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Background and Purpose: Public campaigns to increase stroke preparedness have been tested in different contexts, showing contradictory results. We evaluated the effectiveness of a stroke campaign, designed specifically for the Italian population in reducing prehospital delay., Methods: According to an SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial) design, the campaign was launched in 4 provinces in the northern part of the region Emilia Romagna at 3-month intervals in randomized sequence. The units of analysis were the patients admitted to hospital, with stroke and transient ischemic attack, over a time period of 15 months, beginning 3 months before the intervention was launched in the first province to allow for baseline data collection. The proportion of early arrivals (within 2 hours of symptom onset) was the primary outcome. Thrombolysis rate and some behavioral end points were the secondary outcomes. Data were analyzed using a fixed-effect model, adjusting for cluster and time trends., Results: We enrolled 1622 patients, 912 exposed and 710 nonexposed to the campaign. The proportion of early access was nonsignificantly lower in exposed patients (354 [38.8%] versus 315 [44.4%]; adjusted odds ratio, 0.81; 95% confidence interval, 0.60-1.08; P =0.15). As for secondary end points, an increase was found for stroke recognition, which approximated but did not reach statistical significance ( P =0.07)., Conclusions: Our campaign was not effective in reducing prehospital delay. Even if some limitations of the intervention, mainly in terms of duration, are taken into account, our study demonstrates that new communication strategies should be tested before large-scale implementation., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01881152., (© 2017 American Heart Association, Inc.)

Aims: This study aimed to assess the prevalence and electrophysiological features of ulnar entrapment neuropathy in patients with type 2 diabetes mellitus (DM)., Methods: Nerve conduction studies (NCS) were performed in a sample of consecutive diabetic patients aged 25-75 years, referred by the Diabetology Unit. NCS of the median, ulnar, radial, peroneal and sural nerves were performed on the non-dominant side. Median entrapment neuropathy at the wrist (MNW) and ulnar neuropathy at the elbow (UNE) and wrist (UNW) were diagnosed according to standard electrodiagnostic criteria., Results: Sixty-four patients were enrolled, 28 male (44%), average age 61, average DM duration 14.5 years. Polyneuropathy was diagnosed in 45 subjects (70%). UNE was detected in 22 patients (34%) (4 did not have polyneuropathy), in the abductor digiti minimi in 16, the first interosseus in 14 and in both in 8. UNW was detected in 7 (11%) subjects and MNW in 40 (63%). NCS alterations consistent with ulnar neuropathy were detected in a high proportion of patients (45%), suggesting that the ulnar nerve is very susceptible to focal entrapment in DM., Conclusions: Upper limb sensory and motor NCS, including motor conduction velocity across the elbow, should be considered in the staging of DM patients., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Clinical success of atrial fibrillation ablation depends on persistent transmurality of the lesions. Although bipolar radiofrequency grants acute pulmonary vein isolation, the fate of such ablations in the clinical setting is unknown. We assessed postoperative pulmonary vein isolation up to 3 weeks after open chest bipolar radiofrequency ablation., Methods: Thirteen consecutive patients with mitral valve disease (mean age, 60 +/- 10 years) and atrial fibrillation undergoing concomitant ablation with the BP2 bipolar device (Medtronic, Inc, Minneapolis, Minn) were enrolled for electrophysiologic assessment. During surgery, pairs of additional temporary wires were positioned on the right pulmonary veins and on the roof of the left atrium before bipolar ablation. Entrance block (abatement or disconnection of electrogram potentials) and exit block (no entrainment during pulmonary vein pacing) of the right pulmonary veins and of the free left atrium were assessed before and after ablation. After right pulmonary vein isolation was obtained, one additional encircling line was added. Electrophysiologic assessment was repeated before discharge and at 3 weeks., Results: Baseline right pulmonary vein pacing threshold was 2.9 +/- 1.6 mA. After 3 +/- 1 encircling ablations, bidirectional block was attained in all pulmonary veins. At pre-discharge electrophysiologic study, complete isolation persisted in all cases. At 3 weeks, conduction block persisted in 11 (85%) of 13 patients. All patients were discharged in sinus rhythm. At follow-up (19 +/- 7 months), 12 (92%) of 13 patients were still free from atrial fibrillation., Conclusions: Irrigated bipolar radiofrequency ablation provides acute transmurality after multiple ablations. However, total recovery of conduction occurred in 15% of the patients after 3 weeks. Repeated multiple ablations, possibly complemented by block validation, are suggested to help achieve durable transmurality with such technology., (2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)