Reduced Mortality With Antiplatelet Therapy Deescalation After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis

Background:Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. Methods:We performed a pairwise meta-analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. Results:The meta-analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P=0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P<0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P=0.14). Conclusions:In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events

RUOLO DEI MicroRNA IN DIVERSI FENOTIPI DI STENOSI VALVOLARE AORTICA

La Stenosi Valvolare Aortica (SVA) calficico-degenerativa rappresenta la patologia valvolare più comune nei paesi occidentali. La sua incidenza è destinata ad aumentare come conseguenza sia del progressivo aumento dell’aspettativa di vita sia a causa del concomitante aumento di prevalenza della malattia aterosclerotica, cui è eziologicamente correlata. La progressione dalle forme di ostruzione lieve a severa è spesso graduale e si accompagna al lento instaurarsi di alterazioni fisiopatologiche a livello ventricolare sinistro dovute al sovraccarico pressorio, come l’ ipertrofia concentrica e la progressiva fibrosi tissutale. Nella patogenesi della stenosi concorrono sia triggers meccanici che fattori genetici e la fibrosi miocardica sostitutiva contribuisce in maniera determinante all’insorgenza della disfunzione ventricolare diastolica nonché comporta una riduzione dell’inotropismo cardiaco che sfocia in uno stato di scompenso cardiaco cronico. Al giorno d’oggi, le indicazioni all’ intervento di sostituzione valvolare sono poste in presenza di SVA di entità severa, all’insorgenza di sintomi tipici o al manifestarsi di una riduzione della Frazione di Eiezione al di sotto di un cut-off (FE<50%). Tuttavia, la comparsa di sintomi e la riduzione della FE si associano ad alterazioni della contrattilità e modificazioni del tessuto miocardico che a volte non sono reversibili dopo intervento. Inoltre, i parametri emodinamici in uso per definire la severità della SVA sembrano essere limitati per la flusso-dipendenza e spesso discordanti; la FE non è un indicatore abbastanza sensibile di funzionalità sistolica e nel paziente anziano per la presenza di comorbidità è difficile correlare i sintomi alla malattia. Per poter ottimizzare la gestione dei pazienti con SVA, un valido contributo potrebbe essere dato dalle nuove metodiche di imaging e dai biomarcatori plasmatici in grado di valutare l’entità della compromissione miocardica e il remodeling cardiaco causato dalla SVA sin dalle fasi precoci. La biopsia endomiocardica rappresenta il gold-standard per quantificare il contenuto di collagene miocardico,sebbene, ad oggi, le moderne metodiche di imaging ecocardiografico come lo Speckle Tracking Imaging (2D-STI) consentano una valutazione accurata della deformazione miocardica e indirettamente delle alterazioni tissutali che caratterizzano questi pazienti, con buona correlazione con i dati istologici. Tra i più recenti e innovativi biomarcatori valutabili a livello plasmatico rientrano i microRNA (miRNA), piccoli RNA non codificanti messi in circolo tramite microvescicole, che costituiscono il pool circolante di una componente tissutale espressa in vari apparati, fra cui il sistema cardiovascolare. I miRNA agiscono come modulatori negativi dell’espressione genica mediante l’inibizione della traduzione proteica per interferenza con l’RNA messaggero e dato che il loro profilo di espressione risulta alterato in diversi processi fisiopatologici inclusa la fibrogenesi, è stato supposto il loro ruolo come potenziali biomarcatori. Poichè il decadimento progressivo della funzionalità ventricolare è correlato alla progressiva ipertrofia miocardica e alla fibrosi, l’utilizzo del 2D-STI e dei miRNA quali markers di fibrosi permette in maniera rapida e non invasiva di identificare sin dalle fasi precoci le lesioni tissutali. In questo modo si pone attenzione non solo agli indici valvolari o flusso-dipedenti, ma anche al miocardio e alle sue alterazioni,in funzione dell’ottimizzazione della gestione e del trattamento dei pazienti con SVA severa

A Novel Design for Flexible and Conformable 3D-Printed Dielectric Resonator Antennas for WiFi and IoT Applications

The realization of flexible and conformable antennas, suitable for IoT applications, is still a challenging activity. The traditional manufacturing techniques, mostly based on Silicon, rarely allow to realize such devices. Nevertheless, additive manufacturing technologies are good candidates to fulfill such a need, while enabling, in the meantime, the production of otherwise unrealizable geometries. In this paper a new design for a flexible, and conformable Rectangular Dielectric Resonator Antenna, working at 2.45 GHz, enabled by 3D printing, is proposed. Its feasibility is demonstrated by indicating how any part of the prototype could be properly manufactured. Eventually, simulated results proving the performance of the antenna in terms of stability, radiation efficiency, and gain (straight, concave, and convex) are reported and discussed. © 2022 IEEE

Dielectric Resonators Antennas Potential Unleashed by 3D Printing Technology: A Practical Application in the IoT Framework

One of the most promising and exciting research fields of the last decade is that of 3D-printed antennas, as proven by the increasing number of related scientific papers. More specifically, the most common and cost-effective 3D printing technologies, which have become more and more widespread in recent years, are particularly suitable for the development of dielectric resonator antennas (DRAs), which are very interesting types of antennas exhibiting good gain, excellent efficiency, and potentially very small size. After a brief survey on how additive manufacturing (AM) can be used in 3D printing of antennas and how much the manufacturing process of DRAs can benefit from those technologies, a specific example, consisting of a wideband antenna operating at 2.4 GHz and 3.8 GHz, was deeply analyzed, realized, and tested. The obtained prototype exhibited compact size (60 × 60 × 16 mm3, considering the whole antenna) and a good agreement between measured and simulated S11, with a fractional bandwidth of 46%. Simulated gain and efficiency were also quite good, with values of 5.45 dBi and 6.38 dBi for the gain and 91% and 90% for the efficiency, respectively, at 2.45 GHz and 3.6 GHz

Analysis of FDM and DLP 3D-Printing Technologies to Prototype Electromagnetic Devices for RFID Applications

In this work, the application in Radiofrequency Identification (RFID) of different additive manufacturing (AM) 3D-printing technologies is discussed. In particular, the well-known Fused Deposition Modeling (FDM) technology is compared with the promising Digital Light Processing (DLP), which is based on the photopolymerization of liquid resins. Based on the research activity of the authors on this topic, a brief introduction to the fundamentals of 3D-printing in electromagnetics as well as to the different applications of both FDM and DLP in realizing Radio Frequency (RF) devices, is firstly given. Then, a comparison of the two technologies is deeply faced. Finally, after evaluated the rugosity of substrates produced with both techniques to verify the potential impact on the design of electromagnetic structures, the two techniques are both exploited for the realization of the dielectric parts of a tunable RFID tag with unconventional shape. It consists of two elements interlinked one each other. The movement between them enables tuning of the resonance frequency as well as the impedance of the antenna. Despite the differences in terms of losses, rugosity, resolution, and dielectric constant, both techniques guaranteed satisfactory values of tag sensitivity, maximum reading range, and tunability. Nevertheless, the careful analysis of the results proposed at the end of the paper suggests how the selection of one technique over the other must be taken considering the specific application constraints

Fully 3D-printed UHF RFID Antennas: Technological Comparison to Realize Conductive Elements

In this work, two promising Additive Manufacturing (AM)/3D-printing technologies, enable to realize conductive elements, are analysed, and compared with respect to the realisation of RFID applications. The selected techniques are the Fused Filament Fabrication (FFF) and Aerosol Jet® Printing (AJ® P), which have been compared, for the first time, by measuring the performance of an UHF RFID tag, specifically designed and realized for the scope. Results have also been analysed against to data obtained by a reference sample realized using the well-known technique of shaping an aluminium adhesive foil with a cutting plotter. While the resulting FFF-made tag can be read up to maximum 3 meters, the AJ® P one can be read up to 7 meters. Despite having major differences in terms of performance, this work demonstrates that both the technologies are capable to realize functional RFID prototypes

Evaluating the Effectiveness of Planar and Waveguide 3D-Printed Antennas Manufactured Using Dielectric and Conductive Filaments

3D printing is a technology suitable for creating electronics and electromagnetic devices. However, the manufacturing of both dielectric and conductive parts in the same process still remain a challenging task. This study explores the combination of 3D printing with traditional manufacturing techniques for antenna design and fabrication, giving the designer the advantage of using the additive manufacturing technology only to implement the most critical parts of a certain structure, ensuring a satisfying electromagnetic performance, but limiting the production cost and complexity. In the former part of the study, the focus is on three proximity-coupled patch antennas. It demonstrates how hybrid devices made of metal, dielectric, and 3D-printed (using Fused Filament Fabrication) conductive polymers can be successfully simulated and created for different operating frequency bands. In the latter part, the study compares three prototypes of a 5G-NR, high gain, and wideband waveguide antenna: respectively a fully 3D printed one made of electrifi (which is the most conductive commercial 3D-printable filament), an all-metal one, and a hybrid (3D-printed electrifi &#x0026; metal) one. The results show a 15&#x0025; reduction in efficiency when using the all-Electrifi configuration compared to all-metal one, and a 4-5&#x0025; reduction when using the hybrid version

Designing UHF RFID tag antennas with barcode shape for dual-technology identification

International audienc

Designing UHF RFID tag antennas with Barcode shape for dual-technology identification

International audienc