Comment on Jaworska, J. et al. Consensus on the application of lung ultrasound in pneumonia and bronchiolitis in children

To the editor: [...

Fiscoli e muscoli. Archeologia industriale nel Salento leccese,

Lo studio è indirizzato ad approfondire le problematiche di sviluppo industriale nel Salento con riferimento alle attività manifatturiere artigianali local

Lung ultrasound compared to chest X-ray for the diagnosis of CAP in children

Background: community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors focused on the application of ultrasound in lung diseases, but the role of Lung Ultrasound in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine LUS sensitivity and specificity in CAP diagnosis compared to CXR. Finally, we evaluated the role of LUS during the follow-up. Methods: We enrolled 68 children (<16 years old) hospitalized from October 2018 to September 2019 with a clinical and radiological diagnosis of CAP (cases, N=41), or with no respiratory diseases (controls, N=27), in whom a CXR was performed for clinical indication. All the children performed a LUS during hospitalization. The average time needed to perform LUS was 5-10 minutes for each child. 19/41 cases were re-evaluated by LUS and CXR 30 days after discharge. Results: LUS confirmed CAP diagnosis in 40/41 patients. Concordance between the two techniques was K=0.88 for the right lung and K=0.70 for the left lung. LUS showed a sensitivity of 97% and a specificity of 96% compared to CXR. At the follow-up, sensitivity raised to 100% while specificity was 94%. Conclusions: Our study showed a potential benefit of LUS compared to CXR in both the diagnosis and follow-up of CAP

La Natura e il Metodo. La conoscenza come lotta per la libertà in Spinoza

The naturalistic approach to knowledge, as emerges from of Quine’s and Sellars’ works, puts an absolute trust in the way science operates, insomuch that it suggests that philosophy should adopt its criteria and methods. This subsumption of philosophy to science is possible only reducing every discourse on their relationship to a mere question of method. This article aims to point out, by using Spinoza’s thought, the possibility of an escape from this rigid dichotomy. For the Dutch philosopher the study of nature is, in fact, the occasion for a broader consideration on the possibilities of knowledge in contributing to the achievement of an authentic freedom

Comparison of three contemporary surgical scores for predicting all-cause mortality of patients undergoing percutaneous mitral valve repair with the MitraClip system (from the multicenter GRASP-IT registry)

The aim of this study was to explore the adaptability of 3 contemporary surgical scores (Logistic EuroSCORE [LES], EuroSCORE II [ESII], and Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) for prediction of mortality after percutaneous mitral valve repair with the MitraClip system. A total of 304 patients from the multicenter Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly registry (GRASP-IT) were stratified based on LES, ESII, and STS-PROM tertiles and analyzed by different measurements of discrimination, calibration, and global accuracy with focus on 30-day and 1-, 2-, and 3-year mortality. A statistically significant gradient in the distribution of mortality was observed at all time points with ESII, at 2 years with LES, and at 2 and 3 years with STS-PROM. ESII had the best discrimination at 30 days (C-statistic 0.80), which remained acceptable at later follow-up, being significantly superior to that of LES at each time point (p = 0.003 at 30 days, p = 0.005 at 1 year, p = 0.011 at 2 years, and p = 0.029 at 3 years). Compared with STS-PROM, ESII showed better discrimination at 30 days (C-statistic 0.80 vs 0.62, p = 0.023). All scores overpredicted the risk of mortality at 30 days and were miscalibrated at 2 and 3 years. At 1 year, there was a good agreement between the observed and predicted probabilities for ESII and STS-PROM, whereas LES remained overpredictive. ESII showed the best global accuracy at 30 days and 1 year, whereas no notable differences were noted versus LES and STS-PROM at 2 and 3 years. In conclusion, lacking specific tools for risk stratification of patients undergoing MitraClip implantation, ESII holds favorable prognostic characteristics, which makes it a valid surrogate

Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair

BACKGROUND: There is limited information on the long-term outcomes and prognostic clinical predictors after edge-to-edge transcatheter mitral valve repair with the MitraClip system. METHODS: Consecutive patients with mitral regurgitation (MR) undergoing MitraClip therapy between October 2008 and November 2013 in 4 Italian centers were analyzed. The primary end point of interest was all-cause death. The secondary end point was the composite of all-cause death or rehospitalization for heart failure. RESULTS: A total of 304 patients were included, of which 79% had functional MR and 17% were in New York Heart Association functional class IV. Acute procedural success was obtained in 92% of cases, with no intraprocedural death. The cumulative incidences of all-cause death were 3.4%, 10.8%, and 18.6% at 30 days, 1 year, and 2 years, respectively. The corresponding incidences of the secondary end point were 4.4%, 22.0%, and 39.7%, respectively. In the Cox multivariate model, New York Heart Association functional class IV at baseline and ischemic MR etiology were found to significantly and independently predict both the primary and the secondary end point. A baseline, left ventricular end-systolic volume >110 mL was found to be an independent predictor of the secondary endpoint. Acute procedural success was independently associated with a lower risk of all-cause death and the combination of all-cause death or rehospitalization for heart failure at long-term follow-up. CONCLUSIONS: In a cohort of patients undergoing MitraClip therapy, those presenting at baseline with ischemic functional etiology, severely dilated ventricles, or advanced heart failure and those undergoing unsuccessful procedures carried the worst prognosis

Transcatheter Valve-in-Valve Implantation Using CoreValve Revalving System for Failed Surgical Aortic Bioprostheses.

OBJECTIVES: The purpose of this study was to evaluate the performance of CoreValve Revalving System (CRS) (Medtronic, Minneapolis, Minnesota) implantation in patients with failed aortic bioprostheses. BACKGROUND: Transcatheter 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. METHODS: CRS "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). RESULTS: The 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. CONCLUSIONS: CRS 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

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

Clinical Impact of Persistent Left Bundle Branch Block After CoreValve Revalving System Implantation. Insight from a Multicenter Italian Registry.

Conduction disturbances are relatively common after Transcatheter Aortic Valve Implantation (TAVI). Previous data demonstrated an adverse impact of persistent left bundle branch block (LBBB) after surgical aortic valve replacement. It is unclear whether a new onset LBBB may also impact on prognosis of patients after TAVI. Among 1060 patients treated with CRS-TAVI between October 2007 and April 2011 in high volume centers in Italy, we considered those without LBBB nor Pace-Maker at admission (879 patients, 82.7%). Those who had received a PM within 48 hours from the procedure were then excluded (61 patients, 7%), resulting in a final study population of 818 patients. Among them, 224 patients (Group A, 27.3%) developed a persistent LBBB, the remaining 594 patients (Group B, 72.7%) did not. Clinical characteristics were similar between groups.In group A, a low implant was significantly more frequent (15% vs 9.8%, p=0.02).At 30 days as well as at 1 year(mean follow up of 266±248 days, median 180 days), survival analyses and inherent log rank tests showed that LBBB was not associated with a higher all-cause mortality, cardiac mortality, hospitalization for heart failure. At 30 days, but not at 1 year, Group A had a significantly higher rate of PM implantation. In this high volume centers registry, persistent LBBB post CRS-TAVI showed no effect on hard end points. On the other hand, LBBB was associated with a higher short term rate of PM implantation

Il restauro della fotografia. Materiali fotografici e cinematografici, analogici e digitali

Per la prima volta in Italia un numero ampio di restauratori e studiosi della fotografia affrontano la cultura materiale e gli aspetti di prevenzione, conservazione e restauro dei maggiori processi fotografici e cinematografici, dai dagherrotipi alle tecniche argentiche, da quelle non argentiche alle stampe digitali. Le fasi di restauro conservativo sono argomentate in modo analitico, con l'intento di proporre una base metodologica e critica che serva ad affrontare il restauro dei beni fotografici e cinematografici, riconosciuti in Italia come beni culturali solo all'affacciarsi del XXI secolo. Autori: Alice Laudisa, Antonia Giusino, Barbara Cattaneo, Donatella Cecchin, Elvira Tonelli, Emiko Davies, Federica Delia, Giorgio Pedretti , Laura Gasparini, Letizia Baracchini, Lorenza Fenzi, Luisa Casella, Luisa Guerra, Marco Pagni Fontebuoni, Maura Zacchi , Melissa Gianferrari, Mirasol Estrada, Monica di Barbora, Morena Alitta, Pierangelo Cavanna, Roberta Piantavigna, Silvia Berselli, Stefania Ruello, Tania Barbieri, Tiziana Serena, Viviana Goggi DISPONIBILE ANCHE IN EBOO