Valore prognostico delle resistenze microcircolatorie dopo angioplastica coronarica in pazienti con disfunzione ventricolare sinistra post-ischemica.

Obiettivo: Valutare se la misurazione delle resistenze microcircolatorie iperemiche dopo angioplastica coronarica (PTCA) abbia un ruolo nel predire il recupero funzionale in pazienti con disfunzione ventricolare sinistra post-ischemica. Metodi: Quarantotto pazienti con disfunzione ventricolare sinistra post-ischemica distale a una stenosi subocclusiva coronarica sono stati sottoposti a PTCA. Gli indici di severità funzionale (fractional flow reserve [FFR] e coronary flow reserve [CFR]) e gli indici di resistenza della stenosi (hyperemic stenosis resistance [HSR]) e del microcircolo (hyperemic microvascular resistance [HMR]) sono stati misurati prima e dopo PTCA mediante filo guida intracoronarico a doppio sensore di flusso e pressione (ComboWire). La frazione d’eiezione ventricolare sinistra (FEVS) e l’indice di contrazione regionale del territorio miocardico relativo al vaso trattato (Wall Motion Score Index target [WMSI-T]) sono stati valutati mediante ecografia transtoracica prima della PTCA e a 3 mesi dall’intervento. L’indice di perfusione del territorio target (Summed Rest perfusion Score [SRS-T]) è stato valutato mediante tomoscintigrafia miocardica (SPECT) prima della PTCA e a 3 mesi dall’intervento. I pazienti sono stati suddivisi in due gruppi a seconda del valore di HMR post-PTCA utilizzando il cut-off predefinito di normalità di 2.0. Risultati: I valori di FFR, HSR, CFR e HMR sono migliorati in maniera significativa dopo PTCA. In 17 pazienti (Gruppo I: 35.4%) i valori di HMR sono rimasti elevati (HMR>2.0) e significativamente superiori (3.29±1.77 mmHg/cm/sec vs. 1.35±0.34 mmHg/cm/sec; P<0.001) rispetto ai restanti 31 pazienti (Gruppo II: 64.6%). Non vi erano differenze tra gli indici di severità della stenosi epicardica FFR, CFR e HSR prima e dopo PTCA tra i due gruppi di pazienti. Dopo 3 mesi, nei pazienti del Gruppo I non si sono osservati cambiamenti significativi della FEVS (da 41.2 ± 9.4% a 43.1 ± 9.8%; P=0.28), del WMSI-T (da 2.27 ± 0.57 a 2.24 ± 0.58, P=0.33) e del SRS-T (da 10.6 ± 8.9 a 9.4 ± 9.2; P=0.16). I pazienti del Gruppo II hanno invece mostrato un significativo miglioramento della FEVS (da 34.8 ± 7.9% a 40.5 ± 10.3%; P<0.001), del WMSI-T (da 2.57 ± 0.59 a 2.13 ± 0.76; P<0.001) e del SRS-T (da 13.5 ± 5.7 a 10.0 ± 6.0; P<0.001). L’analisi ROC ha mostrato che l’HMR post-PTCA possiede una capacità predittiva significativa di assenza di recupero funzionale del ventricolo sinistro (ΔFE <5%) con sensibilità del 54%, specificità del 96% e valore predittivo positivo del 96% ad un valore di cut-off 1.95 (area sotto la curva 0.69, IC [0.53-0.86], P=0.038). Conclusioni: Questo studio dimostra che l’HMR post-PTCA ha un importante valore prognostico in pazienti con disfunzione ventricolare sinistra post-ischemica; il riscontro di HMR post-PTCA ≤2 si associa infatti a un netto miglioramento sia della cinetica regionale che della perfusione miocardica a 3 mesi dalla procedura. Al contrario, il riscontro di HMR post-PTCA >2 è un predittore affidabile di mancato recupero funzionale del ventricolo sinistro a 3 mesi

Isolated Cardiac Metastasis from Colorectal Cancer in a 35-Year-Old Man

We present the case of a 35-year-old patient who was found to be affected by an isolated clinically silent cardiac metastasis despite a negative CT follow-up at one year from abdominal surgery for colorectal cancer. CT/PET and tumor marker GICA were fundamental in suggesting the diagnosis, which was then confirmed by cardiac magnetic resonance and surgical biopsy. This is a very rare modality of presentation of cardiac metastasis because of the young age of our patient and the absence of disease in other sites

Clinical features and prognostic value of stent-graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes

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Angulation and curvature of aortic landing zone affect implantation depth in transcatheter aortic valve implantation

: In transcatheter aortic valve implantation (TAVI), final device position may be affected by device interaction with the whole aortic landing zone (LZ) extending to ascending aorta. We investigated the impact of aortic LZ curvature and angulation on TAVI implantation depth, comparing short-frame balloon-expanding (BE) and long-frame self-expanding (SE) devices. Patients (n = 202) treated with BE or SE devices were matched based on one-to-one propensity score. Primary endpoint was the mismatch between the intended (HPre) and the final (HPost) implantation depth. LZ curvature and angulation were calculated based on the aortic centerline trajectory available from pre-TAVI computed tomography. Total LZ curvature ( kLZ,tot ) and LZ angulation distal to aortic annulus ( αLZ,Distal ) were greater in the SE compared to the BE group (P &lt; 0.001 for both). In the BE group, HPost was significantly higher than HPre at both cusps (P &lt; 0.001). In the SE group, HPost was significantly deeper than HPre only at the left coronary cusp (P = 0.013). At multivariate analysis, αLZ,Distal was the only independent predictor (OR = 1.11, P = 0.002) of deeper final implantation depth with a cut-off value of 17.8°. Aortic LZ curvature and angulation significantly affected final TAVI implantation depth, especially in high stent-frame SE devices reporting, upon complete release, deeper implantation depth with respect to the intended one

Fibromyalgia position paper

Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purpose to summarise the current scientific knowledge and expert opinions about the main controversies regarding fibromyalgia syndrome, namely: (i) fibromyalgia definition and why it is still not recognised in many countries as a distinct clinical entity; (ii) fibromyalgia severity and how to evaluate treatment outcome; (iii) how to treat fibromyalgia and which is a correct approach to fibromyalgia patients

Diagnostic and therapeutic care pathway for fibromyalgia

Early diagnosis and timely and appropriate treatments positively influence the history of fibromyalgia syndrome (FM), with favourable repercussions at clinical, psychological, social and economic levels. Notwithstanding, there are still significant problems with timeliness of diagnosis, access to pharmacological therapies - particularly to innovative ones - and appropriate and effective taking in charge of patients. All the aforementioned factors have a great impact on FM patients' quality of life. Indeed, even though the World Health Organisation recognised FM as a chronic condition in the International Classification of Diseases 10th edition (ICD-10), many countries still fail to recognise the syndrome, and this negatively influences the capability to appropriately protect and care for patients. This is the case in several European Countries. In Italy, a few Regions have started to put in place precise indications for people suffering from FM, aiming at the implementation of diagnostic-therapeutic pathways. The Diagnostic-Therapeutic Care Pathway (DTCP) provides an important tool to meet the needs of patients suffering from chronic diseases. They present the organisation of an integrated assistance network. This includes a seamless path for disease prevention, diagnosis and treatment, by means of cooperation among physicians and other healthcare professionals

Validation of techniques to mitigate copper surface contamination in CUORE

In this article we describe the background challenges for the CUORE experiment posed by surface contamination of inert detector materials such as copper, and present three techniques explored to mitigate these backgrounds. Using data from a dedicated test apparatus constructed to validate and compare these techniques we demonstrate that copper surface contamination levels better than 10E-07 - 10E-08 Bq/cm2 are achieved for 238U and 232Th. If these levels are reproduced in the final CUORE apparatus the projected 90% C.L. upper limit on the number of background counts in the region of interest is 0.02-0.03 counts/keV/kg/y depending on the adopted mitigation technique.Comment: 10 pages, 6 figures, 6 table

Search for 14.4 keV solar axions from M1 transition of Fe-57 with CUORE crystals

We report the results of a search for axions from the 14.4 keV M1 transition from Fe-57 in the core of the sun using the axio-electric effect in TeO2 bolometers. The detectors are 5x5x5 cm3 crystals operated at about 10 mK in a facility used to test bolometers for the CUORE experiment at the Laboratori Nazionali del Gran Sasso in Italy. An analysis of 43.65 kg d of data was made using a newly developed low energy trigger which was optimized to reduce the detectors energy threshold. An upper limit of 0.63 c kg-1 d-1 was established at 95% C.L.. From this value, a lower bound at 95% C.L. was placed on the Peccei-Quinn energy scale of fa >= 0.76 10**6 GeV for a value of S=0.55 for the flavor-singlet axial vector matrix element. Bounds are given for the interval 0.15 < S < 0.55.Comment: 14 pages, 6 figures, submitted to JCA

The evaluation of the fibromyalgia patients.

Fibromyalgia (FM) is a rheumatic disease characterized by musculoskeletal pain, chronic diffuse tension and/or stiffness in joints and muscles, easy fatigue, sleep and emotional disturbances, and pressure pain sensitivity in at least 11 of 18 tender points. At present, there are no instrumental tests or specific diagnostic markers for FM; in fact, many of the existing indicators are significant for research purposes only. Many differential diagnoses may be excluded by an extensive clinical examination and patient history. Considering overlap of FM with other medical conditions, the treating physicians should be vigilant: chest-X-rays and abdominal ultrasonography are the first steps of general evaluation for all the patients with suspected FM. Functional neuroimaging methods have revealed a large number of supraspinal effects in FM, a disorder mediated by mechanisms that are essentially unknown. Many treatments are used in FM patients, but evaluating their therapeutic effects in FM is difficult because the syndrome is so multifaceted. To address the identification of core outcome domains, the Initiative on IMMPACT and OMERACT workshop convened a meeting to develop consensus recommendations for chronic pain clinical trials