The goal of this study was to measure arterial amino acid levels in patients with chronic heart failure (CHF), and relate them to left ventricular function and disease severity. Amino acids (AAs) play a crucial role for heart protein-energy metabolism. In heart failure, arterial AAs, which are the major determinant of AA uptake by the myocardium, are rarely measured. Forty-one subjects with clinically stable CHF (New York Heart Association (NYHA) class II to IV) were analyzed. After overnight fasting, blood samples from the radial artery were taken to measure AA concentrations. Calorie (KcalI), protein-, fat-, carbohydrate-intake, resting energy expenditure (REE), total daily energy expenditure (REE × 1.3), and cardiac right catheterization variables were all measured. Eight matched controls were compared for all measurements, with the exception of cardiac catheterization. Compared with controls, CHF patients had reduced arterial AA levels, of which both their number and reduced rates are related to Heart Failure (HF) severity. Arterial aspartic acid correlated with stroke volume index (r = 0.6263; p < 0.0001) and cardiac index (r = 0.4243; p = 0.0028). The value of arterial aspartic acid (µmol/L) multiplied by the cardiac index was associated with left ventricular ejection fraction (r = 0.3765; p = 0.0076). All NYHA groups had adequate protein intake (≥1.1 g/kg/day) and inadequate calorie intake (KcalI < REE × 1.3) was found only in class IV patients. This study showed that CHF patients had reduced arterial AA levels directly related to clinical disease severity and left ventricular dysfunction.

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Impacts• From 2008 to 2011, 11 human cases of Lyme Borreliosis were reported in the Verbano-Cusio-Ossola (VCO) province, north-eastern Piedmont, Italy.• The abundance and altitudinal distribution of ticks in VCO and B. burg dorferi s.l. in these vectors were examined. Phylogenetic analyses using ospC gene sequences were performed and 14 of 34 positive samples formed a clade with ospC reference sequences of human invasive strains.• The study supports the need for providing the right information to the institutions, physicians, forestry workers and visitors to adopt proper precautions during season at risk and to protect public health.

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IntroduzioneLa sempre più frequente affluenza ai reparti di cardiologia riabilitativa di pazienti complessi, anziani e con comorbilità di natura psichiatrica e problematicità psicologica suggerisce la necessità di affinare i modelli di screening dei casi che richiedono una presa in carico da parte dei servizi di psicologia. A questa esigenza fa riscontro la crescente competenza infermieristica nell'ambito della individuazione e gestione dei bisogni assistenziali del paziente.Come recita l'articolo 1 della cosiddetta legge Ossicini del 1989 sull'ordinamento della professione di psicologo: "La professione di psicologo comprende l'uso degli strumenti conoscitivi e di intervento per la prevenzione, la diagnosi, le attività di abilitazione-riabilitazione e di sostegno in ambito psicologico rivolte alla persona, al gruppo, agli organismi sociali e alle comunità. Comprende altresì le attività di sperimentazione, ricerca e didattica in tale ambito." (www.psy.it).Da parte sua, "L'infermiere collabora con i colleghi e gli altri operatori di cui riconosce e valorizza In Cardiovascular Rehabilitation the increasing inpatients complexity suggests the necessity to develop screening methods which allow to identify those patients that require a psychological intervention.Material and methods: A Psycho-Cardiological Schedule (PCS) was developed with the aim of detecting the critical situation indicators or the presence of psychological, social and cognitive problems. The PCS, compiled by a nurse or cardiologist in collaboration with a psychologist, allows to assess the need for a deeper psychological examination, clinical and/or with tests. Aim of the present study is to identify the convergence levels among the observational and anamnestic data of the PCS collected by a nurse and the clinical and/or test data of the psychological deeper assessment.Results: Among the 87 patients recruited in JanuaryFebruary 2010, 28 (aged 53.5±12.6, M=20, F=8) fulfilled the criteria for a deeper psychological examination: age <50, manifestation of psychological/behavioural problems, neuropsychological disorders, low adherence to prescriptions, inadequate disease knowledge/representation. From data comparisons emerged convergence levels with 100% concordance as to smoke habits and problems in social-family support. High convergence levels also resulted as to emotional and/or behavioural problems (92.8%) and inadequate adherence to prescriptions (89.3%). Lower levels of concordance (82.1%) emerged when considering disease knowledge/representation, issues specifically linked to cognition and subjective illness experience, not directly detectable from behaviour.Conclusions: our data confirm the synergic efficacy of the two evaluations: the Psycho-Cardiological Schedule reliably identifies the problematic macro-categories, mainly if they are characterized by behavioural indicators, which facilitate the detection. The psychological approach appears more suitable for better specifing macro-categories characteristics and for detecting critical aspects n...

Background:We aimed to investigate whether the assessment of functional capacity by the 6-minute walking test (6MWT) might improve the predictive ability of 2 validated clinical scores for risk stratification in heart failure (HF). Methods and Results:The Cardiac and Comorbid Conditions HF (3C-HF) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores were evaluated in 466 consecutive HF patients who completed a pre-discharge 6MWT. The 12-month event rate was 7.7%. Both the 2 scores and the 6MWT predicted all-cause mortality (all P<0.0001), with a hazard ratio of 2. 6MWTThe test was performed at pre-discharge according to a standardized procedure. 10 Briefly, subjects were asked to walk at their own maximal pace along a 35-m long, flat and straight hospital corridor. The test was symptom limited and supervised by a physical therapist. The distance covered during the test was recorded in meters. Statistical AnalysisComparisons between groups for continuous data were performed by using a t-test. Comparisons for categorical variables were carried out by using the Chi-squared test or Fisher's exact test when appropriate. The association between pairs of variables was assessed by using the Pearson's correlation coefficient.One-year survival curves were estimated by using the Kaplan-Meier method and compared by using the log-rank test after classifying the patients into 3 groups (high, medium and low risk) according to tertiles of the 3C-HF score.