Multivessel revascularisation in ST-elevation myocardial infarction: Too early to change the guidelines

Multivessel revascularisation in ST-elevation myocardial infarction: too early to change the guideline

The authors' reply

We appreciate Dr West's comments on our paper1; he has given us the opportunity to clarify some points that seem unresolved

Numerical Simulation and Experimental Characterization of Emitter Wrap through Solar Cells with Deep Grooved Base Contact (EWT-DGB)

Abstract In this work we present an Emitter Wrap Through cell with Deep Grooved Base contact (EWT-DGB), designed for both 1-sun and concentrating applications. The proposed approach, which consists in a deep grooved hole array composed by holes of two alternating doping type, allows both a reduction of the cell series resistance and an increase in collection efficiency also by using relatively thick substrates with low lifetime. The measured experimental data including dark J-V characteristics, figures of merit (FOMs) under illumination and external quantum efficiency (EQE) are compared to the results of 3-D drift-diffusion TCAD numerical simulations. Moreover, the impact of the hole spacing and of process-dependent physical parameters (interface defects) on FOMs is investigated by means of simulations

Contemporary approach to heavily calcified lesions: tools of the trade, challenges, and pitfalls

coronary artery calcifications (CAC) affect more than 90% of men and more than 67% of women older than 70; the spread is mainly due to the high occurrence of major cardiovascular risk factors. the presence of CAC can be detected by several noninvasive and invasive methods like computed tomography (CT), coronary angiography (CA), Intravascular ultrasound (IVUS), and optical coherence tomography (OCT), with each system providing different information that can be used in the treatment strategy of CAC. several devices can modify calcium during PCI: high-pressure non-compliant balloons, cutting/scoring balloons, atheroablative technologies, and intravascular Lithotripsy (IVL). each technique has advantages and disadvantages that every interventional cardiologist should know to perform an optimal PCI and to achieve the best result and clinical outcome. this is a narrative review that aims to illustrate the contemporary management of CAC, focusing on the available techniques to assess calcifications and their novel advancements and explaining the existing tools to treat CAC with a focus on their significant challenges and pitfalls

The Camera Server of the ASTRI SST-2M Telescopes Proposed for the Cherenkov Telescope Array

The Cherenkov Telescope Array (CTA) project is an international initiative to build the next generation of ground-based very high energy gamma-ray instrument . Three classes of telescopes with different mirror size will cover the full energy range from tens of GeV up to hundreds of TeV. The full sky coverage will be assured by two arrays, with one site located in each of the northern and southern hemispheres. In the current design scenario, the southern hemisphere array of CTA will include seventy small size telescopes (SST, 4m diameter) covering the highest energy region. Their implementation includes proposed intermediate steps with the development of mini-arrays of telescope precursors like the ASTRI mini-array, led by the Italian National Institute for Astrophysics (INAF) in synergy with the Universidade de Sao Paulo (Brazil) and the North-West University (South Africa). The ASTRI mini-array will be composed of nine telescope units (ASTRI SST-2M) based on double-mirror configuration whose end-to-end prototype has been installed on Mt. Etna (Italy) and is currently undergoing engineering tests. In the ASTRI SST-2M prototype, operating in single telescope configuration, the basic camera server software is being deployed and tested; it acquires the data sent by the camera back end electronics as a continuous stream of packets. In near real time, the bulk data of a given run are stored in one raw file. In parallel they are sorted by data type, converted to FITS format and stored in one file for data type. Upon closure, each file is transferred to the on-site archive. In addition, the quick look component allows the operator to display the camera data during the acquisition. This contribution presents how the camera server software of the prototype is being upgraded in order to fulfil the mini-array requirements, where it will be deployed on the camera server of each ASTRI SST-2M telescope. Particular emphasis will be devoted to the most challenging requirements that are related to the stereoscopy, when two or more telescopes have triggered simultaneously. To handle stereoscopy, each camera server has also to: (i) get the timestamp information from the clock distribution and trigger time stamping system, and associate it to the related camera event; (ii) get from the software array trigger the timestamp which passed the stereo trigger criteria; and (iii) forward to the array data acquisition system the stereo trigger events, according to the required data format and communication protocol

Software design of the ASTRI camera server proposed for the Cherenkov Telescope Array

The Italian National Institute for Astrophysics (INAF) is leading the ASTRI project within the ambitious Cherenkov Telescope Array (CTA), the next generation of ground-based observatories for very high energy gamma-ray astronomy. In the framework of the small sized telescopes (SST), a first goal of the ASTRI project is the realization of an end-to-end prototype in dual-mirror configuration (2M) with the camera composed of a matrix of Silicon photo-multiplier sensors managed by innovative front-end and back-end electronics. The prototype, named ASTRI SST-2M, is installed in Italy at the INAF "M.G. Fracastoro" observing station located at Serra La Nave, 1735 m a.s.l. on Mount Etna, Sicily. As a second step, the ASTRI project is focused on the implementation of a mini-array composed at least of nine ASTRI telescopes and proposed to be placed at the CTA southern site. This paper outlines the design of the camera server software that will be installed on the ASTRI mini-array. The software is based on the version installed on the ASTRI SST-2M prototype operating in a single telescope configuration. The migration from single telescope to mini-array context has required additional interfaces in order to guarantee high interoperability with other software and hardware components. In the mini-array configuration each camera communicates with its own camera server via a dedicated high rate data link. The primary goal of the camera server is to acquire the bulk data, packet by packet, without any data loss and to timestamp each packet very precisely. During array operation, the camera server receives from the SoftWare Array Trigger (SWAT) the list of science events that participate in stereo triggered events. These science events, and all others that are flagged either by the camera as interleaved calibration or by the camera server as possible single-muon events, are sent to the Array DAQ. All remaining science events will be discarded. A suitable buffer is provided to perform this processing on all the incoming event packets. The camera server provides interfaces to the array control software to allow for monitoring and control during array operations. In this paper we present the design of the camera server software with particular emphasis on the external interfaces. In addition, we report the results of the first integration activities and performance tests. <P /

Multimodality Imaging Evaluation to Detect Subtle Right Ventricular Involvement in Patients with Acute Myocarditis and Preserved Left Ventricular Ejection Fraction

Background: Evaluation of the right ventricle (RV) in patients with acute myocarditis (MY) remains challenging with both 2D transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). We examined the incremental diagnostic value of CMR feature tracking (FT) to evaluate RV involvement in patients with myocarditis. Methods: We enrolled 54 patients with myocarditis and preserved left ventricle (LV) ejection fraction (EF). The CMR protocol included T2-weighted images for edema detection and late gadolinium enhancement (LGE) images. Global longitudinal strain (GLS) of the left ventricle (LV) and RV free wall strain (CMR-FWS) were obtained with CMR-FT. We identified 34 patients (62%) with inferior and lateral segment (IL-MY) involvement and 20 (38%) noIL-MY in case of any other myocardial segment involved. Here, 20 individuals who underwent CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as the control population. Results: TTE and CMR showed normal RV function in all patients without visible RV involvement at the LGE or T2-weighted sequences. At CMR, LV-GLS values were significantly lower in patients with MY compared to the control group (median −19.0% vs. −21.0%, p = 0.029). Overall, CMR RV-FWS was no different between MY patients and controls (median −21.2% vs. −23.2 %, p = 0.201) while a significant difference was found between RV FWS in IL-MY and noIL-MY (median −18.17% vs. −24.2%, p = 0.004). Conclusions: CMR-FT has the potential to unravel subclinical RV involvement in patients with acute myocarditis, specifically in those with inferior and lateral injuries that exhibit lower RV-FWS values. In this setting, RV deformation analysis at CMR may be effectively implemented for a comprehensive functional assessment

How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p &lt; 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p &lt; 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

The Software Architecture and development approach for the ASTRI Mini-Array gamma-ray air-Cherenkov experiment at the Observatorio del Teide

The ASTRI Mini-Array is an international collaboration led by the Italian National Institute for Astrophysics (INAF) and devoted to the imaging of atmospheric Cherenkov light for very-high gamma-ray astronomy. The project is deploying an array of 9 telescopes sensitive above 1 TeV. In this contribution, we present the architecture of the software that covers the entire life cycle of the observatory, from scheduling to remote operations and data dissemination. The high-speed networking connection available between the observatory site, at the Canary Islands, and the Data Center in Rome allows for ready data availability for stereo triggering and data processing

Very late paclitaxel-eluting stent thrombosis despite 21 months of clopidogrel treatment after percutaneous coronary intervention.

Drug-eluting stents (DES) present a slightly higher incidence of stent thrombosis compared to bare metal stents and some cases of DES thrombosis are described in the literature. Therefore, there is consensus in recommending treatment with clopidogrel for at least 6 months in addition to life-long aspirin administration. We describe a case of very late paclitaxel-eluting stent thrombosis despite 21 months of clopidogrel treatment, which occurred just 2 weeks after its withdrawal, causing an acute coronary syndrome that was promptly resolved with an urgent invasive strategy. In our experience, paclitaxel-eluting stent thrombosis can occur several months after stent implantation despite prolonged clopidogrel treatment