Rheumatic heart disease predisposing to embolic myocardial infarction: a multimodality imaging approach

We report a clinical case of a 45-year-old male with a diagnosis of inferior myocardial infarction and previous history of rheumatic fever during his childhood. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram showed hypokinetic left ventricular inferolateral wall and mitral stenosis; furthermore, speckle tracking analysis revealed reduction of global longitudinal strain involving the inferior wall. A three-dimensional transesophaegeal echocardiography, performed to better characterize the anatomy of the valve and to find possible source of embolic infarct in an enlarged left atrium, showed rheumatic valvular involvement. Cardiac magnetic resonance confirmed the ischemic damage and also provided prognostic information. A multimodality imaging approach should be mandatory in patients with acute myocardial infarction and normal coronary angiography, to define possible sources of embolic infarction and to quantify myocardial damage

Strategie dell’imaging diagnostico nella gestione di pazienti con angina stabile e rischio intermedio di patologia coronarica: studio comparativo dell’efficacia di tecniche diagnostiche esistenti

Il gold standard per la diagnosi di malattia coronarica (CAD) è l’angiografia coronarica invasiva (ICA): tuttavia in Europa il 38-40% dei pazienti sottoposti ad un’ICA in elezione presenta arterie coronariche esenti da stenosi significative. Le evidenze scientifiche suggeriscono che l’ICA abbia un utilizzo potenzialmente eccessivo dal punto di vista diagnostico, in presenza peraltro di alcune complicanze rare correlate alla procedura, ma ipoteticamente anche letali. La definizione di uno standard diagnostico non invasivo accurato, che abbia la funzione di gatekeeper affidabile per l’esecuzione dell’ICA unicamente nei casi in cui sia effettivamente necessaria, potrebbe ridurre il numero di ICA superflue. Infatti, sebbene il tasso di eventi cardiovascolari avversi maggiori (MACE: morte cardiovascolare, infarto del miocardio non fatale, ictus non fatale) dopo un’ICA sia relativamente basso in elezione (0.65%), non è un dato trascurabile. La metodica non invasiva che meglio permette in vivo la valutazione delle arterie coronarie è l’angiografia coronarica tramite tomografia computerizzata (Cardio-TC). Ad oggi, sebbene l’accuratezza diagnostica (efficacy) della Cardio-TC nello studio della CAD sia stata ampiamente studiata, esiste una scarsa evidenza dei suoi reali benefici nella pratica clinica (effectiveness) in una popolazione selezionata di pazienti con angina stabile e rischio intermedio di CAD al test predittivo. Scopo dello studio è quello di valutare gli eventuali benefici nella pratica clinica dell’utilizzo della Cardio-TC rispetto all’ICA in un gruppo selezionato di pazienti con angina stabile e rischio intermedio. Il fine è quello di dimostrare una riduzione delle complicanze peri-procedurali e dei MACE nei pazienti indirizzati a Cardio-TC. Al contrario di quanto accade nella comune pratica clinica nei casi di angina stabile e rischio intermedio, circa il 50% della nostra popolazione di studio è stata randomizzata alla Cardio-TC invece che all’ICA. Da settembre 2016 ad oggi sono stati reclutati 72 pazienti, di cui 34 indirizzati a Cardio-TC e 38 ad ICA. Dopo la valutazione con Cardio-TC quattro pazienti sono stati indirizzati ad ICA per la presenza all’imaging di una CAD ad alto rischio, confermata in tutti i casi all’ICA. Complicanze intra-procedurali maggiori si sono verificate unicamente in due pazienti del gruppo ICA, quali rispettivamente un’occlusione dell’arteria omerale sinistra ed una dissezione dell’arteria succlavia destra. Le complicanze procedurali minori sono state significativamente più frequenti nel gruppo ICA rispetto al gruppo TC (23,6% versus 2,9%, p=0,01). La Cardio-TC, rispetto all’esecuzione diretta dell’ICA, ha ridotto la necessità di ICA dal 100% dei pazienti all’11,7 % (p minore di 0,001) ed è stata associata in modo significativo anche ad una maggiore resa diagnostica dell’ICA, definita come la proporzione di ICA che hanno mostrato l’effettiva presenza di malattia coronarica ostruttiva (100% versus 15,7%; p minore di 0,001). Dopo un follow-up di 1 anno non si sono verificati MACE nel gruppo Cardio-TC; si sono invece registrati 4 MACE su 38 pazienti (10,5%) nel gruppo ICA (p=0.11). L’esposizione media complessiva alle radiazioni ionizzanti, comprendenti l’ICA e le relative procedure di rivascolarizzazione in entrambi i gruppi, è stata simile tra il gruppo TC (5.1 mSv) ed il gruppo ICA (6.5 mSv; p=0.45). La durata media della degenza dei pazienti nel gruppo ICA è stata di 52,9 ore. Tuttavia, nei pazienti che hanno effettuato l’ICA in seguito ai reperti evidenziati dalla Cardio-TC, si è verificata una riduzione della durata della degenza, passando in media da 52,9 a 30,0 ore rispetto ai pazienti del gruppo ICA (p minore di 0,001). Questo studio preliminare mono-centrico randomizzato ha dimostrato che in pazienti con sintomi di malattia coronarica che richiederebbero un’angiografia coronarica invasiva, la Cardio-TC ha evitato l’ICA in modo sicuro e senza incremento dei MACE a lungo termine, riducendo in modo significativo le complicanze procedurali minori, ma non le maggiori, rispetto all’esecuzione diretta dell’ICA. La Cardio-TC è stata inoltre associata a tassi di ICA ridotti ed ha incrementato il rendimento diagnostico di questa procedura invasiva, tuttavia senza ridurre la dose di esposizione alle radiazioni ionizzanti

Fatty images of the heart: spectrum of normal and pathological findings at computed tomography and cardiac magnetic resonance imaging.

Ectopic cardiac fatty images are not rarely detected incidentally at computed tomography and cardiac magnetic resonance, either in exams focused on the heart as in general thoracic imaging evaluations. A correct interpretation of these findings is essential in order to recognize their normal or pathological meaning, focusing on the eventually associated clinical implications. The development of techniques such as computed tomography and cardiac magnetic resonance allowed a detailed detection and evaluation of adipose tissue within the heart. This pictorial review illustrates the most common characteristics of cardiac fatty images at computed tomography and cardiac magnetic resonance, in a spectrum of normal and pathological conditions ranging from physiological adipose images to diseases presenting with cardiac fatty foci. Physiologic intramyocardial adipose tissue may normally be present in healthy adults, being not related to cardiac affections and without any clinical consequence. However cardiac fatty images may also be the expression of various diseases, comprehending arrhythmogenic right ventricular dysplasia, post-myocardial infarction lipomatous metaplasia, dilated cardiomyopathy and lipomatous hypertrophy of the inter-atrial septum. Fatty neoplasms of the heart as lipoma and liposarcoma are also described

Anticoagulation in Peripheral Artery Disease: Are We There Yet?

Thromboembolism in patients with peripheral artery disease (PAD) represents a common cause of morbidity and mortality. In this article, the authors analyse the use of anticoagulants for patients with PAD. Anticoagulants have been used to reduce the risk of venous thromboembolism, but have recently been applied to the arterial circulation. Heparins were introduced to reduce short-term major adverse limb events in patients undergoing arterial revascularisation. Low molecular weight heparins have allowed easier management and carry a lower risk of bleeding than unfractioned heparin. Vitamin K anticoagulants have been tested in trials that included patients with PAD, showing an increased risk of bleeding when compared with aspirin alone, but longer patency rates for venous surgical bypass, although the evidence remains weak. Those anticoagulants are currently recommended only in patients with PAD who need anticoagulation for other diseases. Direct oral anticoagulants have only recently been investigated for use in patients with PAD. Promising results from low dose rivaroxaban plus aspirin have been recently outlined by a randomised controlled trial and supported by international guidelines

Oral self-injuries: clinical findings in a series of 19 patients

Objectives: Self-injury (SI) is defined as a behavioral disturbance consisting of a deliberate harm to one’s own body without suicidal intent, it is not uncommon and ranges in severity from simple nail-biting to more extreme forms of self-mutilation. The head neck region may be the target of such lesions. SI is associated with several medical conditions, of which it can represent the first clinical sign. Aim of this paper is to describe a series of oral SI, giving special emphasis to the clinical findings, etiology and the management of lesions. Material and Methods: A total of 19 patients with oral SI were prospectively examined; attention was paid to the occurrence and characterization of oral lesions. The management of the lesion also varied depending on the patient medical history, on the etiology of the psychiatric behavior, and on the severity, frequency, and method of inflicting injury. Periodic examinations were performed (after two weeks, three months and six months) and registered. Results: All the patients healed gradually and healing was conditioned by the disease underlying. The treatment consisted of behavior modification in 11 cases, pharmacological treatment in 11 cases, psychotherapy in 2 cases, mouth guard in 9 cases, surgery in 2 cases, extractions in 1 case. Conclusions: Oral SI are uncommon in the clinical practice. They may be associated with a known disease or may be the consequence of this, but often they may be the first sign of a psychiatric disorder

Room temperature Bloch surface wave polaritons

Polaritons are hybrid light-matter quasi-particles that have gathered a significant attention for their capability to show room temperature and out-of-equilibrium Bose-Einstein condensation. More recently, a novel class of ultrafast optical devices have been realized by using flows of polariton fluids, such as switches, interferometers and logical gates. However, polariton lifetimes and propagation distance are strongly limited by photon losses and accessible in-plane momenta in usual microcavity samples. In this work, we show experimental evidence of the formation of room temperature propagating polariton states arising from the strong coupling between organic excitons and a Bloch surface wave. This result, which was only recently predicted, paves the way for the realization of polariton devices that could allow lossless propagation up to macroscopic distances

Multifunctional bioinspired sol-gel coatings for architectural glasses

Although several multinational companies have recently released products incorporating bioinspired functional coatings, their practical integration in building envelopes is still an open issue. High production costs associated to the existing vacuum deposition technologies, as well as the difficulties in extending the number of functions achievable by a single coating, represent to date the main limitations to their diffusion on a large scale. This review summarizes the key topics in the field of functional coatings for architectural glasses, focusing in particular on the potential applications of sol-gel based antireflective and self-cleaning coatings, that have received a tremendous attention in the last years. It provides an overview of the recent research efforts aimed to improve their properties and to extend their range of applicability. The bioinspired principles, upon which such coatings are based, are also described and are related to the chemical and morphological properties of such surfaces. (C) 2009 Elsevier Ltd. All rights reserved

Ultrafast flow of interacting organic polaritons

The strong-coupling of an excitonic transition with an electromagnetic mode results in composite quasi-particles called exciton-polaritons, which have been shown to combine the best properties of their bare components in semiconductor microcavities. However, the physics and applications of polariton flows in organic materials and at room temperature are still unexplored because of the poor photon confinement in such structures. Here we demonstrate that polaritons formed by the hybridization of organic excitons with a Bloch Surface Wave are able to propagate for hundreds of microns showing remarkable third-order nonlinear interactions upon high injection density. These findings pave the way for the studies of organic nonlinear light-matter fluxes and for a technological promising route of dissipation-less on-chip polariton devices working at room temperature.Comment: Improved version with polariton-polariton interactions. 13 pages, 4 figures, supporting 6 pages, 6 figure

Highly efficient smart photovoltachromic devices with tailored electrolyte composition

Driven by the tremendous opportunities offered by dye solar cells technology in terms of building integration, a new generation of smart multifunctional photoelectrochemical cells has the potential to attract the interest of a rapidly growing number of research institutions and industrial companies. Photovoltachromic devices are capable to produce a smart modulation of the optical transmittance and, at the same time, to generate electrical power by means of solar energy conversion. In this work, a specifically designed bifunctional counterelectrode has been realized by depositing a C-shaped platinum frame which bounds a square region occupied by a tungsten oxide (WO3) film onto a transparent conductive substrate. These two regions have been electrically separated to make possible distinct operations on one or both of the available circuits. Such an unconventional counterelectrode makes it possible to achieve a twofold outcome: a smart and fast-responsive control of the optical transmittance and a relatively high photovoltaic conversion efficiency. In particular we investigated the effect of the electrolyte composition on both photoelectrochromic and photovoltaic performances of such devices by systematically tuning the iodide content in the electrolyte. The best result was obtained by filling the cell with an iodine concentration of 0.005 M: a coloration efficiency of 61.10 cm(2) C-1 at a wavelength of 780 nm and, at the same time, a photovoltaic conversion efficiency of 6.55% have been reported

Durable superhydrophobic and antireflective surfaces by trimethylsilanized silica nanoparticles-based sol-gel processing.

We present a robust and cost-effective coating method to fabricate long-term durable superhydrophobic, and-simultaneously-antireflective surfaces by a double-layer coating comprising trimethylsiloxane (TMS) surface-functionalized silica nanoparticles partially embedded into an organosilica binder matrix produced through a sol-gel process. A dense and homogeneous organosilica gel layer was First coated onto a glass substrate, and then, a trimethylsilanized nanospheres-based superhydrophobic layer was deposited onto it. After thermal curing, the two layers turned into a monolithic film, and the hydrophobic nanoparticles were permanently fixed to the glass substrate. Such treated surfaces showed a tremendous water repellency (contact angle = 168 degrees) and stable self-cleaning effect during 2000 h of outdoor exposure. Besides this, nanotextured topology generated by the self-assembled nanoparticles-based top layer produced a fair antireflection effect consisting of more than a 3% increase in optical transmittance