Non-surgical acute cholecystitis: 2 cases of gallbladder rupture after internal endoscopic or percutaneous diversion

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Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Augmented Reality: From Video Games to Medical Clinical Practice

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Non-surgical acute cholecystitis: 2 cases of gallbladder rupture after internal endoscopic or percutaneous diversion

Gallbladder rupture is a rare but serious complication of acute cholecystitis. We describe two cases of acute cholecystitis in patients not candidate for surgery that underwent internal biliary drainage with endoscopic and percutaneous approach, respectively. Both experienced gallbladder rupture&nbsp; in the postoperative period. The complication occurred after percutaneous internal drainage was treated conservatively, whereas the latter occurred after the endoscopic maneuver required an external percutaneous approach. After a brief revision of the literature about the interventional management of acute cholecystitis, the Authors discuss the possible reasons of galbladder rupture.&nbsp;</p

Position and Velocity Estimation of a Non-Cooperative Source From Asynchronous Packet Arrival Time Measurements

We tackle the problem of identifying the trajectory of a moving radio source from Time-of-Arrival (TOA) measurements collected by a set of cooperating receivers. The considered system is completely asynchronous: nodes clocks are affected by unknown time and frequency offsets, and no control is exerted over packet transmission times. In the proposed solution, the receiver clock offset terms are estimated from TOA measurements on packets originated by non-cooperative reference transmitters, possibly but not necessarily coincidental with reference receivers. Transmission time ambiguity is resolved by exploiting the redundancy associated to the reception of the same packet at multiple receivers. A distinguishing feature of the proposed solution is that it seeks to identify the parameters of the trajectory as a whole, rather than the individual points of transmission as done in traditional point-based approaches. This allows the effective exploitation of TOA measurements collected in lossy scenarios, where the generic packet is received by a smaller subset of the available receivers (at least two). For the problem at hand we provide distinct estimators based on TOA and Time-Difference-of-Arrival (TDOA) and prove their equivalence. Numerical results from simulations and from a real WiFi testbed are provided to validate the effectiveness of the proposed method

Valutazione dell'efficacia terapeutica dell'aggiunta della terapia fotodinamica al trattamento parodontale non chirurgico

Il trattamento meccanico e delle superfici e la rimozione del biofilm sopra e sottogengivale (ablazione del tartaro, SRP) sono considerati gli strumenti più idonei per il trattamento delle malattie infiammatorie parodontali, con l'obiettivo di distruggere il biofilm batterico, ridurre i batteri e rallentare la ricolonizzazione da parte dei microrganismi patogeni. Recentemente la terapia fotodinamica è stata suggerita come un potenziale strumento per migliorare l'esito del trattamento non chirurgico parodontale. La PDT nel primo mese rispetto alla terapia SRP ha evidenziato un miglioramento dei parametri parodontali per cui si consiglia di effettuare il trattamento com PDT ogni 3 mes

The radiologist empowerment through virtual multidisciplinary tumor boards: The commitment of oncologic care during COVID-19 pandemic

Highlights: Implementing a virtual tumor board program should represent a feasible goal for every health-care provider pursuing clinical excellence; even in time of COVID-19, the multidisciplinary commitment to oncologic care should remain imperative, as cancer may not forgive delays; working daily with advanced computer technologies, radiologists should lead virtual multidisciplinary tumor boards by present key images

CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR

Background In HIV-HCV co-infected patients, the long-term effects of HCV eradication on HIV disease progression are still unclear. Objectives This study aims to determine if CD4 and CD4/CD8 ratio slopes improved after anti-HCV treatment in patients achieving a sustained virological response (SVR). Study design A total of 116 HIV-HCV co-infected patients, previously treated with Peg-IFN/RBV, were divided into two groups: SVR (55 patients who had achieved SVR), and non-SVR (61 patients). Retrospective data before and after anti-HCV therapy were obtained for all patients, with a median 8 year-follow-up. Multilevel mixed models were fitted to assess the trends over time of FIB-4 score, APRI score, CD4, CD8 cell count and CD4/CD8 ratio. Results Median HIV-infection duration, HCV-RNA and GGT baseline levels were higher in non-SVR compared to the SVR group. A significantly decreased FIB-4 (p&nbsp;&lt;&nbsp;0.001) and APRI trend (p&nbsp;&lt;&nbsp;0.001) after SVR was observed in SVR patients compared to those non-SVR. After adjustment for HIV duration, there was no significant difference between the two groups for absolute CD4 (p&nbsp;=&nbsp;0.08) or percentage CD4 slope (p&nbsp;=&nbsp;0.6) over time. The CD4/CD8 ratio trend also demonstrated a similar progressive increase in both groups (p&nbsp;=&nbsp;0.2). During follow-up, six deaths were reported in the non-SVR group versus no death for the SVR group, while no difference in AIDS and non-AIDS events was observed. Conclusions Achievement of SVR determines an important beneficial impact in terms of liver-related mortality and fibrosis regression, but does not seem to alter neither the slope of long term CD4 gain nor the CD4/CD8 ratio evolution in ART-treated HIV-HCV co-infected patients