Twenty-Minute No-Touch Period Before Controlled DCD Heart Retrieval: Is There Still a Chance for Successful Recovery? The Italian Experience

Purpose: Hearts from cDCD donors are becoming an increasing source for heart transplantation (HT). Unfortunately, their use has been questioned for years in Italy given the longest-in-the-world no-touch period after death declaration (20 min). We aimed to analyze the early Italian experience using cDCD hearts for transplantation. Methods: We prospectively collected and analyzed all clinical data of all patients who underwent cDCD HT since ethical approval of the program by the National Transplant Center (CNT) (April 2023), in 5 centers which were authorized to perform cDCD HT. Results: Since April 2023, 8 cDCD HT were performed (recipient M 100%, median recipient age 58 years, IQR 44-60). Two patients were hospitalized and under inotropes before HT, no patients were on mechanical support before HT. Donor hearts (M 100%, median age 37 years, IQR 23-51) did not present any coronary lesions. Median warm ischemic time (WIT), functional WIT and asystolic time were 53min (IQR 46-62), 42min (IQR 39-44) and 28min (IQR 26-29), respectively. All the cases were performed under TA-NRP (7 CPB, 1 ECMO) through femoral vessels cannulation. No ex vivo machine perfusion devices were used. Median TA-NRP duration was 106min (IQR 86-140). Median time within TA-NRP stop and donor cardiectomy was 56min (IQR 40-126). Median cold ischemic time was 93min (IQR 78-144). Two patients required ECMO; of these, 1 patient was switched to RVAD and was finally recovered. 30-day and in-hospital mortality occurred in only 1 patient. Among the 7 alive patients, only 1 patient presented acute cellular rejection≥2 after HT. All the alive patients showed preserved ejection fraction (≥55%) and preserved RV function, with only mild tricuspid regurgitation at discharge (Table 1). Conclusion: Our preliminary data show that cDCD heart transplantation is feasible and safe also with longer donor asystolic times. Additional follow-up data and a larger cohort of patients are required to confirm these promising results

Modelling the consent acquisition time in organ donor management through clustering and mixture probability models

Time is a critical variable in organ transplantation. Brain-dead donors may be or become unstable. Organs are subject to degradation and must be transplanted as soon as possible. An unavoidable source of delay in the process is the time needed to get consent to the donation by the potential donor's relatives. Information about the likely consent acquisition time would allow us to predict and minimize the time needed for the overall harvesting and transplantation process. In this paper, by using a real dataset of consent acquisition time from a local transplantation centre, we identify three clusters associated with early, regular, and late consent-givers and provide a probability model for the consent acquisition time based on a mixture of three gamma components

Effect of water management treatments on rice characteristics and cooking behaviour

Rice (Oryza sativa L.) is adapted to grow both in submerged and aerobic soils. Changes in the agro-environmental conditions and socio-cultural needs of rice farmers, as well as the reduction in the availability of irrigation water in some rice-growing areas, have led to the introduction of new cultivation practices. The different irrigation conditions, however, may influence rice composition and its cooking quality. The work aims at investigating the effect of different water management on rice milling yield, grains biometric characteristics, nitrogen and amylose content, pasting properties and cooking behaviour. Baldo, Gladio, Loto and Selenio varieties were grown in 3 different agricultural systems, characterised by a progressively more intense use of water: dry seeding and delayed flooding (A); dry seeding and rotational irrigation (B); water seeded and continuous flooding (C). The various agricultural systems did not affect the milling yield of Baldo, Gladio, and Selenio, while a significant (P<0.05) decrease was observed only for Loto when cultivated in system A. A significant (P<0.05) increase of the nitrogen content for Gladio, and a decrease for Selenio, were observed when conditions A and B were used in comparison with the conventional irrigation. As regards the amylose, practice A determined a significant (P<0.05) reduction for Gladio and Baldo. The three irrigation practices also slightly affected the pasting properties of the samples, but with different trends depending on the variety. Loto cultivated in condition B showed a greater resistance to gelatinization and a higher consistency than the corresponding sample cultivated in water. Considering the overall dataset, it is not possible up to now to highlight an univocal influence of the water-soil regime on rice quality, since the investigated characteristics seem to be mainly influenced by the variety

Boundaries and perspectives from a multi-model study on rice grain quality in Northern Italy

Grain quality is crucial to meeting market demand and preserve the sustainability of the European rice sector. However the relationships between agro-meteorological conditions and major features of pre-harvest quality are not well understood. The evaluation of available models is needed to assess their suitability for predicting grain quality for different environmental conditions. This study presents a multi-site and multi-year evaluation of 26 models for the simulation of rice grain composition, milling quality and cooking quality, in the main European rice district (Northern Italy). The analysis was performed using data from 16 sites where the cultivars Loto (japonica) and Gladio (tropical japonica) were grown in 2011\u20132014. Model performances denoted models\u2019 ability to reproduce grain quality variables, with increased modelling efficiencies (EF) from grain composition ( 120.78 < EF < 0.62; median =0.34) to cooking quality ( 120.09 < EF < 0.85; median =0.44). In general, models based on biological parameters (0.18 < EF< 0.85, median =0.52) performed better than those that include empirical coefficients ( 120.78 < EF < 0.80, median =0.29), with the best results achieved for proteins, breakdown viscosity and pecky grains for Loto cultivar (0.04 < EF < 0.85, median =0.65). The calibration of cultivar-specific coefficients, led the models based on empirical parameters to the best balance between goodness-of-fit and complexity, thus resulting as a possible alternative to models using biological parameters under the explored conditions

GLORIFY : a new forecasting system for rice grain quality in Northern Italy

A reliable forecast of the pre-harvest grain quality is requested by stakeholders in the rice sector, which is increasingly oriented to the achievement of superior standards to meet the market demand. Despite its economic importance, very few simulation models of the qualitative aspects of rice productions including the effects of weather conditions and farming practices are available. This paper presents GLORIFY, a forecasting system targeting the simulation of head rice yield (HRY), which represents the main determinant of rice market price at global level. A new HRY model was developed using experimental data collected in Northern Italy in 2006\u20132013 and referred to Loto (japonica) and Gladio (tropical japonica) cultivars, and it was coupled to the WARM rice simulator. Historical simulations were then performed in the period 1994\u20132013 to reproduce observed HRY variability, with model outputs and weather variables used as independent variables to build multi-regression models. At field level, model performances denoted a good agreement between observed and simulated HRY (R2 and modelling efficiency in the range 0.73\u20130.93). At province level, best results were obtained for Loto variety, as the regression model was able to explain 78% of the HRY variability, with a root mean square error (RMSE) of 0.77%. The model accuracy slightly decreased when leave-one-out cross-validation was applied (R2 = 0.61, RMSE = 1.04%). The present study lays the basis for a reliable estimation of HRY variability under different management and weather conditions

Effects of water management on rice characterisitics

Rice (Oryza sativa L.) is adapted to grow both in submerged and aerobic soils. The effects of different water management systems on several characteristics of rice (milling yield, biometric characteristics, nitrogen and amylose content, pasting properties and cooking behavior) were investigated. The effectiveness of Near Infrared (NIR) spectroscopy to provide comprehensive information regarding the effects of water management on the quality traits of rice was also evaluated. Four rice varieties (Baldo, Gladio, Loto and Selenio) were grown in two consecutive harvesting years in three agricultural systems, characterized by a progressively more intensive use of water: dry seeding and delayed flooding (DRY); dry seeding and rotational irrigation (IRR); water seeded and continuous flooding (FLD). NIR spectral data were collected in reflectance mode using a FT-NIR spectrometer. The spectral data were correlated with biometric, chemical and rheological parameters by Principal Component Analysis (PCA) and PLS regression algorithm. Considering the overall dataset, a univocal influence of the water management on rice properties was not found, since the characteristics regarding quality, before and after cooking, seem to be mainly related to the harvest year and variety, in particular to its amylose content. By Principal Component Analysis of NIR spectra it was possible to determine both harvesting year (PC1, PC2; total explained variance of 84%) and rice variety (PC1, PC3; total explained variance of 77%). Moreover, good correlations were found through PLS algorithm for nitrogen content (R2= 0.98), viscoamylographic breakdown (R2= 0.93) and optimal cooking time (R2= 0.89). The NIR spectroscopy has proven to be a reliable and sensitive technique, suitable for evaluating not only chemical indices but also cooking attributes

Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resyncvhronisation therapy delivery.

AIMS: Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory. METHODS AND RESULTS: We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters. CONCLUSION: Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success