La minitoracotomia come approccio per il trattamento concomitante della fibrillazione atriale

RIASUNTO Introduzione La fibrillazione atriale (FA) è un tachiaritmia sopraventricolare caratterizzata dalla presenza di un'attivazione atriale caotica ed incoordinata con conseguente inefficacia nell'attività meccanica. La fibrillazione atriale costituisce la più comune aritmia nella pratica clinica ed un importante problema sanitario con alto peso economico e sociale. La sua prevalenza nella popolazione generale si aggira tra 0,4% e 1% e sale all'8% negli ultra ottantenni. Cardiopatie organiche, malattia della valvola mitrale in particolare, costituisce importane ruolo nell'eziologia della FA. Il gold standard della terapia chirurgica della FA ovvero la procedura di Cox-Maze IV. La chirurgia mini-invasiva cardiaca sta diventando sempre più popolare nel mondo. Implementazione della chirurgia mini-invasiva nel trattamento della FA è un aspetto promettente. Materiali e metodi Sono stati raccolti i dati in modo retrospettivo riferiti al periodo Gennaio 2007 e Dicembre 2009. In questo periodo settantacinque (75) pazienti consecutivi sono stati sottoposti preso l'Ospedale del Cuore “G. Pasquinucci”, Fondazione CNR-Regione Toscana “G. Monasterio” di Massa, a trattamento chirurgico della FA in corso di interventi di chirurgia mini-invasiva valvolare per via minitoracotomica destra. La nostra popolazione è composta da 43 (57,3%) individui di sesso femminile e 32(42,7%) di sesso maschile. L'età media dei pazienti al ricovero era di 66,7 ± 9,8 anni. La durata media della FA nella casistica complessiva era di 25,1±22,7 mesi. Tutti i pazienti sono stati sottoposti ad ECG, ecocardiografia transtoracica bidimensionale, doppler e color doppler, e studio coronarografico. Tutti i pazienti sono stati sottoposti alla stessa procedura di anestesia generale. In tutti i pazienti l’allestimento della circolazione extracorporea è stato eseguito secondo la nostra tecnica standard per le procedure di chirurgia mininvasiva minitoracotomica. La mini-toracotomia destra di circa 5-6 cm è stata fatto al livello 2, 3, 4 spazio seconda intervento chirurgico eseguito. Tutti pazienti sono stati sottoposti RF ablazione compresi intervento chirurgico principali. I dati sono stati espressi come media ± deviazione standard nel caso di variabili continue e come percentuali nel caso di variabili categoriche. L'analisi Kaplan-Meier di sopravvivenza libera da tachiaritmie sopraventricolari e l'analisi di sopravvivenza libera da eventi è stata effettuata con programma statistico StatView®. Risultati Tutti i 75 pazienti della nostra casistica sono stati sottoposti ad ablazione a RF della FA con l'impiego di sistemi di erogazione monopolare, bipolare o di entrambi. Più dell'80% dei pazienti l'unico tipo di energia impiegata è stata la RF monopolare. Circa la modalità di erogazione nel 44% dei pazienti è avvenuta per via epicardica, nel 21,3% per via endocardica e nel 34,7% con entrambe le modalità. Nello specifico, tutti i 75 pazienti sono stati sottoposti a isolamento delle vene polmonari (PVI); 6 (8%) mediante encircling separato delle vene polmonari di destra e di sinistra in posizione antrale, 9 (12%) mediante il confezionamento di una box lesion con RF monopolare endocardica, 47 (62,7%) mediante box lesion con RF monopolare epicardica, 13 (17,3%) mediante box lesion con RF bipolare. In 22 pazienti (29,3%) all'isolamento delle vene polmonari è stata aggiunta una linea di lesione verso l'anulus mitralico posteriore. L'esclusione chirurgica dell'auricola sinistra e una linea di connessione tra l'auricola stessa e la vena polmonare superiore sinistra (LSPV) è stata effettuata in 12 (16%) pazienti. Solo in un paziente (1,3%) si è proceduto ad una Cox-Maze IV sinistra completa ed in un altro paziente ad una Cox Maze IV biatriale. Solo 1 (1,3%) decesso perioperatorio per sanguinamento incoercibile per rottura di cuore. Nell'unica conversione intraoperatoria in sternotomia per sanguinamento si è evidenziata una lesione dell'apice dell'auricola sinistra. Alla dimissione 43 (57,3%) pazienti erano in RS e 30 (40%) in FA. Al termine di un follow-up medio di 21,6±10,1 mesi con range 5-45 mesi, completo al 98,6%, ad un'analisi di prevalenza, 46 pazienti (63%) risultano in RS stabile e 27 (37%) in FA. Da un'analisi statistica effettuata con valutazione della curva di sopravvivenza libera da fibrillazione atriale o oltre tachiaritmie sopraventricolari secondo Kaplan-Meier si evincono risultati sovrapponibili all'analisi di prevalenza. Tra gli eventi avversi postoperatori tardivi si segnalano: 3 nuovi impianti di Pace- maker; 2 TIA; 1 ictus cerebri senza reliquati. Al follow-up, 26 (56,5%) pazienti sono liberi da terapia antiaritmica mentre 19 (42,2%) sono tuttora trattati con almeno un farmaco. Conlusione Al base del nostro studio, possiamo concludere che il trattamento concomitante della fibrillazione atriale con approccio mini-invasivo minitoracotomico destro con energia a radiofrequenza in pazienti candidati a chirurgia cardiaca per differenti valvulopatie è fattibile, sicuro e riproducibile

Inspection of a novel penetration enhancer for transungual drug delivery system: Pelargonium hortorum

This study was to search some natural penetration enhancer and formulate them in  a transungual drug delivery formulation. This natural penetration enhancer helps to overcome the main problem in front of success of transungual drug delivery system. We selected to formulate fluconazole as a model drug  for the nail fungal infection treatment with extracted penetration enhancer (PE). Model drug i.e. fluconazole was formulated with the natural extracted penetration enhancer with different deigned formula. The solvent for PE extraction was methanol and that extracts were air dried. The cadaver human nail plates were used for penetration study, were collected from the same volunteer for negligence in the thickness and chemical composition concentration in the nail plate. The extracted PE (pelargonium hortorum) was selected for formulation on the basis of ethanopharmaceutical history. The human cadaver nail plates were treated with the formulation with and without the extracted PEs. Ex - vivo drug penetration was evaluated by Franz diffusion cells using cadaver human nail plate upto 36 hours. The drug filmability was found to be best with the polymer like HPMC K4M, Ethyl cellulose and hydroxyl propyle cellulose in the ratio of 1:1:1, mixture of propanol and butanol in 7:3 as solvent and 30% w/w DBP as plasticizer. The formula FT25AP4 shows total 35.67% drug penetraion i.e. near about two times of drug penetration across the nail plate when compare to the same formulation but without any penetration enhancer. The “p” value (0.0011) of drug penetration was less than 0.05.&nbsp

Ambient Air Quality Modelling Using Aermod and Particulate Matter Characterization in Opencast Mines

Particulate Matter (dust) pollution is the most hazardous environmental issue associated with any opencast mining activity. Opencast extraction activities are major sources of air pollution in mining environment. The operations such as drilling, blasting, overburden/material handling and mineral processing generates large quantities of respirable particulate matter concentrations and are a potential source of air pollution. These airborne particulate matters are the main reason for the several severe health related issues such as Visibility disorder, Pneumoconiosis, neurological disorders etc. not only to the miners but to the people residing closer to mines. Therefore, the prediction of particulate matter concentration in and around the mine is essential to analyze the impact assessment of the mining activity over the surrounding environment. It is also necessary to identify the constituents of the particulate matter such that the severity of its impact can be analyzed at micro level.Considering the above situation the present work focuses on the monitoring of the different sources of particulate matter generation in Iron and Manganese mines using the gravimetric dust samplers (Envirotech APM 460 NL). The prediction of the fugitive dust concentration at different locations of mine and nearby areas is carried out using AERMOD software. The particulate matter characterization (PM10) of some Iron and Manganese ore Mines such as Kalta, Essel, Oraghat, Tantra and Sanindpur mines from Sundargarh district of Odisha has been carried out using Atomic Absorption Spectrophotometer to find the presence of major mineral compositions in it. Patmunda project which is an opencast manganese mine situated in Sundergarh district of Odisha, was chosen for the modelling purpose, where ambient air monitoring was conducted from September 2014 to November 2014 at an averaging period of 1 hour, 24 hour and monthly basis to derive the particulate matter generation behaviour in and around the mines. Different modelling options with different source pathways have been evaluated viz: Line source modelling, Volume source modelling and open pit. It is found that prescribed limits of NAAQS 2009. On the basis of these findings suitable mitigation and environmental plans can be devised for the sensitive areas

Dynamic inconsistency and preferential taxation of foreign capital

In a two-period dynamic model in which a single country attempts to attract two large investors endowed with capital with varying rate of returns, we show that the result of Kishore and Roy (Econ Lett 124:88–92, 2014) that a country has incentives to commit to a non-preferential regime to circumvent a dynamic inconsistency problem does not hold. The tax revenue of the government may be higher under a preferential regime compared to a non-preferential regime.http://link.springer.com/journal/107972018-06-30Economic

A Hybrid Filter for Image Enhancement

Image filtering processes are applied on images to remove the different types of noise that are either present in the image during capturing or introduced into the image during transmission. The salt & pepper (impulse) noise is the one type of noise which is occurred during transmission of the images or due to bit errors or dead pixels in the image contents. The images are blurred due to object movement or camera displacement when we capture the image. This pepper deals with removing the impulse noise and blurredness simultaneously from the images. The hybrid filter is a combination of wiener filter and median filter

Impact of COVID-19 on Stock Markets: An Investigation and Way Forward

This study analyzes the impact of the COVID-19 pandemic on stock markets in different regions of the world. Impact of COVID-19 on the stock market is like a black swan event. To analyze the impact of COVID-19 on the stock market, study includes different indices, ratios, strategies and past events to compare. Study is focused on the stock market of countries such as the United States and India to see effects on developed and developing countries. The trends were found similar worldwide. The United States, which has been a bull market for a long time, is also experiencing a plummeting stock market. In the Dow Jones Index’s first quarter history, this year’s first quarter has marked the worst performance ever. In the year 2020, Indian stock market from 1st January to 23rd March SENSEX has plunged 37.1% and from 1st January to 18th May SENSEX has plunged 27.2%. The study tries to touch upon the past crises and its impact on various stock markets.Sentiments of an investor play a major role in the stock market. A good strategy if used in this type of stock market can help generate profits and remain stable in the volatile situation as well

Kinetics of Heterogeneous Reaction between o-Toluidine Nitrate & Red Fuming Nitric Acid

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A study of risk factors in young patients of myocardial infarction

Background: Coronary Artery Disease (CAD) is the major cause of morbidity and mortality burden in the world. Young patients with CAD are specific subset of population requiring attention. A variety of possible contributing factors  that include substance abuse, coronary artery anomalies, hypercoagulablestate, oral contraceptive use in young women have been implicated for the pathogenesis of myocardial infarction. The purpose of this study is to collect data of young patients presenting with AMI so that it would be helpful in future for better management in this particular group of patients. Aim of the present investigation was to study clinical profile of acute myocardial infarction in young patients 18-45 years of age and to study the incidence of various risk factors in young patients with myocardial infarction.Methods: The study was conducted in Department of medicine of Santosh medical college & hospital. Study was conducted on 50 cases of acute myocardial infarction if they satisfied the following selection criteria after getting formal consent and ethical clearance.Results: In our study, we have examined patients of myocardial infarction who are aged between 18-45 yrs. and other eligibility criteria for the assessment of modifiable and non-modifiable risk factors in Ghaziabad area. The ratio of male to female sex ratio in our study is 5.25:1 and 64% of the patients in present study had anterior wall MI while 24% had inferior wall MI and 12% had antero-septal wall MI.Conclusions: Mean age of study group is 36.24 ±4.32 years. The maximum number of patients was in 35-40 years of age. Youngest patient was 25 years old male. The incidence of acute myocardial infarction is increasing in younger age group.

Study on the effect of high energy ball milling (a nano material process) on the microstructure and mechanical properties of a (Al-Si-Fe-Cu) alloy

Mechanical alloying is a solid-state powder processing technique involving repeated welding, fracturing, and rewelding of powder particles in a high-energy ball mill. Mechanical Alloying has now been shown to be capable of synthesizing a variety of equilibrium and non-equilibrium alloy phases starting from blended elemental or prealloyed powders.Materials have been found to attain unusual properties in their nano level sizes which are not found in their conventional form.Al-Si alloys containing other transition metals are used in the as cast condition for automotive and aerospace for the engine components. Srivastava etal have studied Al-18%Si-5%Fe-1.5%Cu by rapid solidification technique and have compared the microstructure with that in the cast condition. In the present work an attempt was made to develop this alloy through mechanical alloying route