CORONARY PERFUSION:IMPACT OF FLOW DYNAMICS AND GEOMETRIC DESIGN OF TWO DIFFERENT AORTIC PROSTHESES OF SIMILAR SIZE

BackgroundAortic valve replacement leads to improvement of coronary flow but not to complete normalization. Coronary hypoperfusion contributes to higher left ventricular mass persistence, arrhythmias, congestive heart failure and sudden death. This prospective study compares 2 similarly sized aortic prostheses (mechanical and porcine) regarding coronary flow and hemodynamic performances in patients who underwent surgery for pure aortic stenosis.MethodsSixty patients having undergone aortic valve replacement for pure aortic stenosis with Medtronic Mosaic Ultra bioprosthesis 21 mm (n = 30) or St Jude Regent mechanical valve 19 mm (n = 30) were evaluated preoperatively and 12 months postoperatively comparing the coronary flow and the hemodynamic behavior. Echocardiography and cardiac positron emission tomography were performed at rest and during exercise or adenosine maximal stimulation, respectively.ResultsThe St Jude Regent mechanical valve, compared with the Medtronic Mosaic Ultra bioprosthesis, had reduced coronary flow reserve (2.1 ± 0.3 vs 2.3 ± 0.2; P = .003), less favorable systolic/diastolic time ratio (0.87 ± 0.02 vs 0.78 ± 0.03; P < .001), and higher mean transprosthetic gradient (46 ± 11 vs 38 ± 9; P = .003) during exercise. Multivariate analysis of impaired coronary reserve related indexed effective orifice area less than 0.65 cm/m2 (risk ratio [RR], 1.9; 95% confidence intervals [CI], 1.5-2.8; P < .001), mechanical valve (RR, 2.5; 95% CI, 1.7-3.3; P < .001), and systolic/diastolic time ratio greater than 0.75 (RR, 2.6; 95% CI, 1.8-3.8; P < .001), as well as high transprosthetic gradient (RR, 1.7; 95% CI, 1.3-2.4; P < .001) ) during exercise with coronary reserve less than 2.2.ConclusionsImprovement of coronary flow and reserve was more evident for bioprostheses than for mechanical valves. The bioprostheses demonstrated superior hemodynamics during exercise, which may have some impact on exercise capability during normal daily life

Welcome on board: A note on gender quotas regulation in Europe

Using a diff-in-diff approach, we compare the impact on board and directors’ characteristics of mandatory vs advisory regulations on gender quotas in corporate boards. We focus on the experience of three European countries: France and Italy (mandatory regime) vs UK (advisory regime). Our results show that while the percentage of Women on Boards (WoB) generally increases after the introduction of the regulation, this effect is stronger in mandatory regimes. We also find that the quality of the board, measured by several indicators such as size, busyness, qualifications, independence, generally improves more in mandatory regimes. Finally, we also document that gender quotas have had no effect on the likelihood of appointing female executives and board chairwomen in either regime

The survey and mapping of sand-boil landforms related to the Emilia 2012 earthquakes: preliminary results.

Sand boils, which are also known as sand blows or sand volcanoes, are among the most common superficial effects induced by high-magnitude earthquakes. These generally occur in or close to alluvial plains when a strong earthquake (M >5) strikes on a lens of saturated and unconsolidated sand deposits that are constrained between silt-clay layers, where the sediments are converted into a fluid suspension. The liquefaction phenomena requires the presence of saturated and uncompacted sand, and a groundwater table near the ground surface. This geological\u2013geomorphological setting is common and widespread for the Po Plain (Italy). The Po Plain (ca. 46,000 km2) represents 15% of the Italian territory. It hosts a population of about 20 million people (mean density of 450 people/km2) and many infrastructures. Thus, the Po Plain is an area of high vulnerability when considering the liquefaction potential in the case of a strong earthquake. Despite the potential, such phenomena are rarely observed in northern Italy, because strong earthquakes are not frequent in this region; e.g., historical data report soil liquefaction near Ferrara in 1570 (M 5.3) and in Argenta 1624 (M 5.5). In the Emilia quakes of May 20 and 29, 2012, the most widespread coseismic effects were soil liquefaction and ground cracks, which occurred over wide areas in the Provinces of Modena, Ferrara, Bologna, Reggio Emilia and Mantov

The survey and mapping of sand-boil landforms related to the Emilia 2012 earthquakes: preliminary results.

Sand boils, which are also known as sand blows or sand volcanoes, are among the most common superficial effects induced by high-magnitude earthquakes. These generally occur in or close to alluvial plains when a strong earthquake (M >5) strikes on a lens of saturated and unconsolidated sand deposits that are constrained between silt-clay layers, where the sediments are converted into a fluid suspension. The liquefaction phenomena requires the presence of saturated and uncompacted sand, and a groundwater table near the ground surface. This geological–geomorphological setting is common and widespread for the Po Plain (Italy). The Po Plain (ca. 46,000 km2) represents 15% of the Italian territory. It hosts a population of about 20 million people (mean density of 450 people/km2) and many infrastructures. Thus, the Po Plain is an area of high vulnerability when considering the liquefaction potential in the case of a strong earthquake. Despite the potential, such phenomena are rarely observed in northern Italy, because strong earthquakes are not frequent in this region; e.g., historical data report soil liquefaction near Ferrara in 1570 (M 5.3) and in Argenta 1624 (M 5.5). In the Emilia quakes of May 20 and 29, 2012, the most widespread coseismic effects were soil liquefaction and ground cracks, which occurred over wide areas in the Provinces of Modena, Ferrara, Bologna, Reggio Emilia and Mantov

The face of Glut1-DS patients : A 3D craniofacial morphometric analysis

Introduction - Glut1 deficiency syndrome (Glut1-DS) is a neurological and metabolic disorder caused by impaired transport of glucose across the blood brain barrier (BBB). Mutations on the SCL2A1 gene encoding the glucose transporter protein in the BBB cause the syndrome, which encompasses epilepsy, movement disorders and mental delay. Such variability of symptoms presents an obstacle to early diagnosis. The patients seem to share some craniofacial features, and identification and quantification of these could help in prompt diagnosis and clinical management. Materials and method - We performed a three-dimensional morphometric analysis of the faces of 11 female Glut1-DS patients using a stereophotogrammetric system. Data were analyzed using both inter-landmark distances and Principal Component Analysis (PCA). Results - Compared to data collected from age-, sex- and ethnicity-matched control subjects, common and homogenous facial features were identified among patients, which were mainly located in the mandible and the eyes. Glut1-DS patients had a more anterior chin; their mandibular body was longer but the rami were shorter, with a reduced gonial angle; they had smaller and down-slanted eyes with a reduced intercanthal distance. Conclusions - This study highlights the importance of morphometric analysis for defining the facial anatomical characteristics of the syndrome better, potentially helping clinicians to diagnose Glut1-DS. Imnproved knowledge of the facial anatomy of these patients can provide insights into their facial and cerebral embryological development, perhaps further clarifying the molecular basis of the syndrome

The survey and mapping of sand-boil landforms related to the Emilia 2012 earthquakes: preliminary results

Sand boils, which are also known as sand blows or sand volcanoes, are among the most common superficial effects induced by high-magnitude earthquakes. These generally occur in or close to alluvial plains when a strong earthquake (M >5) strikes on a lens of saturated and unconsolidated sand deposits that are constrained between silt-clay layers [Ambraseys 1988, Carter and Seed 1988, Galli 2000, Tuttle 2001, Obermeier et al. 2005], where the sediments are converted into a fluid suspension. The liquefaction phenomena requires the presence of saturated and uncompacted sand, and a groundwater table near the ground surface. This geological– geomorphological setting is common and widespread for the Po Plain (Italy) [Castiglioni et al. 1997]. The Po Plain (ca. 46,000 km2) represents 15% of the Italian territory. It hosts a population of about 20 million people (mean density of 450 people/km2) and many infrastructures. Thus, the Po Plain is an area of high vulnerability when considering the liquefaction potential in the case of a strong earthquake. Despite the potential, such phenomena are rarely observed in northern Italy [Cavallin et al. 1977, Galli 2000], because strong earthquakes are not frequent in this region; e.g., historical data report soil liquefaction near Ferrara in 1570 (M 5.3) and in Argenta 1624 (M 5.5) [Prestininzi and Romeo 2000, Galli 2000]. In the Emilia quakes of May 20 and 29, 2012, the most widespread coseismic effects were soil liquefaction and ground cracks, which occurred over wide areas in the Provinces of Modena, Ferrara, Bologna, Reggio Emilia and Mantova (Figure 1). These were the causes of considerable damage to buildings and the infrastructure. The soil liquefaction and ground cracks were accompanied by sand boils, which are described in this report. The spatial distribution and geomorphological setting of sand boils and ground cracks are also described here. A detailed three-dimensional (3D) reconstruction of these features is also presented, which was carried out using terrestrial photogrammetry. Since archeological times, fluvial ridges, and in general sandy deposits on low plains have been the preferred sites for human infrastructure, colonial houses, roads, etc. Therefore, it is very important to understand how the local topography/ morphology interacts in the liquefaction processes. Numerous distinctive seismic landforms were generated by the May 2012 strong earthquakes (seven with M >5), and in particular, sand boils and ground fractures. The sand-boil landforms, also known as sand craters or sand volcanoes, are formed by low mounds of sand that have been extruded from fractures [Tuttle 2001]. The cone is a generally shortlived structure that naturally collapses, starting from the center holes that mark the water retreat back into the fracture. Sand boils also occurred along larger cracks (with decimetric lateral and vertical displacements). Here, the upper scarps block the formation of craters and allow the deposition of a sandy layer several centimeters thick (e.g. ca. 4 cm in the San Carlo crack), on the lower side of the steep slope. These landforms are highly vulnerable to erosion. After a few weeks, they are washed out by rain, destroyed by human activity, or masked by growing crops. Thus, ground surveys that investigate these events have to be carried out as soon as possible [Panizza et al. 1981]. In this report, we present preliminary results using methods to map the detailed micro-morphology of some representative liquefaction features (Figure 2) that normally disappear for the aforementioned reasons, or that are recorded only in qualitative terms

Laparoscopic Ovariectomy in Standing Mule Mares

Mules are hybrids bred from the mating of a jack donkey and a horse mare, known for their strength and resistance and still used to work in agriculture. Although they have been for long considered sterile, evidence of estrus cycle has been demonstrated together with abnormal behavior related to ovarian activity. In this study, a bilateral standing laparoscopic ovariectomy technique using the LigaSure technology was applied in 10 mare mules for treating unwanted behavioral patterns. The technique was effectively performed on these animals avoiding the risk of general anesthesia, and the use of the LigaSure technology allowed good hemostasis and reduced surgical time. Owners declared to be satisfied with the resolution of the behavior

External Validation of Equations to Estimate Resting Energy Expenditure in 2037 Children and Adolescents with and 389 without Obesity : a Cross-Sectional Study

We performed an external cross-validation study of 10 equations to estimate resting energy expenditure (REE) in 2037 children with and 389 without obesity. Inclusion criteria were Caucasian ethnicity, age 64 18 years, and availability of REE. REE was measured using indirect calorimetry. The correct classification fraction (CCF) of an equation was defined as the fraction of subjects whose estimated REE was within 10% of measured REE. The Moln\ue1r equation was the most accurate REE prediction equation with CCFs of 0.70 (95% CI 0.65 to 0.76) in girls without obesity, 0.64 (95% CI 0.61 to 0.66) in girls with obesity, 0.76 (95% CI 0.67 to 0.83) in boys without obesity, and 0.66 (95% CI 0.63 to 0.69) in boys with obesity. The Mifflin equation was the second most accurate equation with CCFs of 0.67 (95% CI 0.61 to 0.73) in girls without obesity, 0.61 (95% CI 0.58 to 0.64) in girls with obesity, 0.75 (95% CI 0.66 to 0.82) in boys without obesity, and 0.66 (95% CI 0.63 to 0.69) in boys with obesity

Evaluation of Different Adiposity Indices and Association with Metabolic Syndrome Risk in Obese Children: Is there a Winner?

Body shape index (ABSI) and triponderal mass index (TMI) have been recently associated with cardiovascular risk in adults. A cross-sectional study was conducted to evaluate the relationship between different anthropometric adiposity indexes and metabolic syndrome (MetS) in Caucasian obese children and adolescents. Consecutive obese children aged 657 years have been enrolled. Anthropometric parameters, body composition (by bioelectrical impedance), and systolic and diastolic blood pressure have been measured. Fasting blood samples have been analyzed for lipids, insulin, glucose. A multivariate logistic regression analyses, with body mass index z-score, waist to height ratio, ABSI z-score, TMI, conicity index as predictors for MetS (IDEFICS and IDF criteria according to age) has been performed. Four hundred and three (179 boys and 224 girls) obese children, aged 7\u201320 years, have been evaluated. When we explored the joint contribution of each anthropometric and adiposity index of interest and BMIz on the risk of MetS, we found that the inclusion of ABSIz improved the prediction of MetS compared to BMIz alone. ABSI-BMI can be a useful index for evaluating the relative contribution of central obesity to cardiometabolic risk in clinical management of obese children and adolescents