The usability of the IdroGEO web platform for the dissemination of information on landslides and floods in Italy

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A 60-Year-Old Woman with Primary Biliary Cholangitis and Crohn's Ileitis Following the Suspension of Ursodeoxycholic Acid

BACKGROUND There is a recognized association between inflammatory bowel disease (IBD) and hepatobiliary autoimmune disease, particularly primary sclerosing cholangitis (PSC). There have been fewer reported cases of IBD and primary biliary cholangitis (PBC), which is treated with ursodeoxycholic acid (UDCA). This report presents the case of a 60-year-old woman with PBC who was diagnosed with Crohn's ileitis after suspension of UDCA treatment. CASE REPORT A 66-year-old female patient with PBC was admitted to our department for irrepressible chronic diarrhea and recurrent abdominal pain. PBC was diagnosed on the basis of serological data: chronic (>6 months) increase in alkaline phosphatase (ALP) associated with positivity for specific anti-nuclear antibodies (sp100 and gp210), without requiring a liver biopsy and a magnetic resonance cholangiopancreatography to rule out PSC. Given the intolerance and non-responsiveness according to the Toronto criteria (ALP <1.67 times the normal limit after 2 years) to UDCA at 15 mg/kg/day, an oral monotherapy treatment using obeticholic acid at 5 mg/day was prescribed. The patient complained of abdominal pain and upper gastrointestinal symptoms. The endoscopic/histologic and radiologic examinations supported the diagnosis of Crohn's ileitis. Given the potential benefits to PBC patients of what is described as off-label therapy, budesonide at a dosage of 9 mg/day p.o. was also administered. One month after discharge, an improvement was observed both in the cholestasis indices and in gastrointestinal symptoms. CONCLUSIONS This report presents a case of PBC in which the patient was diagnosed with Crohn's ileitis after cessation of treatment with UDCA, and highlights the importance of recognizing the association between autoimmune hepatobiliary disease and IBD

Correlation of Left Ventricular Myocardial Work Indices with Invasive Measurement of Stroke Work in Patients with Advanced Heart Failure

ObjectivesThis study aimed to explore the correlation between left ventricular (LV) myocardial work (MW) indices and invasively-derived LV stroke work index (SWI) in a cohort of patients with advanced heart failure (AHF) considered for heart transplantation. BackgroundLeft ventricular MW has emerged as a promising tool for diagnostic and prognostic purposes in heart failure (HF) but its relationship with hemodynamic data derived from right heart catheterization (RHC) has not been assessed in patients with advanced heart failure yet. Materials and methodsConsecutive patients with AHF considered for heart transplantation from 2016 to 2021 performing RHC and echocardiography as part of the workup were included. Conventional LV functional parameters and LV MW indices, including LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), LV global work efficiency (GWE), and other were calculated and compared with invasively-measured LV SWI. ResultsThe population included 44 patients. Median time between RHC and echocardiography was 0 days (IQR: 0-24). Median age was 60 years (IQR: 54-63). For the most part, etiology of HF was non-ischemic (61.4%) and all patients were either on class NYHA II (61.4%) or III (27.3%). Median left ventricular ejection fraction was 25% (IQR: 22.3-32.3), median NT-proBNP 1,377 pg/ml (IQR: 646-2570). LV global longitudinal strain (GLS) significantly correlated with LV SWI (r = -0.337; p = 0.031), whereas, LV ejection fraction (EF) did not (r = 0.308; p = 0.050). With regard to LV MW indices, some of them demonstrated correlation with LV SWI, particularly LV GWI (r = 0.425; p = 0.006), LV GCW (r = 0.506; p = 0.001), LV global positive work (LV GPW; r = 0.464; p = 0.003) and LV global systolic constructive work (GSCW; r = 0.471; p = 0.002). ConclusionAmong LV MW indices, LV GCW correlated better with invasively-derived SWI, potentially representing a powerful tool for a more comprehensive evaluation of myocardial function

TCT-709 Early and Mid-term Outcomes Of 1904 Patients Undergoing Transcatheter Balloon-Expandable Valve Implantation: results the ITER Registry

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Characterization and Management of Stable Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation.

Background/Objectives: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. Methods: REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up. Results: A total of 2025 patients from 30 centers worldwide with complete follow-up were included in the registry. Most patients had single-vessel CAD (56.1%). An involvement of proximal coronary tracts was detected in 62.5% of cases, with 12.0% of patients having CAD in left main (LM). Most patients received percutaneous coronary intervention (PCI) (n = 1617, 79.9%), especially those with proximal CAD (90.4%). At 2 years, the rates of all-cause death [Kaplan-Meier (KM) estimates 20.1% vs. 18.8%, plog-rank = 0.86] and of the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure (KM estimates 29.7% vs. 27.5%, plog-rank = 0.82) did not differ between patients undergoing PCI and those who were not. Conclusions: Patients undergoing TAVI with obstructive CAD more commonly had a single-vessel disease and an involvement of proximal coronary tracts. They were commonly treated with PCI, with similar outcomes compared to those treated conservatively

Transcatheter Aortic Valve Replacement in Patients at High Risk of Coronary Obstruction.

BACKGROUND: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves. METHODS: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection. RESULTS: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves. CONCLUSIONS: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself

DOES PRE-EXISTING AORTIC REGURGITATION PROTECTS FROM DEATH IN PATIENTS WHO DEVELOP PARAVALVULAR LEAK AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION?

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Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS). Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date. Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry i

Landslide databases in the Geological Surveys of Europe

Acceso electrónico sólo desde el IGMELandslides are one of the most widespread geohazards in Europe, producing significant social and economic impacts. Rapid population growth in urban areas throughout many countries in Europe and extreme climatic scenarios can considerably increase landslide risk in the near future. Variability exists between European countries in both the statutory treatment of landslide risk and the use of official assessment guidelines. This suggests that a European Landslides Directive that provides a common legal framework for dealing with landslides is necessary. With this long-term goal in mind, this work analyzes the landslide databases from the Geological Surveys of Europe focusing on their interoperability and completeness. The same landslide classification could be used for the 849,543 landslide records from the Geological Surveys, from which 36% are slides, 10% are falls, 20% are flows, 11% are complex slides, and 24% either remain unclassified or correspond to another typology. Most of them are mapped with the same symbol at a scale of 1:25,000 or greater, providing the necessary information to elaborate European-scale susceptibility maps for each landslide type. A landslide density map was produced for the available records from the Geological Surveys (LANDEN map) showing, for the first time, 210,544 km2 landslide-prone areas and 23,681 administrative areas where the Geological Surveys from Europe have recorded landslides. The comparison of this map with the European landslide susceptibility map (ELSUS 1000 v1) is successful for most of the territory (69.7%) showing certain variability between countries. This comparison also permitted the identification of 0.98 Mkm2 (28.9%) of landslide-susceptible areas without records from the Geological Surveys, which have been used to evaluate the landslide database completeness. The estimated completeness of the landslide databases (LDBs) from the Geological Surveys is 17%, varying between 1 and 55%. This variability is due to the different landslide strategies adopted by each country. In some of them, landslide mapping is systematic; others only record damaging landslides, whereas in others, landslide maps are only available for certain regions or local areas. Moreover, in most of the countries, LDBs from the Geological Surveys co-exist with others owned by a variety of public institutions producing LDBs at variable scales and formats. Hence, a greater coordination effort should be made by all the institutions working in landslide mapping to increase data integration and harmonization.Earth Observation and Geohazards Expert Group (EOEG), EuroGeoSurveys, the Geological Surveys of Europe, BélgicaGeohazards InSAR Laboratory and Modeling Group, Instituto Geológico y Minero de España, EspañaRisk and Prevention Division, Bureau de Recherches Géologiques et Minières, FranciaEngineering Geology Department, Institute of Geology and Mineral Exploration, GreciaGeoHazard team, Geological Institute of Romania, RumaníaGeological Survey of Slovenia, EsloveniaCroatian Geological Survey, CroaciaItalian Institute for Environmental Protection and Research, Geological Survey of Italy, ItaliaSwiss Federal Office for the Environment, SuizaGeological Survey of Austria, AustriaPolish Geological Institute, National Research Institute, PoloniaGeological Survey of Ireland, IrlandaCzech Geological Survey, República ChecaFederal Institute for Geosciences and Natural Resources, AlemaniaGeological Survey of Norway, NoruegaCyprus Geological Survey, ChipreGeological Survey of Sweden, SueciaInstitut Cartogràfic i Geològic de Catalunya, EspañaBritish Geological Survey, Reino UnidoGeological Survey of Slovakia, EslovaquiaGeological Survey of Lithuania, LituaniaFederalni zavod za geologiju, Bosnia y HerzegovinaGeological Survey of Estonia, EstoniaLaboratório Nacional de Energia e Geologia, PortugalGeological Survey of Hungary, HungríaNorwegian Water and energy Directorate of Norway, Norueg

Identification and characterization of rainfall events responsible for triggering of debris flows and shallow landslides

The aim of this study is the development of objective and replicable methodologies for the identification, analysis and characterization of rainfall events responsible for the triggering of shallow landslides and debris flows, in order to define empirical rainfall thresholds. The study area is the province of Trento (6208 km2), located in the north-eastern Alps, and characterized by complex orography, with 70% of the area at an altitude above 1000 m. A rigorous statistical methodology has been defined for the identification of the beginning of the triggering event, based on the critical duration, i.e. the minimum dry period duration separating two stochastically independent rainy periods. The critical duration has been calculated for each rain gauge of the studied area and its variability during the months of the year has been analyzed. An analysis of the rainfall spatial variability in a neighborhood of the landslide detachment zone has been carried out. The adopted methods are: the examination of the Monte Macaion radar maps during some summer convective events, the comparison of rainfall records of rain gauges located in a 10 km buffer around the landslide, and the calculation of the Pearson's correlation coefficient between pairs of neighboring rain gauges. The following rainfall thresholds have been then calibrated with the frequentist approach and compared: average intensity–event duration (I–D), which represents the rainfall event in its entirety, and intensity–duration associated with the event maximum return period (IRP–DRP), which considers the most critical portion of the event. In the absence of information about the landslide time of activation, the end of the triggering event has been identified using two criteria: the rainfall peak intensity and the last registration of the day. The methodology adopted for the objective identification of the beginning of the triggering event has demonstrated good applicability for rainfall induced landslides. During convective summer events the low representativeness of the rainfall information recorded at the nearest rain gauge with respect to the precipitation over the landslide source area has been evaluated as a critical issue for rainfall threshold definition