Hamartoma of mature cardiac myocytes: a cardiac tumour with preserved contractility

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Synthesis and biological evaluation of new indazole derivatives

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Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Ascending Aorta Resection and End-to-End Anastomosis: Redistribution of Wall Shear Stress Induced by a Bioprosthetic Heart Valve

Although aortic resection and end-to-end anastomosis are applied to repair ascending aortic aneurysm, there is a lack of information on the late risk of post-operative complications, such as aortic dissection and aneurysmal re-dilatation. It is recognized that altered hemodynamic forces exerted on an aortic wall play an important role on dissection and aneurysm formation. We present a case in which the hemodynamic forces were investigated prior and after repair of an ascending aorta treated by resection with end-to-end anastomosis and a bioprosthetic heart valve. Post-operative wall shear stress was redistributed uniformly along the vessel circumference, and this may suggest a reduced risk of complications near aortic root, but not exclude the re-dilatation of the ascending aorta

A Case of Conservative Treatment of Postsurgical Aortic False Aneurysm

A 51-year-old male underwent replacement of the ascending aorta for acute type A dissection. The post-operative course was uncomplicated, and he was discharged home. Approximately a month later, control CT revealed an enlarging pseudoaneurysm of the proximal anastomosis. The patient was re-operated, and a Bentall operation with mechanical prosthesis was performed. Again, surgery was uncomplicated, but follow-up CT scan revealed a recurrent small pseudoaneurysm of the proximal suture line. He was managed with close observation, and control CT at four months showed complete resolution. Conservative treatment of small postsurgical pseudoaneurysms is discussed

Extracorporeal membrane oxygenation and left ventricular unloading:What is the evidence?

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