Luca Bastiani

Background: Heart rate variability (HRV) monitoring during real-world closed-circuit rebreather (CCR) diving remains methodologically challenging. This exploratory case report describes phase-related HRV variations obtained from a wearable device during a military CCR dive. Methods: A trained male military diver underwent continuous monitoring with a RootiRx^® single-lead wearable device placed in a custom waterproof enclosure. Three consecutive 20 min segments were analyzed: pre-dive, CCR dive, and immediate post-dive. The post-dive segment was not acquired under standardized resting conditions, and the participant continued to wear the device throughout this period. RR interval data were analyzed using Kubios HRV Scientific 4.3.0 with medium-threshold artifact correction, smoothness-prior detrending (λ = 500), and 4 Hz interpolation. Time-domain, frequency-domain, and nonlinear HRV indices were evaluated descriptively. Results: Mean heart rate was 88.1 beats/min pre-dive, 102.8 beats/min during the dive, and 86.4 beats/min post-dive. SDNN values were 35.3, 29.9, and 49.2 ms, while RMSSD values were 29.7, 24.6, and 40.3 ms, respectively. The PNS index was −1.44, −2.08, and −1.10, and the SNS index was 1.66, 2.98, and 1.26 across the three phases. LF/HF values were 1.77, 1.46, and 3.92, respectively. Automatically corrected beats represented approximately 0.34%, 0.54%, and 0.46% of beats, with effective analyzable data proportions exceeding 99.7% in all three segments. Conclusions: An analyzable RR interval series was obtained across the three operational phases in this individual recording. However, the single-subject uncontrolled design, non-standardized recording conditions, multiple confounding factors, and absence of independent underwater validation prevent causal attribution of the observed differences to immersion, CCR exposure, or autonomic adaptation. Further controlled studies using validated underwater ECG systems are required.

Executive functions (EFs) are a set of higher-order cognitive processes that regulate fundamental, domain-specific neuropsychological functions, such as language, visuospatial processing, and memor...

Objective: To evaluate early and mid-term outcomes of thoracic endovascular aortic repair (TEVAR) using the Castor single-branched aortic stent graft in a real-world multicenter Italian experience. Methods: This retrospective, nonrandomized, multicenter study included all consecutive patients treated with the Castor stent graft between January 2019 and April 2025 in eight Italian centers. The device was used in patients with thoracic aortic pathologies requiring TEVAR in proximal landing zones 1 or 2. Primary endpoints included technical success, intraoperative major adverse events (MAEs), and deployment accuracy. Secondary endpoints were aortic-related mortality, neurological complications, reinterventions, and endoleaks. Results: Fifty-one patients (mean age 68.8 ± 8 years, 75.5% male) were treated, primarily for type B aortic dissection (45.1%) and thoracic aortic aneurysm (27.5%). Proximal landing was in zone 2 in 92.1% and zone 1 in 7.8% of cases. The technical success rate was 94.1%, with three cases (5.8%) of intraoperative type Ia endoleak. No intraoperative deaths or major adverse events occurred. Two cases of minor embolic stroke (3.9%) were observed, both in zone 1 procedures involving left common carotid artery revascularization. At a median follow-up of 22.3 months (range 2–58), no additional endoleaks or neurological events were reported, with 100% branch patency rate. Conclusions: The Castor single-branched stent graft is a feasible option for TEVAR in zone 2, with high technical success and low rates of neurological complications. Accurate case selection and procedural planning are essential.

Background: New-onset postoperative atrial fibrillation (NOAF) is the most prevalent arrythmia after cardiac surgery with a significant clinical and economic impact. Therefore, simple and practical biomarkers for NOAF prediction remain a clinical priority. Increasing evidence indicates that malnutrition is linked to postoperative complications, including the onset of atrial fibrillation. The Prognostic Nutritional Index (PNI), which reflects the immunonutritional and inflammatory status through serum albumin concentration and lymphocyte count, has emerged as a reliable prognostic indicator in cardiovascular disease. The present study aimed to investigate the association between PNI and the development of NOAF in patients undergoing surgical aortic valve replacement (SAVR). Methods: A total of 241 consecutive patients who underwent AVR for severe aortic stenosis or regurgitation were enrolled in this study. The population was stratified into two groups according to the development of NOAF (NOAF group) or the lack thereof (no NOAF group). Results: In both univariate and multivariate logistic regression analyses adjusted for several established NOAF determinants, age and PNI, both as continuous variables, were independently associated with NOAF in both univariate (OR = 1.03; CI 95% = 1.01–1.06, p = 0.009, and OR = 0.9; CI 95% = 0.8–0.9, p = 0.01, respectively) and multivariate models (OR = 1.02; CI 95% = 1.01–1.06, p = 0.05, and OR = 0.9; CI 95% = 0.8–0.9, p = 0.03, respectively). When PNI was analyzed by tertiles, patients in the lowest tertile (PNI < 41.5) showed a significantly higher risk of developing NOAF at both univariate (OR = 1.9; CI 95% = 1.2–2.8, p = 0.004) and multivariate analysis (OR = 1.6; CI 95% = 1–2.6, p = 0.03), whereas age lost statistical significance (OR = 1.0; 95% CI = 0.9–1.05; p = 0.06). Furthermore, when the study population was divided into two groups based on the median age (70 years), PNI values differed significantly between NOAF and no NOAF patients only in patients under 70 years (p = 0.01). In this younger subgroup, PNI remained an independent predictor of NOAF, both when considered as a continuous variable (OR = 0.86; CI 95% = 0.74–0.98, p = 0.02), and nominal variable (PNI < 41.5, OR = 0.88; CI 95% = 0.80–0.97, p = 0.01). Conclusions: Overall, these findings identify PNI as an independent predictor of NOAF following SAVR, particularly in patients younger than 70 years. This study underlines the potential clinical value of preoperative nutritional assessment for risk stratification. Incorporating nutritional parameters such as PNI into current predictive models may enhance the accuracy of prognostic evaluation and support targeted perioperative management strategies.

Background/Objectives: Swallowing and speech rely on shared brainstem circuits coordinating oropharyngeal motor functions. In neurodegenerative diseases affecting the brainstem—such as progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA)—bulbar dysfunction often impairs tongue propulsion and motility, affecting both swallowing (dysphagia) and phonation (dysarthria). This study aimed to investigate whether vowel-based acoustic features are associated with swallowing severity in brainstem-related disorders and to explore their potential as surrogate markers of bulbar involvement. Methods: This was a cross-sectional observational study. Thirty-one patients (13 PSP, 12 ALS, 6 MSA) underwent clinical dysarthria assessment, acoustic analysis of the first (F1) and second (F2) formants during sustained phonation of /a/, /i/, /e/, and /u/, and swallowing evaluation using standardized clinical scales (DOSS, FOIS, ASHA-NOMS) and fiberoptic endoscopic evaluation (Pooling Score, Penetration-Aspiration Scale). The vowel space area (tVSA, qVSA) and Formant Centralization Ratio (FCR) were computed. Results: Significant correlations emerged between acoustic vowel metrics and dysphagia severity, especially for liquids. The FCR showed strong correlations with DOSS (ρ = −0.660, p < 0.0001), FOIS (ρ = −0.531, p = 0.002), ASHA-NOMS (ρ = −0.604, p < 0.0001), and instrumental scores for liquids: the Pooling Score (ρ = 0.538, p = 0.002) and PAS (ρ = 0.630, p < 0.0001). VSA measures were also associated significantly with liquid swallowing impairment. F2u correlated with dysarthria severity and all liquid-related dysphagia scores. Conclusions: Vowel-based acoustic parameters, particularly FCR and F2u, reflect the shared neuromotor substrate of articulation and swallowing. Acoustic analysis may support early detection and monitoring of bulbar dysfunction, especially where instrumental assessments are limited.

Background/Objectives: Myocarditis can occur in patients with coronavirus disease 2019 (COVID-19) as part of the systemic involvement of this infectious syndrome. The persistence of this non-ischemic late gadolinium enhancement (LGE) pattern can be considered an indicator of ongoing myocardial involvement or a sequela of myocarditis. We aimed to assess the effects of LGE on cardiac function and morphology in patients with COVID-19 admitted in intensive care unit for acute respiratory distress syndrome. Methods: Fifty patients (age 59 ± 11, female n = 15) were enrolled. Results: The prevalence of LGE was 33.3%. LGE was present in the lateral wall in all patients except for one, with LGE positivity at the interventricular septum. In general, patients with and without LGE had similar CMR variables values. In one case, LGE was associated with regional wall motion abnormality. The factor associated with LGE was the duration of hospitalization (7.97 ± 3.8 and 12.5 ± 6.7 days in patients without and with LGE, p = 0.007). Conclusions: LGE non-ischemic pattern was not associated with left ventricular dilatation or dysfunction or remodeling in patients with severe clinical manifestation of COVID-19. LGE is mainly present in patients with more prolonged duration of hospitalization. LGE may represent a residual scar with limited prognostic impact that larger multicenter studies could confirm.

Background: Elderly patients with severe aortic stenosis (AS) need individualized decision-making in their management in order to benefit in terms of survival and improvement of quality of life. Frailty, a common condition in elderly patients, needs to be considered when weighing treatment options. Aim: We aimed to evaluate outcomes including survival and functional parameters according to disability criteria at six years of follow-up in an older population treated for severe AS using a frailty-based management. Methods: We evaluated data derived from a pilot clinical project involving elderly patients with severe AS referred to a tailored management based on classification by Fried’s score into pre-frail, early frail, and frail and a multidimensional geriatric assessment. A Frailty, Inflammation, Malnutrition, and Sarcopenia (FIMS) score was used to predict the risk of mortality at six years of follow-up. Functional status was evaluated by telephonic interview. Results: At six years of follow-up, we found a survival rate of 40%. It was higher in the pre-frail patients (long rank < 0.001) and in the patients who underwent TAVR treatment (long rank < 0.001). The cut-off FIMS score value of ≥1.28 was an independent determinant associated with a higher risk of mortality at six years of follow-up (HR 2.91; CI 95% 1.7–5.1; p-value 0.001). We found a moderate increase of disability levels, malnutrition status, comorbidities, and number of drugs, but none of them self-reported advanced NYHA class III–IV heart failure. Conclusion: An accurate clinical–instrumental and functional geriatric evaluation in an elderly population with AS is required for a non-futile interventional treatment in terms of survival and functional status even in long-term follow-up.

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.

Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for “frailty-based management” of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; p = 0.007), and death (41.9% vs. 12.8%; p < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3–10.7; p = 0.01) and hospital readmission (OR: 3.6 CI 1.1–11.6; p = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04–6.74; p-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.

Background: Well-being encompasses physical, mental, social, and cultural aspects. Sleep quality and pathologies are among the objective conditions jeopardising it. Chronic insomnia, inflammatory-based diseases, and mood disorders often occur in a single cluster, and inflammation can negatively impact sleep, potentially harming well-being. Some evidence from specific clinical populations suggests that also some resolved past diseases could still have an impact on present sleep quality and well-being. The aim of the present study is to investigate, in the general population, whether and to what degree well-being and insomnia are associated with resolved pathologies. Methods: A cross-sectional survey (IPSAD^®) was carried out using anonymous postal questionnaires that investigated past and present general health, well-being, and insomnia. A total of 10,467 subjects answered the questionnaire. Results: Several classes of both current and resolved pathologies resulted in increased odds ratios for current insomnia (odds ratios = 1.90; 1.43, respectively) and impaired well-being (odds ratios = 1.75; 1.33, respectively), proportional to the number of the displayed pathologies. Notably, both current and resolved past psychiatric disorders were strongly associated with both current impaired well-being (odds ratios = 5.38; 1.70, respectively) and insomnia (odds ratios = 4.99; 2.15, respectively). Conclusions: To explain these associations, we suggest that systemic inflammation conveyed by several medical conditions disrupts homeostatic processes, with final effects on sleep quality and behaviour.