New approaches to the treatment of aortic valvulopathy

Background L’incidenza di malattie valvolari aortiche è in costante aumento. La terapia definitiva è chirurgica o interventistica, determinando un evidente miglioramento della qualità di vita, a fronte di un rischio operatorio ormai estremamente basso. Le linee guida internazionali più recenti pongono in classe I entrambe le procedure nella fascia di età fra 65 e 80 anni. Materiali e metodi È stata effettuata un’analisi retrospettiva dei pazienti di età compresa fra 65 e 80 anni, sottoposti a sostituzione valvolare aortica isolata chirurgica con bioprotesi sutureless (gruppo SU-AVR), oppure trans-catetere (gruppo TAVR), presso Maria Cecilia Hospital tra gennaio 2011 e dicembre 2021. Mediante propensity score matching sono stati analizzati, nei due gruppi risultanti, gli outcomes di mortalità e complicanze intraospedaliere, a 30 giorni, ad un anno e attuariale. Risultati Sono stati inclusi nello studio 638 pazienti, di cui 338 (52.98%) nel gruppo SU-AVR e 300 (47.02%) nel gruppo TAVR. Dopo propensity score matching, sono stati ottenuti due gruppi di pazienti (124 per gruppo) senza differenze statisticamente significative nelle comorbidità preoperatorie. La mortalità a 30 giorni è risultata sovrapponibile nei 2 gruppi. Il gruppo TAVR ha mostrato un’incidenza significativamente maggiore di impianto di pacemaker definitivo e di danni vascolari maggiori, mentre il gruppo SU-AVR ha mostrato una maggior incidenza di fibrillazione atriale, di trasfusioni e di insufficienza renale. La mortalità per tutte le cause a un anno è risultata significativamente maggiore per il gruppo TAVR e il divario continua ad aumentare con il tempo. Conclusioni La sostituzione valvolare aortica trans-catetere (TAVR) mostra risultati molto buoni nel breve termine nei pazienti fra 65 e 80 anni di età. Al follow-up a medio termine, tuttavia, i risultati preliminari mostrano un miglior outcome dei pazienti sottoposti a sostituzione valvolare chirurgica, sia in termini di mortalità per qualsiasi causa che di eventi cardiovascolari e cerebrovascolari maggiori.Background The incidence of aortic valve disease is constantly increasing. The definitive therapy is surgical or interventional, resulting in a clear improvement in the quality of life, with an extremely low operative risk. The most recent international guidelines place both procedures in class I in the age group between 65 and 80 years. Materials and methods A retrospective analysis of patients aged 65 to 80 years undergoing surgical isolated aortic valve replacement with sutureless bioprostheses (SU-AVR group), or trans-catheter (TAVR group) was performed at Maria Cecilia Hospital between January 2011 and December 2021. Using propensity score matching, intrahospital, 30-day, one-year and actuarial mortality and complications outcomes were analyzed in the two resulting groups. Results A total of 638 patients were included in the study, counting 338 (52.98%) in the SU-AVR group and 300 (47.02%) in the TAVR group. After propensity score matching, two groups of patients (124 per group) were obtained without statistically significant differences in preoperative comorbidities. Mortality at 30 days was comparable in the 2 groups. The TAVR group showed a significantly higher incidence of definitive pacemaker implantation and major vascular damage, while the SU-AVR group showed a higher incidence of atrial fibrillation, transfusions and renal failure. One-year all-cause mortality was significantly higher for the TAVR group, and the gap continues to increase with time. Conclusions Transcatheter aortic valve replacement (TAVR) shows very good results in the short term in patients between 65 and 80 years of age. At medium-term follow-up, however, preliminary results show a better outcome of patients undergoing surgical valve replacement, both in terms of all-cause mortality and major cardiovascular and cerebrovascular events

GNN for Deep Full Event Interpretation and hierarchical reconstruction of heavy-hadron decays in proton-proton collisions

The LHCb experiment at the Large Hadron Collider (LHC) is designed to perform high-precision measurements of heavy-hadron decays, which requires the collection of large data samples and a good understanding and suppression of multiple background sources. Both factors are challenged by a five-fold increase in the average number of proton-proton collisions per bunch crossing, corresponding to a change in the detector operation conditions for the LHCb Upgrade I phase, recently started. A further ten-fold increase is expected in the Upgrade II phase, planed for the next decade. The limits in the storage capacity of the trigger will bring an inverse relation between the amount of particles selected to be stored per event and the number of events that can be recorded, and the background levels will raise due to the enlarged combinatorics. To tackle both challenges, we propose a novel approach, never attempted before in a hadronic collider: a Deep-learning based Full Event Interpretation (DFEI), to perform the simultaneous identification, isolation and hierarchical reconstruction of all the heavy-hadron decay chains per event. This approach radically contrasts with the standard selection procedure used in LHCb to identify heavy-hadron decays, that looks individually at sub-sets of particles compatible with being products of specific decay types, disregarding the contextual information from the rest of the event. We present the first prototype for the DFEI algorithm, that leverages the power of Graph Neural Networks (GNN). This paper describes the design and development of the algorithm, and its performance in Upgrade I simulated conditions

Structural and electrical properties of annealed Ge2Sb2Te5 films grown on flexible polyimide

The morphological, structural, and electrical properties of as-grown and annealed Ge2Sb2Te5 (GST) layers, deposited by RF-sputtering on flexible polyimide, were studied by means of optical microscopy, atomic force microscopy, X-ray diffraction, Raman spectroscopy, and electrical characterization. The X-ray diffraction annealing experiments showed the structural transformation of GST layers from the as-grown amorphous state into their crystalline cubic and trigonal phases. The onset of crystallization of the GST films was inferred at about 140 degrees C. The vibrational properties of the crystalline GST layers were investigated via Raman spectroscopy with mode assignment in agreement with previous works on GST films grown on rigid substrates. The electrical characterization revealed a good homogeneity of the amorphous and crystalline trigonal GST with an electrical resistance contrast of 8 x 10(6)

Renin-Angiotensin-Aldosterone System Inhibitors, Statins, and Beta-Blockers in Diabetic Patients With Critical Limb Ischemia and Foot Lesions

Medical therapy for secondary prevention is known to be under-used in patients with peripheral artery disease (PAD). Few data are available on the subgroup with critical limb ischemia (CLI). Prescription of cardiovascular preventive therapies was recorded at discharge in a large, prospective cohort of patients admitted for treatment of CLI and foot lesions, stratified for coronary artery disease (CAD) diagnosis. All patients were followed up for at least 1 year. The primary endpoint was major adverse cardiovascular events (MACE). 618 patients were observed for a median follow-up of 981 days. Renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, beta-blockers, and antithrombotic drugs were prescribed in 52%, 80%, 51%, and 99% of patients, respectively. However, only 43% of patients received optimal medical therapy (OMT), defined as the combination of RAAS inhibitor plus statin plus at least one antithrombotic drug. It was observed that the prescription of OMT was not affected by the presence of a CAD diagnosis. On the other hand, it was noticed that the renal function affected the prescription of OMT. OMT was independently associated with MACE (HR 0.688, 95%CI 0.475-0.995, P = .047) and, after propensity matching, also with all-cause mortality (HR 0.626, 95%CI 0.409-0.958, P = .031). Beta-blockers prescription was not associated with any outcome. In conclusion, patients with critical limb ischemia are under-treated with cardiovascular preventive therapies, irrespective of a CAD diagnosis. This has consequences on their prognosis