Comparison between Aorto-bifemoral Bypass and Aorto-iliac Kissing Stent in Patients with Complex Aorto-iliac Obstructive Disease

Introduction: To retrospectively compare early and late results of aorto-bifemoral bypass and endovascular recanalization with the kissing stent technique in the management of TASC II C and D lesions in the aorto-iliac district in a multicentre study. Methods: From January 2006 to December 2013, 293 open and endovascular interventions for TASC-II class C and D aorto-iliac obstructive lesions were performed at three Italian teaching hospitals. In 210 patients the intervention was performed for aortic and bilateral iliac involvement: an aorto-bifemoral bypass was performed in 82 patients (Group 1) while in the remaining 128 an endovascular recanalization with the kissing stent technique (Group 2). Early results in the two groups were compared with \u3c72 test. Follow up results were analyzed with Kaplan-Meyer curves and compared with log rank test. Results: There were no differences between the two groups in terms of demographic data, comorbidities, or risk factors for atherosclerosis, except for a higher percentage of females and of diabetic patients in group 2. Critical limb ischemia was present in 29 patients in group 1 (35.5%) and in 31 patients in group 2 (24%, p = 0.07). Technical success in group 2 was 98.5%; two patients required immediate conversion to open surgery for iliac rupture. There was one peri-operative death in group 1 (mortality rate 1.2%, p = 0.2 in comparison with group 2). Four peri-operative thromboses occurred; two in group 1 and two in group 2 (in one case requiring conversion to open surgical intervention) and no amputations at 30 days were recorded. Post-operative local and systemic complications occurred in 20 patients in group 1 (24%) and in 13 patients in group 2 (10% p = 0.006). Mean duration of follow up was 39 months (range 1 \u2013108 months). Survival rates at 6 years were 65% (SE 0.07) in group 1 and 82% (SE 0.05) in group 2 (p = 0.07). At the same time interval, primary, assisted primary and secondary patency rates were similar; re-intervention rates were 6% in group 1 (SE 0.05) and 11% in group 2 (SE 0.04; p = 0.2). Conclusion: Endovascular repair of complex aorto-iliac lesions with the kissing stent technique, in the multicentre experience, provided similar satisfactory early and late results to those obtained with open surgery, however with a lower rate of peri-operative complications and a trend towards better long-term survival

Effect of Functional Fitness on Plasma Oxidation Level in Elders: Reduction of the Plasma Oxidants and Improvement of the Antioxidant Barrier

Aging is characterized by a progressive decline in the physiological function due to the gradual alteration of molecules, cells and tissues. Reactive oxygen species (ROS) are the by-product of aerobic metabolism, and their increase is physiologically counteracted by the activation of the antioxidant machinery. A typical hallmark of aging is the imbalance of such equilibrium, due to either an increase of the amount of radicals or a failure of the antioxidant system. Literature reports that physical exercise is able to restore and maintain the homeostasis of oxidants and antioxidants during aging. Recently, growing interest has been turned to functional fitness, a special physical activity aimed to enhance the ability to perform everyday tasks, such as dressing, climbing stairs and preparing meals. The aim of this work was to assess whether a 24 weeksfunctional fitness program carried out on 28 elderly participants (57-86 years old) could be able to improve their oxidative status. For this purpose, dROMs (diacron Reactive Oxygen Metabolites) and BAP (Biological Antioxidant Potential) were analysed at the beginning and at the end of the study. Furthermore, both plasma and saliva protein carbonylation levels were explored through proteomics analysi

Effects of a physical activity program on functional fitness, oxidative stress and salivary cortisol levels in older adults

Quality of life into later life is influenced by multiple factors. The physical ability to perform common everyday activities represents a key factor to maintain a healthy and independent lifestyle. Moreover, aging is a process characterized by physiological alterations resulting in a progressive decline in biological functions, decreased resistance to stress, and increased susceptibility to diseases. Especially in elderly people, alterations such as imbalance between pro and antioxidant activity and/or hormonal dysregulation negatively affect the physical capacity, the emotional status and the overall general health and quality of life [1]. On the other hand, regular physical activity is considered an effective strategy for older adults to prevent and reduce the risk of developing those negative conditions arising from aging. A 24-week regular physical activity program (twice weekly, 1 hour per session) focused on functional fitness exercises was performed by 20 older adults (aged 55 years or more). A set of anthropometric (height, weight, BMI and body fat percentage) and physical measurements (grip strength, chair sit to stand, sit and reach and back scratch) assessing the functional fitness performance [2] were evaluated. Moreover, biochemical markers (d-ROMs and BAP tests as assessment of oxidative stress and antioxidant potential; salivary cortisol levels) were measured before and after the intervention program. The results confirm the benefits of a regular physical activity in older adults resulting in improved physical strength and flexibility in the functional fitness parameters, and in regulating pro and antioxidant activity and cortisol levels

Radiological Protection in Industries Involving NORM: A (Graded) Methodological Approach to Characterize the Exposure Situations

The interest in radiation protection in industrial sectors involving Naturally Occurring Radioactive Materials (NORM) is increasingly growing. This is due also to the recent implementation of the European Council Directive 59/2013/Euratom which in Italy and in the other European Union Member States extends the field of application to industrial sectors never involved before. This paper reports main results of a research project on radiation protection in industries involving NORM carried out in Italy aimed to provide useful tools for stakeholders to comply new legal obligations. The project activities were mainly focused on different aspects relevant to the NORM involving industries, accounting for the positive list reported in the Italian law. Firstly, the inventory of the industries currently operating in Italy in order to identify the industrial sectors with an important radiological impact on population and workers was updated. Based on this information, a general methodology was elaborated taking into account a graded approach. The first phase consists in the identification and characterization of the most critical exposure scenarios and of the radiological content of NORMs involved in the different phases of the industrial processes. In the second phase calculation methods were developed for dose estimation for workers and members of public. These tools require the use of existing and well tested calculation codes, and the development of a dedicated user-friendly software

Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics

La radioprotezione applicata alle industrie NORM: sviluppo di un sistema di strumenti metodologici, conoscitivi e formativi a sostegno degli stakeholders. Stato dell’arte del progetto di INAIL

Con il recepimento della Direttiva Europea 59/2013 EURATOM, la normativa italiana di radioprotezione ha introdotto nuovi obblighi per gli esercenti di diversi settori industriali “NORM”. Per sostenere l’assolvimento di tali obblighi che garantiscono la protezione di lavoratori e popolazione, dal 2019 è in corso un progetto di ricerca, nell’ambito del quale sono state realizzate diverse attività. Alcune di esse hanno avuto sviluppi anche in ambito internazionale, a testimonianza di quanto questa tematica sia di grande interesse. Lo scopo del presente lavoro è presentare i nuovi risultati del progetto, dall’aggiornamento del censimento dei settori NORM attualmente attivi in Italia, all’ applicazione e declinazione dell’approccio graduale per l’individuazione di situazioni di particolare interesse dal punto di vista della radioprotezione, fino allo sviluppo di metodologie operative e di calcolo applicate ad alcuni settori

Sviluppo di protocolli di campionamento e di valutazione della dose per settori industriali con presenza di NORM

Nell’ambito delle attività del progetto INAIL - BRIC ID 30 “Protocolli operativi e metodologie di calcolo per l’attuazione della nuova normativa di radioprotezione, recepimento della Direttiva 59/2013/Euratom, in settori industriali NORM di particolare impatto radiologico”, è stato sviluppato un approccio metodologico per gli adempimenti previsti dall’art. 22 del D.lgs. 101/2020. Una proposta di protocollo per la misura della concentrazione di attività delle matrici e per la valutazione della dose efficace per lavoratori e popolazione è stata elaborata per il settore della produzione di cemento e per l’industria dello zircone e zirconio

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended