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Vanhees L.,Catholic University of Leuven | Rauch B.,Center for Ambulatory Cardiac and Angiologic Rehabilitation | Piepoli M.,Guglielmo da Saliceto Hospital | Van Buuren F.,Ruhr University Bochum | And 6 more authors.
European Journal of Preventive Cardiology | Year: 2012

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity, cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training - frequency, intensity, time (duration), type (mode), and volume (dose: intensity × duration) of exercise - are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding frequency, intensity, time and type of PA, and safety aspects during exercise in patients with cardiovascular disease. This paper is the third in a series of three papers, all devoted to the same theme: the importance of the exercise characteristics in the management of cardiovascular health. Part I is directed to the general population and Part II to individuals with cardiovascular risk factors. In general, PA recommendations and exercise training programmes for patients with coronary artery disease or chronic heart failure need to be tailored to the individual's exercise capacity and risk profile, with the aim to reach and maintain the individually highest fitness level possible and to perform endurance exercise training 30-60 min daily (3-5 days per week) in combination with resistance training 2-3 times a week. Because of the frequently reported dose-response relationship between training effect and exercise intensity, one should seek sufficiently high training intensities, although more scientific evidence on effect sizes and safety is warranted. At present, there is insufficient data to give more specific recommendations on type, dosage, and intensity of exercise in some other cardiovascular diseases, such as congenital heart disease, valve disease, cardiomyopathies, channelopathies, and patients with implanted devices. © 2011 The European Society of Cardiology.

Cuda D.,Guglielmo da Saliceto Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Objective: To describe a simple technique for pediatric cochlear implant receiver-stimulators (R/S) fixation and long term results with it. Methods: Clinical sample include thirty-two children with severe-to-profound or profound hearing loss candidate for cochlear implantation. Low-profile devices were used (Med El Concerto© and Nucleus CI512©). The R/S was housed into a tight subperiosteal pocket carefully dissected behind the mastoidectomy. The pocket was closed with a single periosteal to bone suture around the posterior edge of mastoidectomy. No skull drilling was required for housing the device. Results: No intraoperative complications have been observed. 20% of operating time was saved. No migration of R/S over time was apparent at follow up. Conclusions: The back-pocket technique seems effective in retaining the CI package and in optimizing surgical time and safety in pediatric cochlear implantation. It seems particularly suitable with new generation low profile CI devices. © 2013 Elsevier Ireland Ltd.

A commercially available technique named "NAVIGATOR" (Esaote, Italy) easily enables a 3-D reconstruction of a single 2-D acquisition of Contrast Enhanced Ultrasound (CEUS) imaging of the whole liver (with a volumetric correction thanks to the electromagnetic device of NAVIGATOR). Aim of the study was to evaluate this "panoramic" technique in comparison with conventional US and spiral CT in the detection of new hepatic lesions. 144 cirrhotic patients (previously treated for hepato cellular carcinoma (HCC)) in follow-up with detection of 98 new nodules (N), 28 multinodular (Nmulti), 14 loco-regional regrowth (LR) 94 efficaciously treated without new nodules (neg) and four multinodular without new nodules, were submitted to 200 examinations with this new technique from November 2008 to November 2009. 3DNavCEUS was performed using SonoVue (Bracco), as contrast agent, and a machine (Technos MPX, Esaote). Spiral CT and 3DNav CEUS were performed in the same month during follow up. Sens.,Spec.,diagn.-Acc.,PPV and NPV were evaluated; comparison and differences between the techniques were obtained with chi-square (SPSS release-15). Final diagnosis was: 98 new lesions (N) (one to three), 28 multinodular HCC (Nmulti) and 14 loco-regional regrowth (LR); in 94 no more lesions were observed during follow-up; conventional US obtained: 58 N (+18 multinodularN and 8 LR), 40 false negative (+10 Nmulti and 6 LR) (sens:59.2, spec:100%, Diagn Accur:73.6, PPV:100; NPV:70.1); spiral CT obtained: 84N (+26-multinodularN and 14-LR), 14 false-negative (+2-Nmulti), and one false-positive (sens:85.7, spec:97.9%, Diagn Accur:90.9, PPV:97.7; NPV:86.8); 3DNAV obtained: 92N (+28 multinodularN and 14LR), 6 false-negative, and two falsepositives (sens:93.9, spec:97.9%, Diagn Accur:95.6, PPV:97.9; NPV:93.9). 3-DNav CEUS is significantly better than US and almost similar to spiral CT for detection of new HCC. This technique, in particular, showed the presence of lesions even in the cases not detected with spiral CT. © 2011 by the authors; licensee MDPI, Basel, Switzerland.

Biasucci G.,Guglielmo da Saliceto Hospital | Rubini M.,Guglielmo da Saliceto Hospital | Riboni S.,Guglielmo da Saliceto Hospital | Morelli L.,Catholic University of the Sacred Heart | And 2 more authors.
Early Human Development | Year: 2010

The first colonisation of the intestine is one of the most profound immunological exposures faced by the newborn and it is influenced by external and internal factors. The early composition of human microbiota could have long-lasting metabolic effects and the initial composition of human intestinal bacteria is also known to affect postnatal immune system development, as we are already aware that reduced microbial stimulation during infancy would result in slower postnatal maturation of the immune system and development of an optimal balance between TH1 and TH2-like immunity. Mode of delivery has a major role on the composition of intestinal microbiota in early infancy, as it has been shown that infants born by Caesarean section (CS) have lower numbers of Bifidobacteria and Bacteroides compared with vaginally born infants.We designed a study to investigate the influence of mode of delivery (CS vs. vaginal delivery) on intestinal microbial composition on day 3 of life using PCR-denaturing gradient gel electrophoresis (DGGE) and PCR-temperature gradient gel electrophoresis (TGGE). Both DGGE and TGGE analyses have been used, together with the specific amplifications for 10 Bifidobacterium sp., 3 Ruminococcus sp., and Bacteroides that all have a highly relevant physiological role in the intestinal ecosystem of the newborn.A total of 46 term infants were enrolled in the study, consecutively recruiting all the CS-delivered babies (n = 23; 8 males and 15 females) and the immediately following spontaneously delivered babies (n = 23; 11 males and 12 females). DGGE analysis carried out with Bifidobacterium-specific primers revealed the presence of this genus in 13 of 23 (56.5%) samples derived from vaginally delivered newborns but in none of the samples obtained from newborns delivered by CS. PCR analysis with Bifidobacterium-species-specific primers showed that naturally delivered infants had a large number of bifidobacterial species, whereas in CS-delivered babies only two samples (8.7%) gave positive results, one for B. longum and another for B. gallicum. In all babies enrolled, micro-organisms belonging to Ruminococcus species were absent and Bacteroides was found in 8.7% of spontaneously delivered babies only.Based on our findings, it seems that newborn's intestinal bacteria during the first 3. days of life are strongly influenced by mode of delivery. The intestinal flora of CS and vaginally delivered infants appears to be very different; the former being altered and characterised by a substantial absence of Bifidobacteria sp., the latter characterised by subject-specific microbial profiles, although predominant groups such as B. longum and B. catenulatum could be identified.In summary, mode of delivery does affect the early stage of intestinal bacterial colonisation, which is altered in CS-delivered infants compared with vaginally delivered infants, with only a minor influence of the type of feeding. In addition, the importance of methodological aspects for determining intestinal microbiota in clinical trials requires emphasis if intestinal microbiota composition is to be considered a measure of postnatal adaptation. © 2010 Elsevier Ltd.

Maniscalco P.,Guglielmo da Saliceto Hospital | Pizzoli A.L.,C Poma Hospital | Brivio L.R.,C Poma Hospital | Caforio M.,Guglielmo da Saliceto Hospital
Injury | Year: 2014

The authors report their experience of treating complex elbow fracture-dislocations in elderly people, using a minimally-invasive approach with a new articulated external fixator that is associated with minimal internal fixation. The clinical results for 19 patients are presented according to outcome factors, such as range of motion, pain and function, rate and type of complications, and reoperation rate. The results indicate that this treatment strategy should be considered as a good alternative to other treatment options reported in the literature, including conservative treatment, ORIF with angular stable plates and total elbow arthroplasty. © 2014 Elsevier Ltd. All rights reserved.

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