Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI.Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications

Technical and Clinical Outcome of Talent versus Endurant Endografts for Endovascular Aortic Aneurysm Repair

The technical evolution of endografts for the interventional management of infrarenal abdominal aortic aneurysms (AAA) has allowed a continuous expansion of indications. This study compares the established Talent endograft with its successor, the Endurant endograft, taking individual aortoiliac anatomy into account.From June 2007 to December 2010, 35 patients with AAA were treated with a Talent endograft (33 men) and 36 patients with an Endurant endograft (34 men). Aortoiliac anatomy was evaluated in detail using preinterventional computed tomography angiography. The 30-day outcome of both groups were compared regarding technical and clinical success as well as complications including endoleaks.The Endurant group included more patients with unfavorable anatomy (kinking of pelvic arteries, p = 0.017; shorter proximal neck, p = 0.084). Primary technical success was 91.4% in the Talent group and 100% in the Endurant group (p = 0.115). Type 1 endoleaks occurred in 5.7% of patients in the Talent group and in 2.8% of those in the Endurant group (p = 0.614). Type 3 endoleaks only occurred in the Talent group (2.9% of patients; p = 0.493). Type 2 endoleaks were significantly less common in the Endurant group than in the Talent group (8.3% versus 28.6%; p = 0.035). Rates of major and minor complications were not significantly different between both groups. Primary clinical success was significantly better in the Endurant group (97.2%) than in the Talent group (80.0%) (p = 0.028).Endurant endografts appear to have better technical and clinical outcome in patients with difficult aortoiliac anatomy, significantly reducing the occurrence of type 2 endoleaks

Pharmacological Undertreatment of Coronary Risk Factors in Patients with Psoriasis: Observational Study of the Danish Nationwide Registries

BACKGROUND: Patients with psoriasis have increased prevalence of coronary risk factors and limited recent results have suggested that these risk factors are undertreated in patients with psoriasis. This may contribute to the increased risk of cardiovascular diseases observed in patients with psoriasis. OBJECTIVE: To examine the pharmacological treatment of coronary risk factors in patients with severe psoriasis treated with biologic agents in a real-world setting. METHODS AND FINDINGS: Medical history of patients with severe psoriasis treated with biologic agents in the time period 2007-09 was retrieved from a Danish nationwide registry (DERMBIO). Individual-level linkage of nationwide administrative registries of hospitalizations, concomitant medications, and socioeconomic status was performed to gain insights into the use of pharmacological treatment. A total of 693 patients (mean age 46.1 ± 12.7 years, 65.7% male) with severe psoriasis treated with biologic agents were identified. Hypertension, hypercholesterolemia, and diabetes mellitus were identified in 16.6%, 9.2%, and 6.7% of cases, respectively. Patients with severe psoriasis were significantly less likely to receive cardiovascular pharmacotherapy compared to age, sex, and coronary risk factor matched controls. In psoriatic patients with hypertension 27.7% received no antihypertensive pharmacotherapy. Patients with dyslipidemia received cholesterol-lowering medications in 55.8% of cases and patients with diabetes mellitus received angiotensin converting enzyme inhibitors/angiotensin II receptor blockers and cholesterol-lowering medications in 42.1% and 23.7% of cases, respectively. Similar results were found for the subset of patients with >1 coronary risk factor and for high risk patients with established atherosclerotic disease. CONCLUSION: This nationwide study of patients with severe psoriasis demonstrated substantial undertreatment of coronary risk factors. Increased focus on identifying cardiovascular risk factors and initiation of preventive cardiovascular pharmacotherapy in patients with psoriasis is warranted

Swan-Ganz-Induced Pulmonary Artery Rupture: Management With Stent Graft Implantation

Pulmonary artery catheterization is a useful tool for the diagnosis and management of lung or cardiac disease. This procedure is considered safe and associated with a low incidence of major complications. However, pulmonary artery rupture during right heart catheterization, albeit rare, remains a severe complication. Despite modern management with metal-coil embolization, selective intubation and deployment of bronchial blocker, the mortality rate may be as high as 50%. In this case, we report a new approach to deal with a Swan-Ganz-induced pulmonary artery rupture based on stent graft implantation leading to successful sealing of the pulmonary perforation with final patency and normal antegrade blood flow in the pulmonary branch. (c) 2010 Wiley-Liss, Inc

Pushing wrist access to the limit: Homolateral right ulnar artery approach for primary percutaneous coronary intervention after right radial failure due to radial loop

A 67-year-old man underwent primary percutaneous coronary intervention for acute anterior ST elevation myocardial infarction. The right radial artery was the access of choice. After easy cannulation, a 360-degree loop was found at the elbow level. The brachial artery and a large ulnar artery were visible by injecting contrast through the radial loop. After an unsuccessful attempt to engage the loop, the operator switched entry site for the homolateral ulnar artery. Leaving the radial sheath in place, the cannulation of the ulnar artery was successful and uncomplicated. The operator could easily perform a successful intervention of the culprit vessel. An angiogram of the wrist, via the ulnar sheath showed the presence of a big interosseous artery with flow up to the hand and no flow in the radial and ulnar arteries distal to the sheaths. The ulnar and radial arteries were successfully sealed after a few hours, a valid pulsation was present on both arteries and no signs of ischemia were evident in the right hand the day after. © 2011 Wiley Periodicals, Inc

Foredune psammophilous communities and coastal erosion in a stretch of the Ligurian sea (Tuscany, Italy)

Italy sandy coasts are characterised by a great diversity of habitats and, at the same time, many of these coastal stretches are in erosive condition. Therefore, it is important to understand, in areas where marine erosion is particularly strong, which are the most vulnerable and most threatened habitats. The paper sets out data from the survey of foredune habitats (annual vegetation of drift lines, embryonic dunes, mediterranean white dunes, sensu Directive 92/43/EEC) in the San Rossore Estate sandy coast (Northern Tuscany, Italy) strongly subjected to erosion. The surveys, in addition to updating the information collected, aim to point out the arrangement of these habitats in relation to coastal retrogradation and foredune erosion, in order to identify appropriate management tools for mitigating disturbance factors. The surveys, conducted in the field and by photo-interpretation, revealed the presence of foredune plant communities hardly referable, from the phytosociological point of view, to known associations of neighboring coasts. The Cakile maritima plant communities of annual vegetation of drift lines, the Elymus farctus/ Othantus maritimus phytocoenosis of embryonic dune and the Ammophila arenaria/Euphorbia paralias communities of white dunes, are markedly altered in their floristic composition; the coverage and distribution of the different plant communities are in a highly differentiated manner according to erosion gradients. The understanding of dynamics of alteration of psammophilous plant communities in relation to coastal erosion may suggest potential aid in the management actions aimed at containing the transformations or and/or useful for the restoration of the same habitats

Problematiche nell'affinamento delle comunit\ue0 ittiche di riferimento per l\u2019applicazione dell\u2019ISECI in aree con carenze informative e quadro zoogeografico incerto. Il caso di studio del bacino del Basento in Basilicata.

The ISECI is the index identified by the D.L.152 / 2006 in agreement with the Water Framework Directive 2000/60/EC for assessing the BQE fish fauna for inland surface waters. It provides a judgment on the ecological status of the observed fish community by assessing differences with the reference fish community theoretically present in natural conditions. The definition of the reference fish community is therefore a critical step that significantly influences the final result of the index and which sometimes is extremely unreliable. Many taxawidely distributed throughout Italy are under review by the scientific community and there iscurrently no clear recommendation on the checklist of native species of the different italian zoogeographical districts. In this study, an overview of issues related to the definition of a reference fish community and a comprehensive picture of the discrepancies within published studies on the autochthony of several fish species in the Basento river basin in Basilicata are reported. Basento river basin, like other Jonian arc basins, shows an unresolved zoogeography which needs further geological and molecular-genetic studies. In addition, the consequences of choosing incorrect reference conditions, both in terms of loss in analytical power of the index and in terms of implications in respecting ecological quality limits imposed by the WDF, were evaluated byapplying the ISECI to 23 sampled ichthyic peopling under different theoretical zoogeographical scenariosL\u2019ISECI \ue8 l\u2019indice individuato dal D.L.152/2006 in adeguamento alla Water Framework Directive (WDF) 2000/60/CE per la valutazione dell\u2019EQB fauna ittica nelle acque interne superficiali. Fornisce un giudizio sullo stato ecologico della comunit\ue0 ittica osservata, valutando quanto questa differisca dalla comunit\ue0 ittica di riferimento teoricamente presente in condizioni di naturalit\ue0. La definizione della comunit\ue0 ittica di riferimento \ue8, quindi, un passaggio fondamentale che influenza profondamente la veridicit\ue0 del risultato finale dell\u2019indice ma che ha talora un grado di incertezza estremamente elevato. Molti taxa diffusi sul territorio nazionale sono oggetto di revisione da parte della comunit\ue0 scientifica e non vi \ue8 parere univoco riguardo la checklist delle specie autoctone dei singoli distretti zoogeografici italiani. In questo studio \ue8 presentata una panoramica delle problematiche relative alla definizione della comunit\ue0 ittica di rifermento nel bacino del fiume Basento in Basilicata fornendo un quadro complessivo delle discordanze fra i principali autori in merito allo status di autoctonia delle diverse specie ittiche. Il bacino del Basento, come gli altri bacini dell\u2019arco jonico, ha un quadro zoogeografico poco chiaro che necessita di approfondimenti di carattere geologico e genetico-molecolare. Le conseguenze della scelta di condizioni di riferimento errate, sia in termini di perdita di potere analitico dell\u2019indice sia per le implicazioni relative al rispetto dei limiti di qualit\ue0 ecologica imposti dalla WDF, vengono presentate tramite l\u2019applicazione dell\u2019ISECI a 23 popolamenti di fauna ittica secondo diversi possibili scenari zoogeografici teorici

CONSIDERAZIONI SOPRA IL MONITORAGGIO DELLE SOSTANZE PRIORITARIE NEL BIOTA NEI BACINI IDROGRAFICI DELLA REGIONE BASILICATA

Il presente documento riporta considerazioni applicative e metodologiche riguardanti il monitoraggio delle sostanze prioritarie nel Biota come definito nel documento di ISPRA \u201cLinea guida per il monitoraggio delle sostanze prioritarie \u2013 Manuali e Linee Guida 143/2016\u201d. Tali considerazioni vogliono essere un contributo alla definizione e standardizzazione degli aspetti operativi necessari alla realizzazione delle attivit\ue0 di monitoraggio delle sostanze prioritarie nel Biota e nascono dalla partecipazione a tavoli di lavoro e da contributi specifici degli scriventi sull\u2019argomento in questione. Per ciascuna delle criticit\ue0 individuate vengono proposte anche soluzioni applicative ed a conclusione del documento viene presentato un vademecum con la sintesi del modus operandi che si ritiene pi\uf9 opportuno. Le argomentazioni per la realizzazione del un piano di monitoraggio delle sostanze prioritarie nel Biota sono specificatamente riferite alle caratteristiche dei bacini idrografici della regione Basilicata; le criticit\ue0 e le soluzioni proposte sono valide o facilmente estendibili anche in altri contesti nazionali

The phylogenetic signal in cranial morphology of Vipera aspis: a contribution from geometric morphometrics

Morphological variation in the frontal bone and cranial base of Vipera aspis was studied using geometric morphometrics. Significant differences in shape were found among samples from subspecies present in Italy (V. a. aspis, V. a. francisciredi, V. a. hugyi). Sexual dimorphism was negligible as well as allometry and size differences. The most divergent subspecies was V. a. aspis, possibly in relation to its recent history of geographic isolation in a glacial refugium. Shape clusters were in good agreement with clusters from studies of external morphology and completely congruent with results from molecular studies of mtDNA