Implantation of a left ventricular assist device as a destination therapy in Duchenne muscular dystrophy patients with end stage cardiac failure: management and lessons learned

Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder, characterized by progressive skeletal muscle weakness, loss of ambulation, and death secondary to cardiac or respiratory failure. End-stage dilated cardiomyopathy (DCM) is a frequent finding in DMD patients, they are rarely candidates for cardiac transplantation. Recently, the use of ventricular assist devices as a destination therapy (DT) as an alternative to cardiac transplantation in DMD patients has been described. Preoperative planning and patient selection play a significant role in the successful postoperative course of these patients. We describe the preoperative, intraoperative and postoperative management of Jarvik 2000 implantation in 4 DMD pediatric (age range 12-17 years) patients. We also describe the complications that may occur. The most frequent were bleeding and difficulty in weaning from mechanical ventilation. Our standard protocol includes: 1) preoperative multidisciplinary evaluation and selection, 2) preoperative and postoperative non-invasive ventilation and cough machine cycles, 3) intraoperative use of near infrared spectroscopy (NIRS) and transesophageal echocardiography, 4) attention on surgical blood loss, use of tranexamic acid and prothrombin complexes, 5) early extubation and 6) avoiding the use of nasogastric feeding tubes and nasal temperature probes. Our case reports describe the use of Jarvik 2000 as a destination therapy in young patients emphasizing the use of ventricular assist devices as a new therapeutic option in DMD

L'intervento pubblico a sostegno dell'economia

The Italian State has implemented numerous interventions to support the economy in response to the crisis produced by the Covid-19 pandemic, and the reactivity and capacity of economic policy have become crucial. Are administrative offices capable of managing aid, or must they make use of the help of third parties, such as publicly held companies? What is the distance between normative prefiguration and actual data, taking into consideration the actor implementing the measures? This article, which addresses these and other issues, is divided as follows. First, it provides the coordinates of the current European discipline on State support for the economy, within which the national measures have been introduced. This is followed by three parts. The first one reconstructs the support mechanisms introduced in Italy. The second one analyses those envisaged in Germany and France, for comparative purposes. The third one considers certain worrisome trends on using public funds to respond to the current crisis and makes proposals to improve the quality and efficiency of State action in this field

La prelazione storico-artistica dei beni di propriet\ue0 pubblica

Il saggio si propone di analizzare le problematiche relative alla prelazione storico artistica nel caso in cui ad alienare il bene culturale non sia un privato ma un ente pubblico. In particolare l'attenzione \ue8 stata rivolta ad verificare se nel caso di specie la prelazione operi ugualmente, e nel caso in cui questa trovi effettivamente applicazione con quali modalit\ue0, evidenziando le eventuali differenze rispetto all'ipotesi classica di alienazione di un bene culturale di propriet\ue0 privata