Considerazioni condivise alla luce delle recenti novità nell’ambito dello scompenso cardiaco: ottimizzazione della gestione del paziente con scompenso cardiaco in medicina interna - Dal ricovero al follow-up

Nuova classificazione dello scompenso cardiaco: ridenominazione di Heart failure with mid-range ejection fraction in Heart failure with mildly reduced ejection fraction (HFmrEF), con raccomandazioni terapeutiche più precise in questa fascia di pazienti Il nuovo algoritmo per il trattamento dello scompenso cardiaco a frazione di eiezione ridotta: Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for Heart Failure Ottimizzazione della terapia: l’ospedalizzazione come opportunità. Impiego precoce di sacubitril/valsartan nel paziente ospedalizzato, stabilizzato. Effetti sulla riduzione della mortalità e delle re-ospedalizzazioni. Effetti sul rimodellamento cardiaco. Effetti sulla QoL Sicurezza dell’uso di sacubitril/valsartan anche in presenza di comorbidità e gestione dell’ipotensione Intervento di ottimizzazione della terapia anche nel paziente con scompenso cardiaco cronico ricoverato per altra patologia acuta Terapia delle comorbidità - non cardiovascolari: diabete, iperkaliemia, carenza di ferro e cancro Terapia non farmacologica ed educazione/formazione del paziente e del caregiver Gestione post-ricovero dello scompenso cardiaco: l’ambulatorio divisionale e la rete territoriale

Group II intron and repeat-rich red algal mitochondrial genomes demonstrate the dynamic recent history of autocatalytic RNAs

Background Group II introns are mobile genetic elements that can insert at specific target sequences, however, their origins are often challenging to reconstruct because of rapid sequence decay following invasion and spread into different sites. To advance understanding of group II intron spread, we studied the intron-rich mitochondrial genome (mitogenome) in the unicellular red alga, Porphyridium. Results Analysis of mitogenomes in three closely related species in this genus revealed they were 3–6-fold larger in size (56–132 kbp) than in other red algae, that have genomes of size 21–43 kbp. This discrepancy is explained by two factors, group II intron invasion and expansion of repeated sequences in large intergenic regions. Phylogenetic analysis demonstrates that many mitogenome group II intron families are specific to Porphyridium, whereas others are closely related to sequences in fungi and in the red alga-derived plastids of stramenopiles. Network analysis of intron-encoded proteins (IEPs) shows a clear link between plastid and mitochondrial IEPs in distantly related species, with both groups associated with prokaryotic sequences. Conclusion Our analysis of group II introns in Porphyridium mitogenomes demonstrates the dynamic nature of group II intron evolution, strongly supports the lateral movement of group II introns among diverse eukaryotes, and reveals their ability to proliferate, once integrated in mitochondrial DNA.

Comparison between single-dose suxamethonium and rocuronium after pretreatment with dexmedetomidine in rapid sequence induction

Background Rapid sequence induction is a well-established anesthetic procedure used in patients with a high risk of gastric aspiration. Suxamethonium has been the drug of choice; however, it carries potential risks and sometimes fatal outcomes. The aim of our study was to compare rocuronium after pretreatment with dexmedetomidine, to suxamethonium in providing excellent intubating conditions in rapid sequence induction in adults. Patients were randomly allocated to one of two groups, of 120 each. Control group (SS), patients received pretreatment with 10 ml 0.9% saline over 10 min and suxamethonium 1mg/kg. Experimental group (DR), received pretreatment with dexmedetomidine 1 μg/kg in 10 ml 0.9% saline over 10 min and rocuronium 0.6 mg/kg. Our primary endpoint was the number of patients who scored “excellent” on intubation conditions score, while secondary outcomes were hemodynamics and adverse events. Results The rate of excellent intubating conditions in the DR group 46% was insignificantly less (P value = 0.548) than that of the SS group 49% (relative risk (RR) of DR compared to SS = 1.04, with a confidence interval (CI) of 0.91–1.48. The percentage of patients with adverse events in the SS group was (30%) nearly more than twofold higher than that of the DR group (11%). A significant difference (P value = 0.016) in the incidence of excellent intubating conditions was higher in the female gender 59% compared to the male gender 38% (adjusted RR = 0.98, with a confidence interval of 0.79–1.1). Conclusion A combination of dexmedetomidine 1μg/kg and standard intubating dose of rocuronium 0.6 mg/kg provided comparable endotracheal intubation conditions to suxamethonium 1 mg/kg during RSI and might be used as an alternative to suxamethonium in situations where suxamethonium is contraindicated. Trial registration ClinicalTrials.gov Identifier: NCT04709315