Telemedicine in chronic diseases like heart failure is rapidly evolving and has two important goals: improving and individualising care as well as reducing costs. In this paper, we provide a critical ...and an updated review of the current evidence by discussing the most important trials, meta-analyses and systematic reviews. So far, evidence for the CardioMEMS device is most convincing. Other trials regarding invasive and non-invasive telemonitoring and telephone support show divergent results, but several meta-analyses and systematic reviews uniformly reported a beneficial effect. Voice-over systems and ECG monitoring had neutral results. Lack of direct comparison between different modalities makes it impossible to determine the most effective method. Dutch studies showed predominantly non-significant results, mainly due to underpowered studies or because of a high standard of usual care. There are no conclusive results on cost-effectiveness of telemedicine because of the above shortcomings. The adherence of elderly patients was good in the trials, being essential for the compliance of telemedicine in the entire heart failure population. In the future perspective, telemedicine should be better standardised and evolve to be more than an addition to standard care to improve care and reduce costs.
Summary
Endothelial cell (EC) apoptosis seems to play an important role in the pathophysiology of pulmonary arterial hypertension (PAH). We aimed to test the hypothesis that circulating ...anti‐endothelial cell antibodies (AECA) of PAH patients induce EC apoptosis. Immunoglobulin (Ig)G was purified from sera of PAH patients (n = 26), patients with systemic lupus erythematosus (SLE) nephritis without PAH (n = 16), patients with systemic sclerosis (SSc) without PAH (n = 58) and healthy controls (n = 14). Human umbilical vein endothelial cells (HUVECs) were incubated with patient or healthy control IgG for 24 h. Thereafter, apoptosis was quantified by annexin A5 binding and hypoploid cell enumeration by flow cytometry. Furthermore, real‐time cell electronic sensing (RT–CES™) technology was used to monitor the effects of purified IgG from patient and healthy control IgG on HUVECs. As demonstrated previously, IgG of AECA‐positive SLE nephritis patients (n = 7) induced a higher percentage of apoptosis of HUVECs compared to IgG of AECA‐negative SLE nephritis patients and healthy controls. Furthermore, IgG of AECA‐positive SLE nephritis patients induced a marked decrease in cell index as assessed by RT–CES™ technology. IgG of AECA‐positive PAH patients (n = 12) and SSc patients (n = 13) did not alter the percentage of HUVEC apoptosis or cell index compared to IgG of AECA‐negative PAH and SSc patients and healthy controls. AECA‐positive PAH patients, in contrast to SLE nephritis patients, do not have circulating IgG AECA that enhances apoptosis of HUVECs in vitro. Further studies should focus on other mechanisms by which AECA may enhance EC apoptosis in PAH, such as antibody‐dependent cell‐mediated cytotoxicity.
Two hypotheses concerning mechanisms of weight gain and of blood pressure elevation in obesity were tested. The first hypothesis is that in human obesity sympathetic nervous system underactivity is ...present, as a metabolic basis for the obesity. The second hypothesis, attributable to Landsberg, is that sympathetic nervous activation occurs with chronic overeating, elevating blood pressure. These are not mutually exclusive hypotheses, since obesity is a heterogeneous disorder.
Whole body and regional sympathetic nervous system activity, in the kidneys and heart, was measured at rest using noradrenaline isotope dilution methodology in a total of 86 research voluteers in four different subject groups, in lean and in obese people who either did, or did not, have high blood pressure.
In the lean hypertensive patients, noradrenaline spillover for the whole body, and from the heart and kidneys was substantially higher than in the healthy lean volunteers. In normotensive obesity, the whole body noradrenaline spillover rate was normal, mean renal noradrenaline spillover was elevated (twice normal), and cardiac noradrenaline spillover reduced by approximately 50%. In obesity-related hypertension, there was elevation of renal noradrenaline spillover, comparable to that present in normotensive obese individuals but not accompanied by suppression of cardiac noradrenaline spillover, which was more than double that of normotensive obese individuals (P<0.05), and 25% higher than in healthy volunteers. There was a parallel elevation of heart rate in hypertensive obese individuals.
The sympathetic underactivity hypothesis of obesity causation now looks untenable, as based on measures of noradrenaline spillover, sympathetic nervous system activity was normal for the whole body and increased for the kidneys; the low sympathetic activity in the heart would have only a trifling impact on total energy balance. The increase in renal sympathetic activity in obesity may possibly be a necessary cause for the development of hypertension in obese individuals, although clearly not a sufficient cause, being present in both normotensive and hypertensive obese individuals. The discriminating feature of obesity-related hypertension was an absence of the suppression of the cardiac sympathetic outflow seen in normotensive obese individuals. Sympathetic nervous changes in obesity-related hypertension conformed rather closely to those expected from the Landsberg hypothesis.
The first operational tests of a low-cost, reconfigurable mini-array for cosmic rays are here reported. Such facility is intended mainly as an educational tool for master and PhD students, to carry ...out quantitative investigations in cosmic ray physics. Each detection module is based on a small scintillator tile, optically coupled to a Wavelength Shifter (WLS) bar and a Silicon photomultiplier for light collection and readout. An Arduino MEGA board is used for trigger, data acquisition and storage. GPS time stamping of the events is also provided. The tests carried out with a set of 30 detection modules, spread over an area of about 50 m2, are here reported. About 300k shower events were collected during a period of 13 days, with a trigger involving at least a three-fold coincidence between the modules. Individual rates of the modules, together with environmental data (pressure and temperature) were also measured along the acquisition period. Multiplicity distributions in stand-alone mode and in coincidence with an additional detector located some distance apart were extracted from the data. The dependence of the shower rate on the atmospheric pressure was also investigated.
Studies on new Eco-gas mixtures for Extreme Energy Events Project Bossini, E.; Abbrescia, M.; Avanzini, C. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
01/2023, Letnik:
1046
Journal Article
Recenzirano
The Extreme Energy Events (EEE) experiment, a joint project of the Centro Fermi and INFN Italian national research institutes, has a dual purpose: a scientific research program for measurements of ...the cosmic rays flux at ground level and an intense outreach and educational program with an active contribution of students and teachers in the construction and operation of the detectors in High Schools. The network counts 60 tracking detectors, each made by three Multigap Resistive Plate Chambers (MRPC), operated so far with a gas mixture composed by 98% C2H2F4 and 2% SF6. Given its high Global Warming Potential (GWP), the collaboration, since few years, started a R&D on alternative mixtures environmentally sustainable. Latest results on a C3H2F4 + He eco-friendly mixture are here presented.
After its successful campaign of measurements beyond the Polar Arctic Circle, the PolarquEEEst experiment measured the cosmic charged particle rate at sea level in a latitude interval between 35
∘
N ...and 82
∘
N. In this paper, these measurements are described and the corresponding results are discussed.
As short‐term cardiorespiratory adaptation to high altitude (HA) exposure has not yet been studied in children, we assessed acute mountain sickness (AMS), hypoxic ventilatory response (HVR) at rest ...and maximal exercise capacity (CPET) at low altitude (LA) and HA in pre‐pubertal children and their fathers. Twenty father–child pairs (11 ± 1 years and 44 ± 4 years) were tested at LA (450 m) and HA (3450 m) at days 1, 2, and 3 after fast ascent (HA1/2/3). HVR was measured at rest and CPET was performed on a cycle ergometer. AMS severity was mild to moderate with no differences between generations. HVR was higher in children than adults at LA and increased at HA similarly in both groups. Peak oxygen uptake (VO2peak) relative to body weight was similar in children and adults at LA and decreased significantly by 20% in both groups at HA; maximal heart rate did not change at HA in children while it decreased by 16% in adults (P < 0.001). Changes in HVR and VO2peak from LA to HA were correlated among the biological child–father pairs. In conclusion, cardiorespiratory adaptation to altitude seems to be at least partly hereditary. Even though children and their fathers lose similar fractions of aerobic capacity going to high altitude, the mechanisms might be different.
The Extreme Energy Events (EEE) ‘telescope’ is made by 3 Multigap Resistive Plate Chambers (MRPC), each with an active area of 158x82 cm2 in size. Each detector is part of a large network of about ...sixty telescopes spread over the Italian territory. Due to the good tracking capabilities (100 ps time resolution and cm2 spatial resolution) the EEE telescope can be used also as test station for large area detectors. The link between the EEE track and signals from the detector under test can be obtained by implementing a streaming DAQ with a common time reference between the two systems given by the GPS signal. The installation and first results of the cosmic muon test facility with the EEE MRPC telescope based on the low-cost, streaming-compatible 12 channels, 250MHz, 14 bits digitizer (INFN-WaveBoard or WB) developed by the JLAB12 Collaboration, is presented.
Experimental results from a dataset collected with a full-scale muon tomograph for the inspection of cargo containers were studied in a single scattering scenario with a multiparametric analysis ...based on the method of the Point Of Closest Approach (Poca). To search for high-Z materials, a 4
dm
3
Pb block was positioned inside the volume to be inspected, in order to quantitatively investigate the appearance of the Poca signal. Signal-to-noise ratio and significance of the Poca signal were investigated by means of mono-dimensional spectra of the Poca components, for different values of the scattering angle between the incoming and outgoing muon tracks and with different angle-dependent weights. A systematic scan of two-dimensional maps was also carried out, as a strategy to search for possible enhancements to the Poca signal. A comparison was also done between the results obtained from the two half-volumes, one containing the Pb block and one left empty, to take into account the response of the detector and some aspects of the Poca strategy.
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