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Takotsubo cardiomyopathy typically presents in menopausal women following episodes of intense physical or mental stress. To our knowledge, the literature contains only two documented cases of Takotsubo cardiomyopathy arising following a suicide attempt, neither of which involved pharmaceutical poisoning. Here, however, we document the case of a young male patient with borderline personality disorder and a clinical and angiographic presentation compatible with Takotsubo cardiomyopathy arising following a suicide attempt by voluntary drug intoxication (risperidone, barbiturates, and benzodiazepine). The potential pathophysiological mechanisms behind this unusual clinical picture are discussed.

To date, infertility affects 10% to 15% of couples worldwide. A male factor is estimated to account for up to 50% of cases. Oral supplementation with antioxidants could be helpful to improve sperm quality by reducing oxidative damage. At the same time, there is a growing interest in the literature on the use of testicular sperm in patients with high DNA fragmentation index (DFI). This narrative review aims to evaluate the effectiveness of supplementation of oral antioxidants in infertile men with high DFI compared to testicular sperm retrieval. The current evidence is non-conclusive because of serious risk of bias due to small sample sizes and statistical methods. Further large well-designed randomised placebo-controlled trials are still required to clarify the exact role of these to different therapeutic approaches.

This paper aims to demystify a lot of misconceptions still widely circulating today about the alleged properties of blockchain and then illustrate the real opportunities that this technology offers for “food system” and how it must be correctly implemented for it to be truly useful, for producers and consumers, particularly in the agrifood sector. The concepts of blockchain opportunities and incompleteness of agri-food chain projects based on blockchain technology are then explained, setting out the minimum and necessary characteristics required to make the use of this technology useful and effective (Minimum Viable Ecosystem). The process governance levels for the development and maintenance of a blockchain traceability project are then illustrated, focusing on the role and responsibility of each player in the supply chain. Finally, the structure of a blockchain solution is described, focusing on a number of structural and technological solutions by outlining the concepts of consistency checking for the validation of input data with appropriate smart contracts, and of information frameworks for the subsequent scrutiny of data in audit operations and the assignment of levels of reliability. These are essential prerequisites for a collaborative blockchain data management to pursue the objective of actual reliability and transparency of information.

Abstract Cardiopulmonary exercise test (CPET) is a functional assessment that helps to detect disorders affecting the system involved in oxygen transport and utilization through the analysis of the gas exchange during exercise. The clinical application of CPET is various, it including training prescription, evaluation of treatment efficacy and outcome prediction in a broad spectrum of conditions. Furthermore, in patients with shortness of breath it provides pivotal information to bring out an accurate differential diagnosis between physical deconditioning, cardiopulmonary disease and muscular diseases. Modern software allows the breath-by-breath analysis of the volume of oxygen intake (VO2), volume of carbon dioxide output (VCO2) and expired air (VE). Through this analysis, CPET provides a series of additional parameters (peak VO2, ventilatory threshold, VE/VCO2 slope, end-tidal carbon dioxide exhaled) that characterize different patterns, helping in diagnosis process. Limitations to the routine use of CPET are mainly represented from the lack of measurement standardization and limited data from randomized multicentric studies. The integration of CPET with exercise stress echocardiography has been recently introduced in the clinical practice by integrating the diagnostic power offered by both the tools. This combined approach has been demonstrated to be valuable for diagnosing several cardiac diseases, including heart failure with preserved or reduced ejection fraction, cardiomyopathies, pulmonary arterial hypertension, valvular heart disease and coronary artery disease. Future investigations are needed to further promote this intriguing combination in the clinical and research setting.

Persistent dyspnoea during daily activities is commonly observed in patient with chronic heart failure (CHF) despite optimised pharmacological therapy. In CHF patients diuretics are essential for symptomatic treatment when fluid overloads with consequent pulmonary congestion or peripheral oedema. Appropriate use of diuretics is key element versus other drugs used for the success of the treatment of HF. Conversely, the inappropriate use of high doses of diuretics can cause adverse effects as electrolyte and fluid depletion, hypotension and hyperazotemia. Dyspnoea and fatigue, in patients with stable HF, are not related only to fluid overload and/or fluid retention but likely other mechanisms are linked to symptoms increase. These patients at the end of a rehabilitative treatment take less diuretic doses than during the period before the rehabilitative treatment, so reducing the principal adverse effects and improving the symptoms. In these patients in absence of venous congestion but in presence of an increase of symptoms augmenting diuretic drugs is not useful: it is very useful, instead, to undergo these patients a rehabilitative treatment because other mechanisms are linked to symptoms increase. In fact, in our report the predominant mechanism determining the increase in dyspnoea is likely related to an increase in physiological dead space.