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Rapid Response Systems (RRSs) are designed to assist hospitalized patients who become unstable, aiming to address “failure to rescue” and prevent cardiac arrests. Despite global implementation, evidence of RRS effectiveness is controversial. This study evaluates the effectiveness and safety of an RRS at Maggiore Hospital in Lodi, Italy, focusing on the Medical Emergency Team (MET) organization. The RRS at Maggiore Hospital was established in 2017 using the National Early Warning Score (NEWS) for monitoring. The MET, consisting of an emergency physician and one nurse, operates from 8:00 PM to 8:00 AM. Data from 2014-2019, divided into PRE (2014-2016) and POST (2017-2019) periods, were analyzed. The primary outcomes were unplanned ICU transfers and in-hospital mortality. A difference-in-differences (DiD) design compared outcomes in MET and non-MET wards before and after RRS implementation. Hospitalizations were similar in the PRE and POST periods. A significant reduction in Intensive Care Unit (ICU) transfers was observed overall (0.26%, p=0.005), but not in mortality (0.10%, p=0.47). Both MET and non-MET wards showed reduced ICU transfers, but the decrease was statistically significant only in MET wards. DiD analysis showed no significant reductions in either ICU transfer (p=0.77) or mortality rates (p=0.15) between MET and non-MET wards. The RRS at Maggiore Hospital effectively reduced ICU transfers without increasing mortality, demonstrating its safety. The MET organization did not significantly impact ICU transfers compared to non-MET wards. Further studies should explore additional measures of clinical deterioration to fully assess the impact of RRS.

Here we reported the virological, entomological and epidemiological characteristics of the large autochthonous outbreak of dengue (DENV) occurred in a small village of the Lombardy region (Northern Italy) during summer 2023. After the diagnosis of the first autochthonous case on August 18, 2023, public health measures, including epidemiological investigation and vector control measures, were carried out. A serological screening for DENV antibodies detection was offered to the population. In the case of positive DENV IgM, a second sample was collected to detect DENV RNA and verify seroconversion. Entomological and epidemiological investigations were also performed. A modeling analysis was conducted to estimate the dengue generation time, transmission potential, distance of transmission, and assess diagnostic delays. Overall, 416 subjects participated to the screening program and 20 were identified as DENV-1 cases (15 confirmed and 5 probable). In addition, DENV-1 infection was diagnosed in 24 symptomatic subjects referred to the local Emergency Room Department for suggestive symptoms and 1 case was identified through blood donation screening. The average generation time was estimated to be 18.3 days (95 % CI: 13.1–23.5 days). R0 was estimated at 1.31 (95 % CI: 0.76–1.98); 90 % of transmission occurred within 500m. Entomological investigations performed in 46 pools of mosquitoes revealed the presence of only one positive pool for DENV-1. This report highlights the importance of synergic surveillance, including virological, entomological and public health measures to control the spread of arboviral infections.

The objective of this study was to evaluate inert gas rebreathing (IGR) reliability in cardiac output (CO) measurement compared with Fick method and thermodilution. IGR is a noninvasive method for CO measurement; CO by IGR is calculated as pulmonary blood flow plus intrapulmonary shunt. IGR may be ideal for follow-up of patients with pulmonary hypertension (PH), sparing the need of repeated invasive right-sided cardiac catheterization. Right-sided cardiac catheterization with CO measurement by thermodilution, Fick method, and IGR was performed in 125 patients with possible PH by echocardiography. Patients were grouped according to right-sided cardiac catheterization–measured mean pulmonary and wedge pressures: normal pulmonary arterial pressure (n = 20, mean pulmonary arterial pressure = 18 ± 3 mm Hg, pulmonary capillary wedge pressure = 11 ± 5 mm Hg), PH and normal pulmonary capillary wedge pressure (PH-NW, n = 37 mean pulmonary arterial pressure = 42 ± 13 mm Hg, pulmonary capillary wedge pressure = 11 ± 6 mm Hg), and PH and high pulmonary capillary wedge pressure (PH-HW, n = 68, mean pulmonary arterial pressure = 37 ± 9 mm Hg, pulmonary capillary wedge pressure = 24 ± 6 mm Hg). Thermodilution and Fick measurements were comparable. Fick and IGR agreement was observed in normal pulmonary arterial pressure (CO = 4.10 ± 1.14 and 4.08 ± 0.97 L/min, respectively), whereas IGR overestimated Fick in patients with PH-NW and those with PH-HW because of intrapulmonary shunting overestimation in hypoxemic patients. When patients with arterial oxygen saturation (SO2) ≤90% were excluded, IGR and Fick agreement improved in PH-NW (CO = 4.90 ± 1.70 and 4.76 ± 1.35 L/min, respectively) and PH-HW (CO = 4.05 ± 1.04 and 4.10 ± 1.17 L/min, respectively). In hypoxemic patients, we estimated pulmonary shunt as Fick − pulmonary blood flow and calculated shunt as: −0.2423 × arterial SO2 + 21.373 L/min. In conclusion, IGR is reliable for CO measurement in patients with PH with arterial SO2 >90%. For patients with arterial SO2 ≤90%, a new formula for shunt calculation is proposed.

The amount of evidence for guideline‐directed new heart failure (HFrEF) disease‐modifying drugs in the context of chronic kidney disease (CKD) is relatively modest, especially in end‐stage CKD. We report a case of dramatic reverse remodelling and disease regression in a naïve HFrEF young woman on haemodialysis treated with sacubitril/valsartan and SGLT2i. At 10‐month follow‐up, the patient normalized left ventricle and atrial volumes and improved ejection fraction to the normal range, assessed both by echocardiography and cardiac magnetic resonance. Cardiac biomarkers and exercise performance improved consensually. The haemodialysis protocol and the loop diuretic dose were unchanged within the whole period.

Although international guidelines recommend increasingly lower thresholds for low-density lipoprotein cholesterol (LDL-C), everyday clinical experience shows that many patients fail to reach these targets, exposing themselves to a significant residual cardiovascular risk. Clear Pathway - a patient-centered approach to dyslipidemia - was developed to bridge this gap by promoting an integrated use of oral lipid-lowering therapies. In the Clear Pathway project, a panel of hospital cardiologists applied a mini-Delphi methodology in two rounds to evaluate 20 statements related to lipid-lowering therapy, divided into three thematic areas: oral combination and fixed-dose strategies; use of LDL-C target distance as a guide to treatment decisions; and personalization based on patient's clinical profile. Each statement was rated on a 1-5 Likert scale and approved if the average score was ≥4.0. Statements not approved in the first round were reformulated and resubmitted. In the first round, 17 out of 20 statements met the consensus threshold and were approved without any modification. The three statements not approved (early intensification in post-acute coronary syndrome patients with LDL-C <140 mg/dl, use of bempedoic acid in patients undergoing elective angioplasty, and in those one with stroke) were reformulated and resubmitted during a second round, where they also reached the approval threshold. The Clear Pathway recommendations outline a model for dyslipidemia management based on integrated oral therapies, with a key role for bempedoic acid. Adopting these guidelines is expected to improve adherence, optimize achievement of LDL-C targets, and reduce the incidence of cardiovascular events in routine clinical practice.

Background When treating bladder cancer patients, the most significant problems usually concern cases with high-grade non-muscle-invasive carcinoma, and a better understanding of which patients would benefit from early radical cystectomy is urgently needed. The uropathology community is seeking more user-friendly approaches to distinguishing between T1 cancers exhibiting different types of clinical behavior. Methods After a retrospective review, we selected a group of 314 patients who underwent transurethral resection of the bladder (TURB) and were diagnosed with high-grade urothelial carcinoma staged as T1. Three different substaging systems were applied: one was the anatomy-based T1 a/b; and two involved micrometric thresholds of either 0.5 mm of invasion (as proposed by van Rhijn et al.), or 1 mm of invasion (as proposed in the present study). Early reTUR (repeated transurethral resection) was performed in 250 patients, and the same substaging approaches were applied to cases of T1. Results It proved feasible to apply the 1 mm substaging system in 100 % of cases, the van Rhijn system in 100 %, and the anatomy-based method (T1 a/b) in 72.3 % of cases. At a mean follow-up of 46 months, the recurrence-free survival rate was significantly better ( p  < 0.001) in the group that underwent reTUR, while none of the three substaging systems reliably predicted recurrences. The 1 mm did seem promising, however, as a threshold for predicting progression, reaching statistical significance in the Kaplan Meier estimates ( p  < 0.04). Conclusion Our study shows that micrometric substaging is feasible in this setting and should be extended to include any early reTUR to complete the substaging done after the first TURB. It can also provide helpful prognostic information.

The paper addresses issues related to the citrus waste valorisation process and its inherent uncertainties from the perspective of a new and innovative firm. Thus, we investigate the relevance/role of a business plan analysis in developing a new business (new biobased value chains) in the case of citrus waste valorisation. We look primarily at the inherent uncertainty associated with the start-up phase of a new business aimed at producing and wholesaling semi-finished products derived from the recovery of citrus waste in southern Italy. In order to do so, we use a qualitative case study approach focusing on a small citrus waste valorisation firm located in Calabria, using Agro Management Development (AMD) as a unit of analysis. The choice of this research setting is not random, given the fact that many companies from the Mediterranean are trying to engage in activities to valorise citrus waste deriving from production value chains. The main findings of our analysis can be summarized as follows: (i) focusing primarily on one area of uncertainty (i.e., market uncertainty) might undermine chances of success, as it could indicate an incomplete business strategy to stakeholders, hence hindering their willingness to commit to a new entrepreneurial initiative; (ii) although a business plan could be an effective way to narrow down uncertainty for a new innovative firm, it should be properly customised in order to address all relevant dimensions of uncertainty. Indeed, an insufficiently developed plan might be counterproductive, revealing (for instance, to possible investors) an inadequate strategy for facing and solving emerging problems, therefore putting the whole business project at risk.

Purpose Complete pulmonary vein isolation (PVI) is the best documented target for catheter ablation, and different technologies have shown comparable outcomes. The multielectrode phased-RF/duty cycled (PhRF/DC) pulmonary vein ablation catheter (PVAC) and its second generation (PVAC-GOLD) have shown promising clinical results in single and multicenter experiences. Our aim is to assess and compare the safety and efficacy in the real clinical practice among two generations of circular PhRF/DC catheters by performing PVI in patients suffering from recurrent atrial fibrillation (AF). Methods Eighty-four AF patients treated with PVAC and 64 with PVAC-GOLD were prospectively followed in five Italian cardiology centers in the mainframe of the 1STOP-ClinicalService project. Results Fluoroscopic and total procedure time were significantly different in the two groups. In particular, in the PVAC-GOLD group, the mean fluoroscopic time was 22.8 ± 12.7 min vs 31.6 ± 18.9 in the PVAC group ( p  = 0.002), and the mean total procedure duration was 117.6 ± 36.0 vs 147.4 ± 40.6, in the PVAC-GOLD group and the PVAC group, respectively ( p  = 0.001). Only two out of 148 patients reported a peri-procedural complication. Over 20.9 ± 12.0 months of follow-up, AF recurrence occurred in 58 patients. Kaplan-Meier freedom from AF recurrence did not differ between the two groups (64.1 ± 10% in the PVAC group vs 68.2 ± 9% in the PVAC-GOLD group at 1 year, p  = ns). Conclusions In our multicenter analysis, AF ablation using two generations of circular PhRF/DC catheters is safe and effective. No difference was observed in terms of safety and efficacy of the AF ablation between the two catheters, with the mean procedural time being shorter in the PVAC-GOLD group.

Razionale. Nonostante le linee guida internazionali raccomandino target sempre più bassi di colesterolo legato alle lipoproteine a bassa densità (C-LDL), l’esperienza quotidiana mostra che molti pazienti non riescono a raggiungerli, esponendosi a un rischio cardiovascolare residuo significativo. Clear Pathway – il trattamento del paziente dislipidemico al centro – nasce per colmare questo divario, valorizzando l’uso integrato di farmaci ipolipemizzanti orali. Materiali e metodi. Nel progetto Clear Pathway, un panel di cardiologi ospedalieri ha applicato una metodologia mini-Delphi in due round per valutare 20 statement relativi alla terapia ipolipemizzante e suddivisi in tre aree tematiche: strategie di combinazione orale e a dose fissa; uso della distanza dal target di C-LDL per guidare le scelte; personalizzazione in base a profili clinici. Ogni affermazione è stata votata su scala Likert 1-5, approvata se media ≥4.0. Le affermazioni non approvate al primo turno sono state riformulate e riproposte.Risultati. Al primo round 17 dei 20 statement hanno superato la soglia di consenso e sono stati approvati senza modifiche. I tre statement non approvati (intensificazione precoce nei pazienti post-sindrome coronarica acuta con C-LDL <140 mg/dl, uso di acido bempedoico in pazienti sottoposti ad angioplastica elettiva ed in quelli con ictus) sono stati brevemente riformulati e ripresentati in un secondo round, superando anch’essi la soglia di approvazione. Conclusioni. Le raccomandazioni di Clear Pathway delineano un modello di cura della dislipidemia basato su terapie orali integrate, con un ruolo chiave per l’acido bempedoico. L’adozione di questi indirizzi è destinata a migliorare l’aderenza, ottimizzare il raggiungimento dei target di C-LDL e ridurre l’incidenza di eventi cardiovascolari nella pratica clinica quotidiana.