A Multistep Approach to Deal With Advanced Heart Failure: A Case Report on the Positive Effect of Cardiac Contractility Modulation Therapy on Pulmonary Pressure Measured by CardioMEMS

During the last years, the management of heart failure (HF) made substantial progress, focusing on device-based therapies to meet the demands of this complex syndrome. In this case report, we present a multistep approach to deal with HF. Specifically, we report the first patient subjected to the implantation of both Optimizer Smart(R) (Impulse Dynamics Inc., Marlton, NJ, USA) and CardioMEMS devices. A 72-year-old male patient with HF and reduced ejection fraction (HFrEF) was admitted to our cardiology department in January 2021, following a progressive shortening of the time between hospitalizations for levosimendan infusions. Specifically, the patient was monitored daily by CardioMEMS, and a strategy of levosimendan infusions guided by the device had been adopted. He was also a carrier of MitraClips and cardiac resynchronization therapy defibrillator (CRT-D) and had optimized HF medical therapy. In January 2021, the patient implanted Optimizer Smart(R) device for cardiac contractility modulation (CCM) therapy because of poor response to therapy and elevated pulmonary artery pressure (PAP). CCM significantly reduced PAP values following discharge (systolic PAP 33.67 & PLUSMN; 2.92 vs. 40.6 & PLUSMN; 3.37 mmHg, diastolic PAP 14.5 & PLUSMN; 2.01 vs. 22.5 & PLUSMN; 2.53 mmHg, mean PAP 22.87 & PLUSMN; 2.20 vs. 30.9 & PLUSMN; 2.99 mmHg, HR 60.93 & PLUSMN; 1.53 vs. 80.83 & PLUSMN; 3.66 bpm; p < 0.0001), with persisting effect at 9 months. The usefulness of CCM is objectively demonstrated for the first time by continuous invasive monitoring of PAP by CardioMEMS, which can suggest the correct timing for CCM implantation

Bridging therapeutic opportunities: a survey by the Italian molecular tumor board workgroup of Alliance Against Cancer

Background: Molecular tumor boards (MTBs) match molecular alterations with targeted anticancer drugs upon failure of the available therapeutic options. Special and local needs are most likely to emerge through the comparative analysis of MTB networks, but these are rarely reported. This manuscript summarizes the state-of-art of 16 active Italian MTBs, as it emerges from an online survey curated by Alliance Against Cancer (ACC).Main text: Most MTBs (13/16) are exclusively supported through local Institutional grants and meet regularly. All but one adopts a fully virtual or a mixed face-to-face/virtual calling/attendance meeting model. It appears that the ACC MTB initiative is shaping a hub-and-spoke virtual MTB network reminiscent of non-redundant, cost-effective health-care organization models. Unfortunately, public awareness of MTB opportunities presently remains insufficient. Only one center has a website. Dedicated e-mail addresses are for the exclusive use of the MTB staff. More than half of ACC members consider a miscellanea of most or all solid and hematological malignancies, and more than one-third consider neoplasms arising at any anatomical location. The average number of Staff Members in MTBs is 9. More than 10 staff members simultaneously attend MTB meetings in 13 MTBs. A medical oncologist is invariably present and is in charge of introducing the clinical case either with (45%) or without previous discussion in organ-specific multidisciplinary Boards. All but two MTBs take charge of not only patients with no standard-of-care (SoC) therapy option, but also cases receiving NGS profiling in SoC settings, implying a larger number of yearly cases. All MTBs run targeted NGS panels. Three run whole-exome and/or RNAseq approaches. ESCAT-ESMO and/or Onco-KB levels of evidence are similarly used for diagnostic reporting. Most MTBs (11) provide a written diagnostic report within 15 days. Conclusions are invariably communicated to the patient by the medical oncologist.Conclusions: MTB networking is crucial not only for molecular diagnosis and therapy assignment, but also for healthcare governance. Survey results show that MTBs review therapeutic opportunities at the crossover between standard-of-care with off-label, the former task being much beyond their scope. Societal and scientific implications of this beyond-the-scope MTB function may be relevant for healthcare in Italy and abroad

Coupling Instrumented Vehicles and Driving Simulators: opportunities from the DRIVE IN2 Project

DRIVE IN2 is an automotive research project within the field of Intelligent Transportation Systems, especially Advanced Driving Assistance Systems (ADAS). The project originates from the idea that the development of new ADAS and evaluation of their effect have to take drivers into account, as well as their behavior while driving: the benefits of adopting new in-vehicle technologies depend also on their adoption and usage by drivers. To this aim, the project develops a Driver-In-the-Loop framework to position observation of the drivers at the center of the research activities. Observations are carried out by coupling different research tools, namely instrumented vehicle and driving simulators. The premise and methodological framework of the research project are presented and discussed. Some preliminary activities with particular reference to validating the driving simulation environment are also described

Dove inizia il sonno? Differenze topografiche dell'EEG durante la transizione veglia-sonno.

Introduzione. Esistono almeno tre diversi criteri che vengono usualmente utilizzati per la definizione elettroencefalografica dell'inizio del sonno: 1. la comparsa della prima epoca di stadio 1in un'epoca di registrazione di 20 o 30 sec, indicata da una presenza di ritmo alpha EEG inferiore al 50% [1]; 2. la presenza di almeno un minuto continuativo di stadio 1 [2]; 3. la comparsa della prima epoca di stadio 2, indicata dalla presenza di un fuso del sonno o di un complesso K [e.g., 3]. La definizione di un criterio univoco per la definizione dell'inizio del sonno appare di notevole interesse nell'ambito della ricerca di base e della clinica dei disturbi del sonno. Lo scopo del presente lavoro è stato quello di confrontare, mediante un'analisi dell'EEG registrato durante l'addormentamento di 26 soggetti normali, due diversi criteri per la definizione dell'inizio del sonno, la prima epoca di stadio 1 o di stadio 2. Metodo. Sono state calcolate le potenze spettrali nel range di frequenze tra 1 e 28 Hz (in bin di 1 Hz e per epoche di 12 sec); le serie temporali individuali sono poi state sottoposte a una procedura di averaging, allineandole in funzione delle due definizioni alternative di inizio del sonno. Le analisi successive sono state eseguite sia con una risoluzione di 1 Hz, sia raggruppando le frequenze EEG in bande più ampie (beta= 17-28 Hz; delta/theta/sigma= 1-7 Hz e 12-16 Hz; alpha =8-11 Hz) mediante un'Analisi delle Componenti Principali. Risultati. Sia l'analisi Hz per Hz che quella per bande di frequenza hanno indicato che l'intero range di frequenze tra 1 e 16 Hz incrementa linearmente dopo l'inizio dello stadio 2, esprimendo la partecipazione di questa larga banda di frequenze basse e medie dell’EEG al processo di sincronizzazione che conduce all'addormentamento. Inoltre, la definizione dell'inizio del sonno come prima epoca di stadio 2 consente una più chiara discriminazione tra veglia e sonno, dal momento che un numero maggiore di bin di 1 Hz differiscono statisticamente nel confronto prima e dopo il punto identificato dal criterio e che una percentuale maggiore di varianza è stata spiegata da modelli di regressione lineare applicati alle serie temporali delle variazioni Hz per Hz dell'EEG durante questa transizione. Infine, l'andamento temporale delle variazioni spettrali dell’EEG suggerisce che lo stadio 1 sia una zona intermedia nel processo di sincronizzazione, nella quale il ritmo alpha cambia il suo significato funzionale, passando da un'associazione positiva con i livelli di attivazione corticale, che caratterizza l'intervallo che precede l'inizio dello stadio 1, a una relazione di tipo negativo dopo l'inizio dello stadio 2. Conclusioni. I risultati ottenuti da diversi livelli di analisi delle variazioni EEG durante l'addormentamento indicano chiaramente come l'inizio dello stadio 2, espresso dalla comparsa di almeno un fuso del sonno o di un complesso K, possa essere considerato il più sensibile confine tra la veglia e il sonno

An integrated systems of driving assistance tools for driving assistance application in extraurban roads

Advanced Driving Assistance Systems (ADAS) have been progressively introduced by car-makers with increasingly ambitious road-safety goals. ADAS range from ISA (Intelligent Speed Adaptation) to ACC (Adaptive Cruise Control), from CWS (Collision Warning Systems) to AEB (Autonomous Emergency Braking). In this paper it is proposed one possible integration of these systems, where the transition from one to the other is actuated by surrogate measures of safety (headway and time-to-collision). The proposed integrated systems is aimed to be perceived the driver as human-like and consistent with his/her own behaviour, and thus instinctively understandable. This enables the driver to be always in-the-loop in the driving control process. The integrated systems has been simulated. Simulations have been supported by real-world driving behaviours, observed within the Italian research project DRIVE IN2 (DRIVEr Monitoring: Technologies, Methodologies, and IN-vehicle INnovative systems for a safe and eco-compatible driving)

An integrated systems of driving assistance tools for driving assistance application in extraurban roads

Advanced Driving Assistance Systems (ADAS) have been progressively introduced by car-makers with increasingly ambitious road-safety goals. ADAS range from ISA (Intelligent Speed Adaptation) to ACC (Adaptive Cruise Control), from CWS (Collision Warning Systems) to AEB (Autonomous Emergency Braking). In this paper it is proposed one possible integration of these systems, where the transition from one to the other is actuated by surrogate measures of safety (headway and time-to-collision). The proposed integrated systems is aimed to be perceived the driver as human-like and consistent with his/her own behaviour, and thus instinctively understandable. This enables the driver to be always in-the-loop in the driving control process. The integrated systems has been simulated. Simulations have been supported by real-world driving behaviours, observed within the Italian research project DRIVE IN2 (DRIVEr Monitoring: Technologies, Methodologies, and IN-vehicle INnovative systems for a safe and eco-compatible driving)