Probing Active Sites During Palladium-Catalyzed Alcohol Oxidation in "Supercritical” Carbon Dioxide

Structural information has been gained during aerobic benzyl alcohol oxidation in "supercritical” carbon dioxide at 150 bar on alumina-supported palladium by X-ray absorption spectroscopy while monitoring simultaneously the performance of the catalyst. The reduction of the catalyst by benzyl alcohol could be monitored by the analysis of the near-edge region of the Pd K-edge. The palladium constituent was mainly in metallic state under operating conditions. Partial reoxidation was observed when only oxygen in "supercritical” carbon dioxide in the absence of alcohol was fed. The catalytic activity of the PdOx/Al2O3 catalyst during benzyl alcohol oxidation was comparable to that in a conventional continuous fixed-bed reactor and depended on the oxygen concentration in the feed. The rate of alcohol conversion went through a maximum when the oxygen concentration was increased. At maximum rate, part of the palladium was in the oxidized state. Upon further increase of the oxygen concentration, the activity decreased because of the formation of surface palladium oxide. The reaction rate in "supercritical” carbon dioxide was strikingly higher than that observed for the corresponding liquid-phase oxidatio

Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique

Background: The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2-incision technique has been recently adopted. Aims: We assessed acute defibrillation efficacy (DE) of S-ICD (DE ≤65 J) according to the implantation technique. Methods: We analyzed consecutive patients who underwent S-ICD implantation and DE testing at 53 Italian centers. Regression analysis was used to determine the association between DFT and implantation technique. Results: A total of 805 patients were enrolled. Four groups were assessed: IM + 2 incisions (n = 546), SC + 2 incisions (n = 133), SC + 3 incisions (n = 111), and IM + 3 incisions (n = 15). DE was ≤65 J in 782 (97.1%) patients. Patients with DE ≤65 J showed a trend towards lower body mass index (25.1 vs. 26.5; p = .12), were less frequently on antiarrhythmic drugs (13% vs. 26%; p = .06) and more commonly underwent implantation with the 2-incision technique (85% vs. 70%; p = .04). The IM + 2-incision technique showed the lowest defibrillation failure rate (2.2%) and shock impedance (66 Ohm, interquartile range: 57-77). On multivariate analysis, the 2-incision technique was associated with a lower incidence of shock failure (hazard ratio: 0.305; 95% confidence interval: 0.102-0.907; p = .033). Shock impedance was lower with the IM than with the SC approach (66 vs. 70 Ohm p = .002) and with the 2-incision than the 3-incision technique (67 vs. 72 Ohm; p = .006). Conclusions: In a large population of S-ICD patients, we observed a high defibrillation success rate. The IM + 2-incision technique provides lower shock impedance and a higher likelihood of successful defibrillation

Probing active sites during palladium-catalyzed alcohol oxidation in "supercritical'' carbon dioxide

ISSN:1011-372XISSN:1572-879

Closed-Loop Transcranial Electrical Neurostimulation for Sustained Attention Enhancement: A Pilot Study towards Personalized Intervention Strategies

Sustained attention is pivotal for tasks like studying and working for which focus and low distractions are necessary for peak productivity. This study explores the effectiveness of adaptive transcranial direct current stimulation (tDCS) in either the frontal or parietal region to enhance sustained attention. The research involved ten healthy university students performing the Continuous Performance Task-AX (AX-CPT) while receiving either frontal or parietal tDCS. The study comprised three phases. First, we acquired the electroencephalography (EEG) signal to identify the most suitable metrics related to attention states. Among different spectral and complexity metrics computed on 3 s epochs of EEG, the Fuzzy Entropy and Multiscale Sample Entropy Index of frontal channels were selected. Secondly, we assessed how tDCS at a fixed 1.0 mA current affects attentional performance. Finally, a real-time experiment involving continuous metric monitoring allowed personalized dynamic optimization of the current amplitude and stimulation site (frontal or parietal). The findings reveal statistically significant improvements in mean accuracy (94.04 vs. 90.82%) and reaction times (262.93 vs. 302.03 ms) with the adaptive tDCS compared to a non-stimulation condition. Average reaction times were statistically shorter during adaptive stimulation compared to a fixed current amplitude condition (262.93 vs. 283.56 ms), while mean accuracy stayed similar (94.04 vs. 93.36%, improvement not statistically significant). Despite the limited number of subjects, this work points out the promising potential of adaptive tDCS as a tailored treatment for enhancing sustained attention

A BPMN-based Framework to Manage ERAS-inspired Pathway for Patients Undergoing Pancreatic Surgery

It has been proved that patients on the way to pancreatic surgery could benefit from a set of activities to improve their psycho-physical status. The Enhanced Recovery After Surgery (ERAS) program is a proven set of evidence-based activities to support the perioperative pathway of patients. On the other hand, the Business Process Model and Notation (BPMN) is able to describe complex process semantics in an intuitive notation that constitutes a common language between different stakeholders. Finally, web-based applications could help clinicians to monitor, support, and manage patients in the perioperative stage, enabling communications with surgeons, psychologists, nutritionists, and physiatrists.In this paper, we propose a framework to model an ERAS-inspired prehabilitation program as BPMN processes, which includes activities in four macro areas: surgery, nutrition, physical activity, and psychology. We also propose Fit to Fight, a process-driven web application (built from scratch) that executes and manages the processes in conjunction with a BPMN process engine. Activities are scheduled during a 30 days time-frame, and the underlying processes implement a fine set of temporal constraints to ensure it. The prehabilitation program considered is the one currently adopted by the Unit of Pancreatic Surgery at the Verona University Hospital, which is part of the Verona Pancreas Institute, the first interdisciplinary center of excellence for diagnosing and treating pancreatic diseases in Italy. Thanks to this close collaboration, we adopted the agile methodology where the prehabilitation program modeling and the web application development were made with the clinicians’ continuous involvement. Finally, we developed an elaborated yet user-friendly and responsive interface to present the activities to patients

Assessing access to MRI of patients with magnetic resonance-conditional pacemaker and implantable cardioverter defibrillator systems: the Really ProMRI study design

Background Despite the fact that magnetic resonance (MR)-conditional pacemaker and lead systems have been introduced more than 5 years ago, it is still not clear whether they have actually facilitated the access of pacemaker patients to this important diagnostic tool. Factors limiting MR scans in daily practice in patients with MR-conditional cardiac implantable electronic device (CIED) systems may be related to organizational, cultural and sometimes legal aspects. The Really ProMRI registry is an ongoing survey designed to assess the annual rate of MR examinations in patients with MR-conditional implants, with either pacemakers or implantable cardioverter defibrillators, and to detect the main factors limiting MRI. Methods The primary endpoint of the Really ProMRI registry is to assess the current access to MRI of patients with MR-conditional pacemaker or implantable cardioverter defibrillator systems during normal practice. Data in the literature reported a 17% annual incidence of medical conditions requiring MRI in CIED patients. The Really ProMRI registry has been designed to detect 4.5% absolute difference with an 80% statistical power, by recruiting 600 patients already implanted with MR-conditional CIED implant. Patients will be followed up for 1 year, during which they will be asked to refer any prescription, execution or denial of an MR examination by patient questionnaires and original source documents. Conclusion The ongoing Really ProMRI registry will assess the actual rate of and factors limiting the access to MRI for patients with MR-conditional CIEDs

Time to therapy delivery and effectiveness of subcutaneous implantable cardioverter-defibrillator

BACKGROUND: At the time of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, successful termination of ventricular fibrillation (VF) is confirmed. A previous study reported cases of prolonged time to therapy during defibrillation testing. OBJECTIVE: We sought to evaluate the time to therapy, identify possible predictors of delay and investigate the impact of delayed therapy on VF conversion. METHODS: We analyzed consecutive S-ICD patients who underwent initial conversion testing at a shock energy of 65J in 53 Italian centers. RESULTS: We analyzed 570 patients (82% male, 48±15 years, BMI 25±6Kg/m2, ejection fraction 47±17%). General anesthesia was used in 29% of patients, with sub-/inter-muscular positioning of the generator in 74%. Cardioversion was successful at 65J in 97.7% of patients. In 12 patients the shock did not convert VF and in 1 patient the shock was not delivered due to noise from entrapped subcutaneous air. All failures were successfully managed by reprogramming or repositioning the device. The mean time to therapy was 15±3s and it exceeded 18s in 51 (9%) patients. Independent predictors of delayed therapy (>18s) were ejection fraction (OR, 0.98; 95%CI, 0.96-0.99; p=0.016) and a 2x gain programmed (OR, 3.66; 95%CI, 1.44-9.30; p=0.006). Effectiveness at 65J was not associated with the time to therapy (OR, 1.13; 95%CI, 0.97-1.32; p=0.122). CONCLUSIONS: In this analysis of a large population of S-ICD patients, delayed therapy during defibrillation testing occurred less frequently than previously reported and had no effect on VF conversion success. Delayed therapies seemed more common when a vector with 2x gain was programmed

Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Women: A Propensity Score-Matched Analysis

Background: Causes of sex differences in incidence of sustained ventricular arrhythmias (SVAs) are poorly understood. Objectives: This study aims to investigate sex-specific risk of SVAs and device therapies by balancing sex groups in relation to several baseline characteristics with the propensity score (PS). Methods: We used a large remote monitoring dataset from implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds). Study endpoints were time to the first appropriate SVA, time to the first device therapy for SVA, and time to the first ICD shock. Results were compared between females and a PS-matched male subgroup. Results: In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. After selecting 488 men PS-matched for 19 variables relative to baseline demographics, implant indications, principal comorbidities, and concomitant therapy, yet the SVA rate at the 2.1-year median follow-up was significantly lower in women than in man (adjusted HR: 0.65; 95% CI: 0.51-0.81; P < 0.001). Women also showed a reduced risk of any device therapy (HR: 0.59; 95% CI: 0.45-0.76; P < 0.001) and shocks (HR: 0.66; 95% CI: 0.47-0.94; P = 0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR: 0.78; 95% CI: 0.55-1.09; P = 0.14) nor in those with an ejection fraction <30% (HR: 0.80; 95% CI: 0.52-1.23; P = 0.31). Conclusions: After matching demographics, indications, principal comorbidities, and concomitant therapy, women still exhibited a lower SVA risk profile than men, except in the subgroups of CRT-D or/and ejection fraction <30%

Intermuscular technique for implantation of the subcutaneous implantable defibrillator: a propensity-matched case-control study

Aims: A previous randomized study demonstrated that the subcutaneous implantable cardioverter defibrillator (S-ICD) was noninferior to transvenous ICD with respect to device-related complications and inappropriate shocks. However, that was performed prior to the widespread adoption of pulse generator implantation in the intermuscular (IM) space instead of the traditional subcutaneous (SC) pocket. The aim of this analysis was to compare survival from device-related complications and inappropriate shocks between patients who underwent S-ICD implantation with the generator positioned in an IM position in comparison with an SC pocket. Methods and results: We analysed 1577 consecutive patients who had undergone S-ICD implantation from 2013 to 2021 and were followed up until December 2021. Subcutaneous patients (n = 290) were propensity matched with patients of the IM group (n = 290), and their outcomes were compared. : During a median follow-up of 28 months, device-related complications were reported in 28 (4.8%) patients and inappropriate shocks were reported in 37 (6.4%) patients. The risk of complication was lower in the matched IM group than in the SC group [hazard ratio 0.41, 95% confidence interval (CI) 0.17-0.99, P = 0.041], as well as the composite of complications and inappropriate shocks (hazard ratio 0.50, 95% CI 0.30-0.86, P = 0.013). The risk of appropriate shocks was similar between groups (hazard ratio 0.90, 95% CI 0.50-1.61, P = 0.721). There was no significant interaction between generator positioning and variables such as gender, age, body mass index, and ejection fraction. Conclusion: Our data showed the superiority of the IM S-ICD generator positioning in reducing device-related complications and inappropriate shocks. Clinical trial registration: Clinical Trial Registration: ClinicalTrials.gov; NCT02275637