Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits

Effects of different soil managements in vineyards to slope stability

Shallow landslides and soil erosion, induced by intense rainy events, are the most widespread slope instabilities that occur in vineyards cultivated along hillslopes. They could cause severe damages in the inter-row space and produce loss of soils characterized for high productivity levels. This fact provokes also land degradation and abandonment in cultivated areas. As a consequence of the higher diffusion of these extreme events in some European regions (e.g. Italy, France, Spain, Germany, Slovenia), it is necessary finding not invasive interventions, able to reduce the susceptibility of vineyards while preserving ecosystem sustainability. The inter-row soil managements at farm level could have effects on root distribution and, as consequence, on root reinforcement. This study aimed to analyze different agronomic techniques and their effect on root reinforcement in soil, in order to increase slope stability of vineyards susceptible to shallow damaging events. This study is supported by Fondazione CARIPLO AttivAree programme - Oltrepò(Bio)diverso project. The research was conducted in Oltrepò Pavese (North-Western Italy), an hilly area where traditional viticulture is present on steep slopes soils affected by several shallow landslides and erosions which caused significant environmental and economic losses. The parameters related on root density and reinforcement were evaluated under different soil management techniques (tillage, permanent grass mulching, alternation in the years of tillage and grass mulching in the inter-row spaces), also in relation to the presence of shallow landslides events. The techniques characterized to produce positive effects on soil stability were identified. This analysis, also, would furnish important guidelines in order to apply sustainable farm practices in vineyards while maintaining better levels of soil biodiversity and fertility and promoting a sustainable economic rising income of the territory

Influences of agricultural practices on the slope stability of cultivated vineyards

Rainfall-induced shallow landslides affect vineyards cultivated along steep slopes in different European countries, provoking plant destructions, degradation of farm roads and infrastructures, loss of fertile soil. As a consequence of climate changes and of increase in abandoned areas, it is required to find innovative solutions, able to reduce hazards in vineyards without undermining their ecosystem and economic sustainability. Soil inter-row space management could have positive effects on roots distribution and soil reinforcement, resulting practices that could be diffused in wide areas making reduction in the proneness to instability. This study analyzes how different techniques could increase the stability of sloping vineyards. This research, supported by Fondazione CARIPLO AttivAree programme - OltrepòBiodiverso project, was conducted in Oltrepò Pavese North- Western Italy, a hilly area characterized by traditional viticulture on steep slopes, prone to shallow landslides. Different soil management practices tillage, permanent grass cover, alternation of tillage and grass cover were evaluated. Root density and reinforcement parameters were monitored, in relation to shallow landslides, identifying which practices could increase stability of susceptible slopes. This research aims to provide important guidelines for applying sustainable farm practices in unstable vineyards along wide territories reducing hazards, while maintaining better levels of soil biodiversity and fertility

Effects of vineyard soil management on the characteristics of soils and roots in the lower Oltrepò Apennines (Lombardy, Italy)

Cultivation of grapevines in sloping soils is very widespread all over the world, representing also fundamental branch of local economy of several hilly areas. Vineyards can be managed in different ways. Agronomical practices in inter-rows can be significantly different and may influence deeply the soil properties and the grapevine root development. Therefore, this paper aimed to analyze the effects of different management practices of inter-rows. We focused on the traditional agricultural techniques of tillage and permanent grass mulching as well as the alternation of these two practices between adjacent inter-rows, in terms of: i) soil physical properties; ii) soil hydrological properties; iii) root density; iv) root mechanical properties and root reinforcement; as well as v) biodiversity. The research was conducted in several test-sites of Oltrepò Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, hydraulic conductivity was the most influenced soil property by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Vineyards with alternation management (grass mulching together with tillage) of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67-73% in comparison to tilled vineyards. Soil microarthropod communities had more complexity where sustainable agricultural practices (permanent grass cover; alternation management of the inter-rows) were applied. The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of root apparatus in the soil

Effects of Vineyard Inter-Row Management on Soils, Roots and Shallow Landslides Probability in the Apennines, Lombardy, Italy

Cultivation of grapevines in sloping soils is very widespread all over the world, representing also a fundamental branch of the local economy of several hilly zones. Vineyards can be managed in different ways especially the inter-rows. These management practices may influence deeply soil properties and grapevine root development. Therefore, this work aims to analyze the effects of different agronomical practices of inter-rows on soil properties, grapevine root systems and proneness towards shallow landslides. We focused on traditional agricultural techniques of tillage and permanent grass cover as well as the alternation of these two practices between adjacent inter-rows. The studied parameters were: (i) soil physical and hydrological properties; (ii) soil biodiversity; (iii) root density; (iv) root mechanical properties and root reinforcement; (v) probability of occurrence of shallow landslides. The research was conducted in several test-sites of the Oltrepò Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, soil hydraulic conductivity was the most influenced one by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Within the soil biological features, soil microarthropod communities showed more complexity where permanent grass cover or alternation management of the inter-rows were applied. Regarding the features of the grapevine root system, vineyards with alternation management of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67–73% in comparison to tilled vineyards. As a consequence, slopes with medium steepness (10–18°) were unstable if inter-rows of vineyards were tilled, while vineyards with permanent grass cover or alternation in the inter rows promoted the stability of slopes with higher steepness (> 21–25° for vineyards with permanent grass cover in the inter rows, 28–33° for vineyards with alternation). The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of the root apparatus. Possible land use managements acting as mitigation measures for shallow landslides susceptibility could be also implemented. This work was supported by the project Oltrepò BioDiverso, funded by Fondazione Cariplo in the frame of AttivAree Program

Effects of Vineyard Inter-Row Management on Soils, Roots and Shallow Landslides Probability in the Apennines, Lombardy, Italy.

Abstract: Cultivation of grapevines in sloping soils is very widespread all over the world, representing also a fundamental branch of the local economy of several hilly zones. Vineyards can be managed in different ways especially the inter-rows. These management practices may influence deeply soil properties and grapevine root development. Therefore, this work aims to analyze the effects of different agronomical practices of inter-rows on soil properties, grapevine root systems and proneness towards shallow landslides. We focused on traditional agricultural techniques of tillage and permanent grass cover as well as the alternation of these two practices between adjacent inter-rows. The studied parameters were: (i) soil physical and hydrological properties; (ii) soil biodiversity; (iii) root density; (iv) root mechanical properties and root reinforcement; (v) probability of occurrence of shallow landslides. The research was conducted in several test-sites of the Oltrep\uf2 Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, soil hydraulic conductivity was the most influenced one by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Within the soil biological features, soil microarthropod communities showed more complexity where permanent grass cover or alternation management of the inter-rows were applied. Regarding the features of the grapevine root system, vineyards with alternation management of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67\u201373% in comparison to tilled vineyards. As a consequence, slopes with medium steepness (10\u201318\ub0) were unstable if inter-rows of vineyards were tilled, while vineyards with permanent grass cover or alternation in the inter rows promoted the stability of slopes with higher steepness (&gt; 21\u201325\ub0 for vineyards with permanent grass cover in the inter rows, 28\u201333\ub0 for vineyards with alternation). The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of the root apparatus. Possible land use managements acting as mitigation measures for shallow landslides susceptibility could be also implemented. This work was supported by the project Oltrep\uf2 BioDiverso, funded by Fondazione Cariplo in the frame of AttivAree Program

Effects of vineyard soil management on the characteristics of soils and roots in the lower Oltrep\uf2 Apennines (Lombardy, Italy)

Cultivation of grapevines in sloping soils is very widespread all over the world, representing also fundamental branch of local economy of several hilly areas. Vineyards can be managed in different ways. Agronomical practices in inter-rows can be significantly different and may influence deeply the soil properties and the grapevine root development. Therefore, this paper aimed to analyze the effects of different management practices of inter-rows. We focused on the traditional agricultural techniques of tillage and permanent grass mulching as well as the alternation of these two practices between adjacent inter-rows, in terms of: i) soil physical properties; ii) soil hydrological properties; iii) root density; iv) root mechanical properties and root reinforcement; as well as v) biodiversity. The research was conducted in several test-sites of Oltrep\uf2 Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, hydraulic conductivity was the most influenced soil property by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Vineyards with alternation management (grass mulching together with tillage) of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67\u201373% in comparison to tilled vineyards. Soil microarthropod communities had more complexity where sustainable agricultural practices (permanent grass cover; alternation management of the inter-rows) were applied. The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of root apparatus in the soi

Quinoa, quali insetti infestanti sono presenti al Nord Italia

La quinoa, anche dove in passato non \ue8 mai stata coltivata, \ue8 oggetto di attacco da parte di gruppi di insetti polifagi che possono dar luogo a infestazioni anche importanti. Negli anni non sono state osservate differenze di attacchi fra le cultivar saggiate e si sono evidenziati gruppi di insetti differenti nelle diverse fasi fenologiche della coltura

General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of &lt;1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended