Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest:a prospective single-center observational study

BACKGROUND:We aimed to observe the dynamic changes in glucose metabolic reprogrammingrelated parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation(ROSC).METHODS:Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Aflliated Hospital of Dalian Medical University from August 1,2017,to May 30,2021,were enrolled.According to 28-day survival,the patients were divided into a non-survival group(n=82) and a survival group(n=38).Healthy adult volunteers(n=40) of similar ages and sexes were selected as controls.The serum levels of glucose metabolic reprogrammingrelated parameters(lactate dehydrogenase [LDH],lactate and pyruvate),neuron-specific enolase(NSE) and interleukin 6(IL-6) were measured on days 1,3,and 7 after ROSC.The Acute Physiology and Chronic Health Evaluation II(APACHE II) score and Sequential Organ Failure Assessment(SOFA) score were calculated.The Cerebral Performance Category(CPC) score was recorded on day 28 after ROSC.RESULTS:Following ROSC,the serum LDH(607.0 U/L vs.286.5 U/L),lactate(5.0 mmol/L vs.2.0 mmol/L),pyruvate(178.0 μmol/L vs.70.9 μmol/L),and lactate/pyruvate ratio(34.1 vs.22.1) significantly increased and were higher in the non-survivors than in the survivors on admission(all P<0.05).Moreover,the serum LDH,pyruvate,IL-6,APACHE II score,and SOFA score on days 1,3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality(all P<0.05).The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve(AUC) of 0.904 [95% confidence interval [95% CI]:0.851–0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950(95% CI:0.911–0.989) with 94.7% specificity for predicting 28-day all-cause mortality,which was the highest among the glucose metabolic reprogramming-related parameters tested.CONCLUSION:Serum parameters related to glucose metabolic reprogramming were significantly increased after ROSC.Increased serum LDH and pyruvate levels,and lactate/pyruvate ratio may be associated with 28-day poor neurological prognosis and all-cause mortality after ROSC,and the predictive eflcacy of LDH during the first week was superior to others.

Antitumor Effect of Apcin on Endometrial Carcinoma via p21-Mediated Cell Cycle Arrest and Apoptosis

Objective Endometrial carcinoma(EC)is a prevalent gynecological malignancy characterized by increasing incidence and mortality rates.This underscores the critical need for novel therapeutic targets.One such potential target is cell division cycle 20(CDC20),which has been implicated in oncogenesis.This study investigated the effect of the CDC20 inhibitor Apcin on EC and elucidated the underlying mechanism involved.Methods The effects of Apcin on EC cell proliferation,apoptosis,and the cell cycle were evaluated using CCK8 assays and flow cytometry.RNA sequencing(RNA-seq)was subsequently conducted to explore the underlying molecular mechanism,and Western blotting and coimmunoprecipitation were subsequently performed to validate the results.Animal studies were performed to evaluate the antitumor effects in vivo.Bioinformatics analysis was also conducted to identify CDC20 as a potential therapeutic target in EC.Results Treatment with Apcin inhibited proliferation and induced apoptosis in EC cells,resulting in cell cycle arrest.Pathways associated with apoptosis and the cell cycle were activated following treatment with Apcin.Notably,Apcin treatment led to the upregulation of the cell cycle regulator p21,which was verified to interact with CDC20 and consequently decrease the expression of downstream cyclins in EC cells.In vivo experiments confirmed that Apcin treatment significantly impeded tumor growth.Higher CDC20 expression was observed in EC tissue than in nonmalignant tissue,and increased CDC20 expression in EC patients was associated with shorter overall survival and progress free interval.Conclusion CDC20 is a novel molecular target in EC,and Apcin could be developed as a candidate antitumor drug for EC treatment.

Weak influence of natural vegetation in urban green spaces compared to agricultural ecosystems on House Martin populations:Insights from nationwide citizen science data in the Czech Republic

The House Martin(Delichon urbicum)is a common farmland bird species in the European landscape,yet its population numbers are currently in decline.However,it is not yet sufficiently explained why this long-term decline occurs.To fill this gap in our knowledge,we investigated how land cover composition affects the abundance of House Martins on the landscape scale by using nationwide citizen science data.Utilizing a generalised linear mixed-effect model(GLMM),we evaluated 12,094 records from the Czech Republic spanning 2009-2017.Our analysis underscores the significance of land cover type in shaping House Martin abundance.More specifically,our results indicate that within agricultural land covers“naturally managed arable lands”exhibited significant positive effect,while forests,orchards,and vineyards were deemed less favourable for House Martin populations.Within urban land covers,we found a clear distinction in the impact on House Martin populations,with a positive effect observed in urban infrastructure,development areas,and post-industrial sites(i.e.,UrbanAreas),while an indifferent impact was noted within urban green spaces and landscaped areas(i.e.,GreenUrban).Notably,our findings suggest that the simple spatial,age,and species structure typical of forests in Europe,and similarly,the uniform structure of parks and gardens,may be responsible for the decline in the abundance of the House Martin.We advocate for the preservation or enhancement of urban greenery,expansion of natural vegetation in rural areas and adoption of ecological management practices in orchards and vineyards to mitigate further declines in House Martin populations.

Hydrangea serrata extract exerts tumor inhibitory activity against hepatocellular carcinoma HepG2 cells via inducing p27/CDK2-mediated cell cycle arrest and apoptosis

Objective:To examine the inhibitory effect of Hydrangea serrata extract against hepatocellular carcinoma HepG2 cells and its underlying mechanisms.Methods:The effects of Hydrangea serrata extract on growth inhibition of tumor cells and spheroids were assessed using MTT and 3D culture assays.Quantitative real-time PCR and Western blot analyses were employed to investigate the changes in mRNA and protein expression levels of molecules related to cell cycle and apoptosis.Results:Hydrangea serrata extract effectively inhibited the growth of both tumor cells and spheroids.The extract also significantly upregulated p27 mRNA expression and downregulated CDK2 mRNA expression,leading to cell cycle arrest.Moreover,increased BAX/Bcl-2 ratio as well as caspase-9 and-3 were observed after treatment with Hydrangea serrata extract,indicating the induction of tumor cell apoptosis.Conclusions:Hydrangea serrata extract has the potential to alleviate tumors by effectively modulating cell-cycle-related gene expressions and inducing apoptosis,thereby inhibiting tumor growth.

Critical Solvation Structures Arrested Active Molecules for Reversible Zn Electrochemistry

Aqueous Zn-ion batteries(AZIBs)have attracted increasing attention in next-generation energy storage systems due to their high safety and economic.Unfortunately,the side reactions,dendrites and hydrogen evolution effects at the zinc anode interface in aqueous electrolytes seriously hinder the application of aqueous zinc-ion batteries.Here,we report a critical solvation strategy to achieve reversible zinc electrochemistry by introducing a small polar molecule acetonitrile to form a“catcher”to arrest active molecules(bound water molecules).The stable solvation structure of[Zn(H_(2)O)_(6)]^(2+)is capable of maintaining and completely inhibiting free water molecules.When[Zn(H_(2)O)_(6)]^(2+)is partially desolvated in the Helmholtz outer layer,the separated active molecules will be arrested by the“catcher”formed by the strong hydrogen bond N-H bond,ensuring the stable desolvation of Zn^(2+).The Zn||Zn symmetric battery can stably cycle for 2250 h at 1 mAh cm^(-2),Zn||V_(6)O_(13) full battery achieved a capacity retention rate of 99.2%after 10,000 cycles at 10 A g^(-1).This paper proposes a novel critical solvation strategy that paves the route for the construction of high-performance AZIBs.

Recovering from prolonged cardiac arrest induced by electric shock:A case report

BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged CA.Currently,there is limited literature on similar incidents,and we present a relevant case report.CASE SUMMARY A 27-year-old Asian male man,experiencing respiratory CA due to electric shock,was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation sessions.In the subsequent stages,the patient received multiple organ function protection measures,leading to a successful recovery and eventual discharge from the hospital.CONCLUSION Prolonging resuscitation time can enhance the chances of survival for patients,this study provide valuable insights into the management of electric shock-induced CA.

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.

A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

Correction:Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

This is an erratum to an already published paper named“Establishment of a prediction model for prehospital return of spontaneous circulation in out-ofhospital patients with cardiac arrest”.We found errors in the affiliated institution of the authors.We apologize for our unintentional mistake.Please note,these changes do not affect our results.

Hypoxia-preconditioned bone marrow-derived mesenchymal stem cells protect neurons from cardiac arrest-induced pyroptosis

Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown.To this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB pathways.Subsequently,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia.The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects.To conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.

Critical Success Factors for Citizen Development

The purpose of the research was to assess the impact of Citizen Development activities on digital transformation. The research identified eight categories that contribute to the success of Low-code No-code (LCNC) projects: 1) Strategy;2) Infrastructure;3) Technology;4) Processes & Procedures;5) Governance;6) Culture;7) People;8) Goals & Metrics and selected six critical success factors from these categories: 1) Operational Efficiency;2) Time Savings;3) Timeframe to Realize Value;4) Employee Engagement;5) Participation;6) Number of Sponsored Ideas. End users of the digital transformation efforts through Citizen Development were asked to assess the six critical success measures in terms of performance and importance criteria. The research results identified that focus should be applied to improving “Timeframe to Realize Value”, on “Operational Efficiency”, and on “Time Savings” to deliver success.

Analysis of Citizen Participation in Urban Planning of Comala,Colima,Mexico-A Secondary Publication

The objective of this study was to determine the degree of citizen participation in urban planning processes in the municipality of Comala,Colima,Mexico to have a broader vision of the citizens and the environment in which they live.An instrument was designed specifically to perform this study and the instrument was validated by calculating Cronbach’s Alpha.The results showed that citizens were highly involved in issues concerning their urban environment,and the main problems of the public spaces were also identified.

Diversity of Macro Invertebrates of the River Rwizi in Western Uganda: A Citizen Science-BioBlitz Approach

This study elucidates the pivotal role of citizen science-BioBlitz methodologies for rapid assessment of the macro-invertebrate taxa within the threatened River Rwizi of South-western Uganda. Utilizing a comprehensive mixed-methods approach, the investigation focused on six distinct river segments to demonstrate the efficacy of participatory citizen science-BioBlitz approaches conducted by experts, students and community volunteers. BioBlitz events included rigorous macro-invertebrate sampling at each of the selected sites along River Rwizi on nine occasions, incorporating collaborative taxonomic identification procedures involving experts, students, and the local community. Analyzing pollution concerns, diversity metrics, and community narratives yielded insights into river health and socio-ecological dynamics. A total of 43 macro-invertebrate families across 17 orders were documented with class Insecta dominating. Participants in BioBlitz events expressed predominantly positive sentiments, emphasizing satisfaction, education, and heightened awareness, besides negative sentiments rooted in historical mistrust. Intriguingly, the study unveiled an unforeseen trend in macro-invertebrate taxa richness, rising from upstream to urban sprawl and diminishing at peri-urban downstream sites. The study underscores the potential of citizen science-BioBlitz methodologies in advancing community science education and unraveling the intricate dynamics of threatened river ecosystems. The insights offered are invaluable for policymakers and conservationists seeking effective strategies to address challenges in the River Rwizi and comparable ecosystems. .

Investigation on the Characteristics of the Senior Citizens' Activities in the Parks and Greenbelts——A Case Study of Nanjing City

From the perspective of senior citizens,questionnaire survey and field investigation were carried on and analyzed in three parks in Nanjing City.The results showed that outdoor activities are the principal ways for the senior citizens to spend their time,the parks near home is their prior choice,and the radiation range of the park and greenbelt mostly is no more than 2 km;most of the senior citizens come to parks on foot and the parks are always within 30 minutes walking distance;the senior citizens always have fixed partners and groups for their exercise-dominant activities.

How Do People Understand Urban Air Pollution? Exploring Citizens’ Perception on Air Quality, Its Causes and Impacts in Colombian Cities

Similarly to other Latin American countries, urban air quality is a major concern in Colombia. The purpose of the present study was to explore citizens’ perception on local air pollution, its causes and impacts. A questionnaire was individually applied to a sample of 994 participants. Relationships between demographic features and the perception on air quality were analyzed using a logistic regression, its odds ratio (OR), and a Chi-square test. Eighty percent of the respondents perceive their local air quality as either bad or fair, 65% recognize particulate matter as the main local air pollutant, and 90% recognize negative impacts on people’s health as the main consequence of air pollution. In contrast to other studies where age and economic status are variables highly related with public perception on the level of atmospheric pollution, in this study only the size of the cities has a statistically significant relationship with the perception on local air quality regarding the level of pollution(OR ≥ 1, confidence intervals > 1 and p-values < 0.05). While area sources such as mining and infrastructure construction are identified as the main sources of pollutant emissions in small towns (less than 50,000 inhabitants), in big cities, road traffic is identified as the main source contributor to atmospheric pollution. Opposite to data from official reports, and regardless of the size of the city, households are perceived as the place with greatest contribution to personal air pollution exposure. Results show that citizens are aware of the state of air quality and its health impact is a major concern. Such findings suggest people’s opinions can be used as provisional indicators in cities without data, as well as to monitor the results of local air quality management. As a complementary process, or at the same level of importance given to technical-based policy, citizen participation can contribute to a collective construction of urban air pollution control strategies.

Developing a nomogram for predicting the depression of senior citizens living alone while focusing on perceived social support

BACKGROUND Although the number of senior citizens living alone is increasing,only a few studies have identified factors related to the depression characteristics of senior citizens living alone by using epidemiological survey data that can represent a population group.AIM To evaluate prediction performance by building models for predicting the depression of senior citizens living alone that included subjective social isolation and perceived social support as well as personal characteristics such as age and drinking.METHODS This study analyzed 1558 senior citizens(695 males and 863 females)who were 60 years or older and completed an epidemiological survey representing the South Korean population.Depression,an outcome variable,was measured using the short form of the Korean version CES-D(short form of CES-D).RESULTS The prevalence of depression among the senior citizens living alone was 7.7%.The results of multiple logistic regression analysis showed that the experience of suicidal urge over the past year,subjective satisfaction with help from neighbors,subjective loneliness,age,and self-esteem were significantly related to the depression of senior citizens living alone(P<0.05).The results of 10-fold cross validation showed that the area under the curve of the nomogram was 0.96,and the F1 score of it was 0.97.CONCLUSION It is necessary to strengthen the social network of senior citizens living alone with friends and neighbors based on the results of this study to protect them from depression.

Relations between Environmental Right for Citizens and the Right to Use Environmental Resources owned by Company and Enterprise

From angles of administrative law and private law, the article analyzes relations between environmental right for citizens and the right to use environmental resources owned by company and enterprise and points out three principles to balancing two relations: A principle of equal protection, a principle that general interest is superior to special interest as well as taking an account for special interest, in specific circumstances, for example, in the circumstance that clashes between environmental and economic interests can not be avoided, policy makers can put an emphasis on more important social interest according after considering weight of each interest. Finally, the article reaches a conclusion that China should establish system of environmental right for citizens from legislative and administrative levels so that a harmonious society can be constructed with guarantee.

The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation

BACKGROUND:The ion shift index(ISI) as a prognostic indicator that can show the severity of hypoxic-ischemic injury.We aimed to evaluate the performance of the ISI in predicting unfavorable neurological outcomes at hospital discharge in cardiac arrest(CA) patients following extracorporeal cardiopulmonary resuscitation(ECPR) and to compare its performance to other prognostic predictors.METHODS:This was a retrospective observational study including adult CA patients treated with ECPR between January 2018 and December 2022 in a tertiary hospital.Data regarding clinical characteristics and laboratory parameters were collected from medical records.The ISI was determined based on the first available serum electrolyte levels after ECPR.The primary outcome was unfavorable neurological status at hospital discharge,defined as Cerebral Performance Categories 3–5.Comparisons of the characteristics between the two groups were made using the χ2 test for categorical variables and the t-test or non-parametric Mann-Whitney U-test for continuous variables,as appropriate.Correlation analysis was performed using Spearman’s rank correlation coeficient.A two-tailed P-value <0.05 was considered statistically significant.RESULTS:Among the 122 patients involved,46(37.7%) had out-of-hospital CA,and 88 had unfavorable neurological outcomes.The ISI was significantly higher in the unfavorable outcome group than in the favorable outcome group(3.74 [3.15–4.57] vs.2.69 [2.51–3.07],P<0.001).A higher ISI level was independently related to unfavorable outcome(odds ratio=6.529,95% confidence interval 2.239–19.044,P=0.001).An ISI level >3.12 predicted unfavorable outcomes with a sensitivity and specificity of 74.6% and 85.2%,respectively(P<0.001).The prognostic performance of ISI(area under the curve [AUC]=0.887) was similar to that of other predictors,such as gray-to-white matter ratio(AUC=0.850,P=0.433) and neuronspecific enolase(AUC=0.925,P=0.394).CONCLUSION:ISI may be used as a prognostic biomarker to predict neurological outcomes in CA patients following ECPR.

Citizens and Air Quality: The Results of the First Survey Carried Out in the Po River Basin (Northern Italy)

The air quality survey investigated the level of perception and awareness of citizens on the air quality in the 42 cities (provincial capitals) of the Po basin in the north west of Italy. This study means that perceptions could then be compared between in the Po basin and other parts of Italy and Europe. This research was carried out as part of the Life15 IPE IT 013 PREPAIR Project (Po Regions Engaged to Policies of Air), which involves 18 national and international partners, and includes all the regions of the Po Basin. The survey involved around 7331 citizens that live in the Po basin that includes 42 cities (provincial capitals) and a total of 6.5 million inhabitants. A multivariate analysis was applied to identify the main citizens’ profiles concerning the topic of air quality and the availability to implement virtuous behaviours to reduce air pollution. Four different profiles emerge from the cluster analysis: “Committed and proactive”, “Willing but …”, “Hesitant”, “Not willing”.