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BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

Pelvic floor muscle (PFM) strength measurement provides useful information for the study of pelvic floor dysfunctions. Vaginal digital palpation, intravaginal pressure measurements, and the use of a dynamometric speculum represent currently available clinical methods for evaluating PFM strength. However, none of these methods provide a dynamic measurement of pelvic floor strength in multiple directions simultaneously. The aim of the present paper is to report the development and first measurement trial of a device that follows the vaginal canal morphology and is able to measure pelvic floor strength multidirectionally.

The in-beam PET is a novel PET application to image the β β β β + activity induced in biological tissues by hadronic therapeutic beams. Thanks to the correlation existing between beam-delivered dose profiles and beam-induced activity profiles, in vivo information about the effective ion paths can be extracted from the in-beam PET image. In-situ measurements, immediately after patient irradiation, are recommended in order to exploit the maximum statistics, by detecting the contribution provided by short lived isotopes. A compact, dedicated tomograph should then be developed for such an application, so as to be used in the treatment room.We have realized a small PET prototype in order to demonstrate the feasibility of such technique for the monitoring of proton therapy of ocular tumors at the CATANA facility (Catania, Italy). The DoPET (Dosimetry with a Positron Emission Tomograph) tomograph consists of two planar heads, with an active area of about 5 cm x 5 cm. Each head is made up of a squared position sensitive photomultiplier (Hamamatsu H8500) coupled to a matrix of the same size of LYSO scintillating crystals (2 mm × 2 mm × 18 mm pixel dimensions). Dedicated, compact electronic boards are used for the signal multiplexing, amplification and digitization. The distance between the pair can be set from 10 cm up to a maximum of about 20 cm.The validation of the prototype was performed using 62 MeV protons at the CATANA beam line and plastic phantoms. Different dose distributions have been delivered and a good correlation between the distal fall-off of the activity profiles and of the dose profiles was found, i.e., better than 2 mm along the beam direction.