Transcatheter valve-in-valve implantation using CoreValve revalving system for failed surgical aortic bioprostheses

ObjectivesThe purpose of this study was to evaluate the performance of CoreValve Revalving System (CRS) (Medtronic, Minneapolis, Minnesota) implantation in patients with failed aortic bioprostheses.BackgroundTranscatheter aortic valve implantation with the CRS is an effective option in high-risk patients with severe aortic stenosis. It may be an option for patients with a failed aortic bioprosthesis, especially when the risk of a surgical redo is deemed prohibitive.MethodsCRS “valve-in-valve” implantation was performed in 25 high-risk patients with a failed bioprosthesis. Their mean age was 82.4 ± 3.2 years. New York Heart Association functional classes III and IV were present in 21 and 4 patients, respectively. The logistic EuroSCORE was 31.5 ± 14.8%, whereas the Society of Thoracic Surgeons score was 8.2 ± 4.2. Patients/prostheses were divided in type A (mainly stenotic, n = 9) and type B (mainly regurgitant, n = 16).ResultsThe implantation success rate was 100%. In group A, the peak aortic gradient significantly decreased from 77.6 ± 21.6 mm Hg to 34.6 ± 19.4 mm Hg (p = 0.001). In all but 2 patients in group B, no significant regurgitation was observed post-implantation. No patients died during the procedure. At 30 days, there were 3 deaths (12%), 2 myocardial infarctions (8%), and 3 atrioventricular blocks requiring pacemaker implantation (12%). At a mean follow-up of 6 months, there were another death (survival rate of 84%) and a pacemaker implantation (cumulative incidence of 16%). New York Heart Association functional class improved in all patients to I and II.ConclusionsCRS implantation was feasible and effective regardless of the prevalent mode of failure. This finding may significantly affect the treatment of patients with a failed bioprosthesis deemed at a prohibitive risk for surgical redo

The Italian Regional Well-Being in a Multi-expert Non-additive Perspective

This paper designs a multidimensional index of well-being for 20 Italian regions, based on a set of 41 indicators organized in an original hierarchical structure, a decision-tree whose four main pillars are Economy, Society, Environment and Health. Our novel approach combines the objective dimension of the evaluation (a comprehensive set of statistical indicators) within a flexible non-additive aggregation model (the Choquet integral) characterized with the preferences of informed Italian stakeholders. Adopting the Choquet integral allows us to overcome the well-known limitations embedded in the linear models, by assigning a weight (capacity) to any coalitions of dimensions, and by allowing a different degree of substitutability within each decision node in the tree. The weights and the parameters for the aggregation are elicited through a computer-based nominal group technique, a method which reduces the occurrences of drastically dissenting valuations and the potential expert-selection bias. Our results show that experts’ perception of synergies and redundancies is quite heterogeneous between levels and nodes in the tree. Moreover, well-being measures are much influenced by the degree of substitutability embedded in the experts’ preferences. Overall, the Italian picture looks more heterogeneous when analysed through the Choquet integral, with respect to a linear model

Resistência a antimicrobianos de bactérias oriundas de ambiente de criação e filés de tilápias do nilo (Oreochromis niloticus) Antibacterial resistance in bacteria from fish pond and Nile tilapia fillets (Oreochromis niloticus)

A resistência de bactérias a antimicrobianos foi determinada em uma piscicultura de tilápias (Oreochromis niloticus) em tanques de terra, sem utilização de antibióticos para profilaxia ou controle de doenças. Foi selecionado um tanque, capturados peixes e coletadas amostras de conteúdo intestinal e superfície dos peixes, água de abastecimento e do tanque, ração, filés de tilápias frescos e congelados. Colônias representativas foram selecionadas e analisadas pelos testes de Gram, catalase, oxidase e oxidaçãofermentação. Foram selecionadas 89 amostras e submetidas a antibiograma, utilizando vários antimicrobianos. A maioria das bactérias pertenceu às famílias Enterobacteriaceae e Vibrionaceae. Tanto no ambiente de criação como nos filés de tilápias observou-se que os isolados bacterianos apresentaramse resistentes principalmente a ampicilina e eritromicina. O índice de múltipla resistência a antimicrobianos (MAR) foi calculado, sendo que do total de 89 isolados analisados 74 (83%), apresentaram MAR ³ 0,2, ou seja apresentaram-se resistentes a dois ou mais antimicrobianos. As freqüências de índice MAR foram altas e maiores na ração.<br>This study was conducted in a freshwater tilapia farm that has not used any antibiotic. It was selected one pond, caught 15 fishes and collected samples of intestinal content and mucus surface, water influent and pond water, ration, fresh tilapia fillets and frozen fillets.. Phenotypical characteristics, Gram stain, oxidase production, oxidative-fermentative utilization of glucose (O-F) were determined of representative colony. Were selected 89 strains and submitted for antimicrobial sensitivy test using several antibiotics. The major identified bacterial families were belonged Enterobacteriaceae and Vibrionaceae. The most isolates showed resistance to ampicilin and eritromicin. From the 89 isolates evaluated 74 (83%) showed a multiple antibiotic resistance index (MAR) ³ 0.2, that mean resistance to two or more antibiotics. The MAR índice frequency were higher and bigger in the rations