Recanalization of the Native Artery in Patients with Bypass Failure

Our objective was to evaluate the possible role of endovascular recanalization of occluded native artery after a failed bypass graft in the case of either acute or chronic limb-threatening ischemia otherwise leading to amputation. In a single-center retrospective clinical analysis, from January 2004 to March 2007 we collected 31 consecutive high-surgical-risk patients (32 limbs) with critical limb ischemia following late ([30 days after surgery) failure of open surgery bypass graft reconstruction. All patients deemed unfit for surgery underwent tentative endovascular recanalization of the native occluded arterial tract. The mean follow-up period was 24 (range, 6–42) months. Technical success was achieved in 30 (93.7%) of 32 limbs. The cumulative primary assisted patency calculated by Kaplan–Meyer analysis was 92% and 88%, respectively, at 12 and 24 months. The limb salvage rate approached 90% at 30 months. In conclusion, our experience shows the feasibility of occluded native artery endovascular recanalization after a failed bypass graft, with optimal results in terms of midterm arterial patency and limb salvage. Our opinion is that successful recanalization of the arterial tract previously considered unsuitable for endovascular approach is allowed by improved competency and experience of vascular specialists, as well as the advances made in catheter and guidewire technology. This group of patients would previously have been relegated to repeat bypass grafts, with their inherently inferior patency and recognized added technical demands. We recognize previous surgical native artery disconnection and lack of pedal runoff to be the main cause of technical failure. Keywords Native artery Bypass failure Endovascular recanalizatio

Increasing vaccination intention in pandemic times: a social marketing perspective

With the release of several COVID-19 vaccines, hopes for ending the pandemic have emerged. However, the uptake of the vaccines is largely voluntary and depends on the intentions of the public. From a social marketing perspective, this study takes the case of Italy to identify and test factors that are likely to increase COVID-19-vaccine intention. A sample of 3893 respondents was collected throughout Italy and a model empirically tested by structural equation modeling. The findings suggest that a social marketing campaign for undertaking COVID-19 vaccines should educate the public, going beyond just safety and efficacy, and create positive social norms by combatting misinformation on various platforms, including social media. Furthermore, it was found that economic hardship from COVID-19 does not automatically translate to vaccination intention and that social marketing campaigns should particularly target economically vulnerable and important segments. Also, instilling a craving for travel could potentially stimulate citizens to undertake COVID-19 inoculation. Finally, contributions and implications for social marketing COVID-19 vaccines in Italy and elsewhere are addressed

Mechanical analysis of the ENEA TF coil proposal for the EU DEMO fusion reactor

The design of the superconducting magnet system of the European DEMO fusion reactor is currently being pursued in the framework of the EUROfusion Magnets Work Package (WPMAG). Three alternative winding pack (WP) options for the Toroidal Field Coils (TFCs) are being proposed by different research units, each featuring a different conductor manufacturing technology (react-and-wind vs. wind-and-react) or winding layout (layer vs. pancake). One of the options (namely, WP#2), proposed by Italian ENEA, features a layer-wound WP design adopting a wind-and-react conductor with rectangular cross section with high aspect ratio, obtained squeezing an initially circular conductor. In order to assess the capability of all the TFC components to withstand the electromagnetic loads due to the huge Lorentz forces without any structural failure during the magnet lifetime, the mechanical analysis of the 2016 version of the WP#2 design option is performed here applying a hierarchical approach herein defined as the Stress Recovery Tool (SRT): the Finite Element Analysis (FEA) of a whole magnet (including the casing) is performed at a low computational cost adopting a coarse WP model with smeared (homogenized) properties. The displacements computed on the smeared WP are then used as boundary conditions for a refined FEA of some WP slices, located in selected (critical) poloidal positions, where all the conductors detailed features (jacket, insulations) are properly accounted for

Surgical management of breast cancer in BRCA mutation carriers: A single centre experience

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Artificial intelligence weights the importance of factors predicting complete cytoreduction at secondary cytoreductive surgery for recurrent ovarian cancer

Objective: Accumulating evidence support that complete cytoreduction (CC) at the time of secondary cytoreductive surgery (SCS) improves survival in patients affected by recurrent ovarian cancer (ROC). Here, we aimed to determine whether artificial intelligence (AI) might be useful in weighting the importance of clinical variables predicting CC and survival. Methods: This is a retrospective study evaluating 194 patients having SCS for ROC. Using artificial neuronal network (ANN) analysis was estimated the importance of different variables, used in predicting CC and survival. ANN simulates a biological neuronal system. Like neurons, ANN acquires knowledge through a learning-phase process and allows weighting the importance of covariates, thus establishing how much a variable influences a multifactor phenomenon. Results: Overall, 82.9% of patients had CC at the time of SCS. Using ANN, we observed that the 3 main factors driving the ability of achieve CC included: disease-free interval (DFI) (importance: 0.231), retroperitoneal recurrence (importance: 0.178), residual disease at primary surgical treatment (importance: 0.138), and International Federation of Gynecology and Obstetrics (FIGO) stage at presentation (importance: 0.088). Looking at connections between different covariates and overall survival (OS), we observed that DFI is the most important variable influencing OS (importance: 0.306). Other important variables included: CC (importance: 0.217), and FIGO stage at presentation (importance: 0.100). Conclusion: According to our results, DFI should be considered as the most important factor predicting both CC and OS. Further studies are needed to estimate the clinical utility of AI in providing help in decision making process

Inspiratory Muscle Training Improves Blood Flow to Resting and Exercising Limbs in Patients With Chronic Heart Failure

ObjectivesWe tested the hypothesis that inspiratory muscle loading could result in exaggerated peripheral vasoconstriction in resting and exercising limbs and that inspiratory muscle training (IMT) could attenuate this effect in patients with chronic heart failure (CHF) and inspiratory muscle weakness.BackgroundInspiratory muscle training improves functional capacity of patients with CHF, but the mechanisms of this effect are unknown.MethodsEighteen patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) and 10 healthy volunteers participated in the study. Inspiratory muscle loading was induced by the addition of inspiratory resistance of 60% of maximal inspiratory pressure, while blood flow to the resting calf (CBF) and exercising forearm (FBF) were measured by venous occlusion plethysmography. For the patients with CHF, blood flow measurements as well as ultrasound determination of diaphragm thickness were made before and after a 4-week program of IMT.ResultsWith inspiratory muscle loading, CHF patients demonstrated a more marked reduction in resting CBF and showed an attenuated rise in exercising FBF when compared with control subjects. After 4 weeks of IMT, CHF patients presented hypertrophy of the diaphragm and improved resting CBF and exercise FBF with inspiratory muscle loading.ConclusionsIn patients with CHF and inspiratory muscle weakness, inspiratory muscle loading results in marked reduction of blood flow to resting and exercising limbs. Inspiratory muscle training improves limb blood flow under inspiratory loading in these patients

Social media use and impact during the holiday travel planning process

Through an empirical study among holiday travellers, residing in the Former Soviet Union Republics, this paper presents a comprehensive view of role and impact of social media on the whole holiday travel planning process: Before, during and after the trip, providing insights on usage levels, scope of use, level of influence and trust. Findings suggest that social media are predominantly used after holidays for experience sharing. It is also shown that there is a strong correlation between perceived level of influence from social media and changes made in holiday plans prior to final decisions. Moreover, it is revealed that user-generated content is perceived as more trustworthy when compared to official tourism websites, travel agents and mass media advertising