90), high Selvester QRS scores (OR 1.59, 95% CI 1.20 to 2.13) and increased homocysteine (HCY) levels (OR 1.37, 95% CI 1.07 to 1.77).

Conclusion
Despite successful recanalisation, certain factors—high admission heart rate, low LVEF, advanced left ventricular diastolic dysfunction, elevated CTnI levels, high Selvester QRS scores, and increased HCY levels—are associated with futile recanalisation in patients with STEMI. These findings highlight the need for targeted monitoring and management strategies to reduce long-term MACE risks in this population.

Introduction
Non-specific pain (NSP), defined as pain without a clear pathological cause, is a common presentation in the emergency department (ED). There is no universally accepted analgesic strategy, but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed. However, the established efficacy of NSAIDs for NSP is limited. Additionally, NSAIDs are associated with an increased risk of upper gastrointestinal bleeding, acute kidney injury and cardiovascular events, such as myocardial infarction and stroke. There is increasing evidence supporting the analgesic effects of open-label placebo (OLP), defined as placebo administered to patients without deception, in a broad variety of settings. Accordingly, OLP could be a safer, effective analgesic treatment option for NSP. To our knowledge, this is the first study investigating the feasibility of OLP for NSP in the ED. Therefore, our primary objective is to assess whether OLP is a feasible treatment option in this setting.

Methods and analysis
Patients diagnosed with acute NSP will be prospectively recruited at discharge in the ED at the University Hospital of Basel, Switzerland. Patients treated with pain medication for >7 days prior to ED visit or with chronic pain will be excluded. Patients will be randomised to receive either OLP (intervention) or ibuprofen (control). Rescue medication will be ibuprofen in both groups. Daily online self-assessment will take place during the first 7 days after the baseline visit as well as on day 30. A qualitative interview will be conducted on day 30. The primary outcome is feasibility, consisting of acceptability, adherence to the protocol and patient satisfaction. Clinical outcomes will focus on pain intensity and interference according to the Brief Pain Inventory Short Form as well as adverse events.

Ethics and dissemination
The study protocol has received approval from the ethics committee for Northwestern and central Switzerland (EKNZ; project ID 2024-00089). The results will be disseminated in peer-reviewed journals and at scientific conferences.

Trial registration number
Swiss National Clinical Trials Portal (SNCTP000005852); Clinicaltrial.gov (NCT06408519).

To the Editor A recent JAMA Clinical Challenge reported the case of a 25-year-old female with incidental thoracic aortic aneurysm and bicuspid aortic valve (BAV). I am concerned that this article missed an important teaching point related to diagnostic workflow and did not identify the cause(s) of the thoracic aortic aneurysm and BAV, needed for diagnosis, treatment, and surveillance of this condition. In this young adult female, the family history of her father having an ascending aorta dissection repaired at age 60 years indicates an autosomal dominant inheritance with a 50% risk for first-degree relatives (children, siblings, and parents).

To the Editor A recent randomized clinical trial indicated that for patients with asymptomatic severe aortic stenosis and myocardial fibrosis, early surgical intervention showed no significant difference on all-cause death or unplanned aortic stenosis–related hospitalization compared with conservative management. To enhance the clinical relevance of this study, I suggest several supplemental analyses.

To the Editor A recent trial demonstrated that among asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no significant effect on all-cause mortality or aortic stenosis–related hospitalization. This study has several limitations that affect its conclusions.

Circulation, Ahead of Print. BACKGROUND:Genetic variants in desmosomal cadherins, desmoglein 2 (DSG2) and desmocollin 2 (DSC2), cause a distinct form of arrhythmogenic right ventricular cardiomyopathy (ARVC), which remains poorly reported. In this study, we aimed to provide a comprehensive description of the phenotypic expression, natural history, and clinical outcomes of patients with this ARVC subset.METHODS:Genetic and clinical data ofDSG2andDSC2variant carriers were collected from 5 countries in Europe and Asia. We assessed the phenotypic profile of these patients and their clinical outcomes, focusing on heart failure and ventricular arrhythmia events.RESULTS:Overall, 271 subjects, 254 withDSG2variants, were included in this study (median age, 38 years [interquartile range, 25–52]; 62.7% male). Of these, 165 were probands, and 200 were diagnosed with definite ARVC. A total of 181 (66.8%) individuals carried missense variants, mainly distributed in the extracellular domains. Notably, we included 78 (28.8%) individuals with multiple variants. Of the 200 cases with diagnosed ARVC, 41 (20.5%) experienced premature cardiac death before the age of 65. Among the 81 individuals for whom both left ventricular ejection fraction and right ventricular fractional area change data were available at presentation, 29 (35.8%) had isolated right ventricular dysfunction, and 16 (19.8%) had biventricular dysfunction. Single-variant carriers who engaged in intense physical exercise were younger at disease onset compared with those who did not (P=0.001). Compared with single-variant carriers, those with multiple variants were more likely to be diagnosed with ARVC (96.2% versus 64.8%;P

Stroke, Volume 56, Issue 4, Page e114-e118, April 1, 2025. Intracranial atherosclerotic stenosis is a leading cause of stroke with a significant risk of recurrent ischemic events despite aggressive medical management. The longstanding benefits of percutaneous angioplasty and stenting in coronary artery disease, where atherosclerosis is the overarching cause in nearly all cases, provided a compelling rationale for exploring similar interventions in intracranial atherosclerotic stenosis. However, 3 percutaneous angioplasty and stenting randomized trials showed negative or neutral results. The recent BASIS trial (Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis) was the first randomized trial in intracranial atherosclerotic stenosis to demonstrate the benefits of endovascular treatment, suggesting that submaximal balloon angioplasty might be in the sweet spot between mitigating early complications and securing long-term efficacy. These findings represent a significant advancement in the field, reinvigorating the goal of effective revascularization as a viable secondary prevention approach for intracranial atherosclerotic stenosis. However, several uncertainties still need to be addressed before the widespread implementation of angioplasty in clinical practice.

Circulation, Volume 151, Issue 12, Page 863-877, March 25, 2025. Hypertension is the leading modifiable risk factor for atrial fibrillation (AF) and is estimated to be present in >70% of AF patients. This Frontiers Review was prepared by 29 expert members of the AF-SCREEN International Collaboration to summarize existing evidence and knowledge gaps on links between hypertension, AF, and their cardiovascular sequelae; simultaneous screening for hypertension and AF; and the prevention of AF through antihypertensive therapy. Hypertension and AF are inextricably connected. Both are easily diagnosed, often silent, and frequently treated inadequately. Together, they additively increase the risk of ischemic stroke, heart failure, and many types of dementia, resulting in greater all-cause mortality, considerable disease burden, and increased health care expenditures. Automated upper arm cuff blood pressure devices with implemented technology can be used to simultaneously detect both hypertension and AF. However, positive screening for AF with an oscillometric blood pressure monitor still requires ECG confirmation. The current evidence suggests that high-risk individuals aged ≥65 years or with treatment-resistant hypertension could benefit from AF screening. Since antihypertensive therapy effectively lowers AF risk, particularly in individuals with left ventricular dysfunction, hypertension should be the key target for AF prediction and prevention rather than merely a comorbidity of AF. Nevertheless, several important gaps in knowledge need to be filled over the next years, including the ideal method and selection of patients for simultaneous screening of hypertension and AF and the optimal antihypertensive drug class and blood pressure targets for AF prevention.

Esperto, problemi combinati a mucose e muscoli della fonazione

Introduction
The cause of ischaemic stroke at a young age remains unknown in 30% of cases, highlighting the need to identify hidden causes and risk factors in young patients. Transient and chronic risk factors may interact with the inflammatory and haemostatic systems, potentially driving key mechanisms in the pathogenesis. The ‘Observational Dutch Young StrokE study—Extended’ (ODYSSEY-nEXT) aims to enhance our understanding of these complex interactions through detailed phenotyping of the immune and haemostatic system and explore their relationship with long-term prognosis.

Methods and analysis
The ODYSSEY-nEXT is a multicentre prospective controlled cohort study of patients aged 18–50 years with a first neuroimaging-proven ischaemic stroke or transient ischaemic attack and healthy controls. We aim to include a total of 200 patients and 60 controls between January 2023 and January 2027. Blood samples will be collected within 72 hours after the index event and at 3 months to assess inflammatory and haemostatic markers. In a subgroup of 20 patients, whole blood analysis will be performed to investigate ex vivo immune cell functionality, the capacity of platelets to release granules and thrombin generation. All patients will complete a questionnaire about trigger and risk factors. Advanced intracranial and extracranial vessel wall imaging with MRI will be performed within a week. Long-term prognosis will be monitored through annual questionnaires about recurrent events for ten years.

Ethics and dissemination
This study was approved by the Medical Ethical Committee region ‘Oost-Nederland’ (NL77518.091.21) and will adhere to the Declaration of Helsinki and its later amendments. Participants have to provide written informed consent, but in cases where the patient cannot sign due to physical limitations as a result of the stroke, such as paresis, verbal consent is obtained from the patient and a legal representative will be asked to sign the consent form on their behalf. The findings of this study will be disseminated to healthcare professionals and the scientific community through peer-reviewed publications and to participants through accessible formats such as summary reports or newsletters.

Trial registration number
NCT05853796.