Use of bivalirudin for heparin-induced thrombocytopaenia after thrombolysis in massive pulmonary embolism: a case report

A 68-year-old man was referred to the emergency department 6 h after onset of sudden acute dyspnoea. Immediate ECG showed sinus tachycardia with the typical S1-Q3-T3 pattern and incomplete right bundle branch block. The echocardiogram showed the presence of mobile thrombus in the right atrium, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Lung spiral computed tomography (CT) showed bilateral pulmonary involvement and confirmed the picture of a thrombotic system in the right atrium and caval vein. Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) and heparin (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Six hours after thrombolysis bleeding gums and significant reduction in platelet count (around 50,000) were observed. Heparin was discontinued and bivalirudin (0.1 mg/kg bolus and 1.75 mg/kg per h infusion) plus warfarin was initiated and continued for 5 days until the international normalised ratio (INR) was within the therapeutic range (2.0–3.0) for 2 consecutive days, with concomitant platelet count normalisation. Lung spiral and lower abdominal CT before discharge did not show the presence of clots in the pulmonary arteries of the right and left lung. This case suggests that bivalirudin could offer promise for use in patients with heparin-induced thrombocytopaenia (HIT) after thrombolysis for massive pulmonary embolism

Thrombolysis for massive pulmonary embolism in pregnancy: a case report

Mortality from pulmonary embolism (PE) in pregnancy might be related to challenges in targeting the right population for prevention. Such targeting could help ensure that the correct diagnosis is suspected and adequately investigated, and allow the initiation of the timely and best possible treatment of this disease. In the literature to date only 18 case reports of thrombolysis in pregnant women with PE have been reported, and showed beneficial effects for both mother and fetus in terms of mortality and complications with acceptable bleeding risks. We present here the case of a pregnant patient with massive PE who underwent successful thrombolysis. A 26-year-old pregnant (at 24 weeks) woman was admitted 4 h after onset of sudden acute dyspnea and chest pain. An immediate electrocardiogram showed a typical S1-Q3-T3 pattern. The echocardiogram showed a distended right ventricle with free-wall hypokinesia and displacement of the interventricular septum toward the left ventricle. Thrombolysis with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Pelvic examination and ultrasound showed regular fetal heart beat, and regular placental and liquid presence. No problems developed for the mother or fetus in the subsequent days or at discharge. In conclusion, in pregnant patients with life-threatening massive PE, thrombolytic therapy can be administered, and the use of echocardiographic, laboratory, and clinical data can be useful tools to achieve a rapid diagnosis and make a therapeutic decision, but additional studies need to be performed to further define its use

Physiological compatibility of wireless chargers for electric bicycles

The Inductive Power Transfer represents a viable solution of wireless battery charging for all users of electric mobility. This method brings some benefits to the electric vehicles, being a convenient technique, compared to the conventional wire-based battery charging. Among the electric vehicles, the electric bicycles particularly fit with this innovative method of battery charging. Nevertheless, the physiological effects of the produced magnetic fields need to be taken into account. In this paper, the design of an Inductive Power Transfer system for E-bike wireless battery charging is presented and the measurements concerning the surrounding magnetic field are provided in order to validate the model and evaluate the physiological compatibility of the system

Pd-Co-Based Electrodes for Hydrogen Production by Water Splitting in Acidic Media

To realize the benefits of a hydrogen economy, hydrogen must be produced cleanly, efficiently and affordably from renewable resources and, preferentially, close to the end-users. The goal is a sustainable cycle of hydrogen production and use: in the first stage of the cycle, hydrogen is produced from renewable resources and then used to feed a fuel cell. This cycle produces no pollution and no greenhouse gases. In this context, the development of electrolyzers producing high-purity hydrogen with a high efficiency and low cost is of great importance. Electrode materials play a fundamental role in influencing electrolyzer performances; consequently, in recent years considerable efforts have been made to obtain highly efficient and inexpensive catalyst materials. To reach both goals, we have developed electrodes based on Pd-Co alloys to be potentially used in the PEMEL electrolyzer. In fact, the Pd-Co alloy is a valid alternative to Pt for hydrogen evolution. The alloys were electrodeposited using two different types of support: carbon paper, to fabricate a porous structure, and anodic alumina membrane, to obtain regular arrays of nanowires. The goal was to obtain electrodes with very large active surface areas and a small amount of material. The research demonstrates that the electrochemical method is an ideal technique to obtain materials with good performances for the hydrogen evolution reaction. The Pd-Co alloy composition can be controlled by adjusting electrodeposition parameters (bath composition, current density and deposition time). The main results concerning the fabrication process and the characterization are presented and the performance in acid conditions is discussed

Pd–Co-Based Electrodes for Hydrogen Production by Water Splitting in Acidic Media

To realize the benefits of a hydrogen economy, hydrogen must be produced cleanly, efficiently and affordably from renewable resources and, preferentially, close to the end-users. The goal is a sustainable cycle of hydrogen production and use: in the first stage of the cycle, hydrogen is produced from renewable resources and then used to feed a fuel cell. This cycle produces no pollution and no greenhouse gases. In this context, the development of electrolyzers producing high-purity hydrogen with a high efficiency and low cost is of great importance. Electrode materials play a fundamental role in influencing electrolyzer performances; consequently, in recent years considerable efforts have been made to obtain highly efficient and inexpensive catalyst materials. To reach both goals, we have developed electrodes based on Pd–Co alloys to be potentially used in the PEMEL electrolyzer. In fact, the Pd–Co alloy is a valid alternative to Pt for hydrogen evolution. The alloys were electrodeposited using two different types of support: carbon paper, to fabricate a porous structure, and anodic alumina membrane, to obtain regular arrays of nanowires. The goal was to obtain electrodes with very large active surface areas and a small amount of material. The research demonstrates that the electrochemical method is an ideal technique to obtain materials with good performances for the hydrogen evolution reaction. The Pd–Co alloy composition can be controlled by adjusting electrodeposition parameters (bath composition, current density and deposition time). The main results concerning the fabrication process and the characterization are presented and the performance in acid conditions is discussed

Il Codice dei contrasti - Codice Civile - Libro III

Strumento snello e versatile per il praticante, che si accinge a sostenere l’esame di abilitazione alla professione forense, soprattutto nella nuova modalità del c.d. “orale rafforzato”, ma anche utile ausilio per il professionista e per lo studente, il Codice dei Contrasti civile si caratterizza per l’immediata facilità di consultazione della giurisprudenza di legittimità più recente, adesiva ad indirizzi consolidati o portatrice di contrasti interpretativi. Il codice contiene la giurisprudenza dell’ultimo biennio e i pronunciamenti delle Sezioni Unite del sessennio 2015-2021. Propone, altresì, l’approfondimento giurisprudenziale degli orientamenti che hanno dato luogo alle sezioni Unite 2020-2021 e dei contrasti non ancora risolti. L’obiettivo con cui è stato concepito il volume è quello di prendere le distanze dal classico repertorio giurisprudenziale, per far emergere il diritto vivente nella sua complessità, mutevolezza e fascino