Possible predicative role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients. preliminary data

Background:Transcatheter aortic valve replacement (TAVR) is an effective procedure capable to change the natural history of the degenerative aortic valve stenosis. Despite the TAVR, the patients with advanced valve disease and severe myocardial damage (low flow, gradient and ejection fraction)show high mortality level. Aim of this study was toevaluate the predicative power of a noninvasive and inexpensive test obtained by means of a simple standard 12-leads electrocardiogram,known as the Electrical Risk Score (ERS). Methods: ERS was composed by seven simple ECG markers: heart rate (>75 bpm); QRS duration (>110 ms), left ventricular hypertrophy (Sokolow-Lyon criteria), delayed QRS transition zone (≥ V4), frontal QRS-T angle (>90°), long QTBazett (>450 ms for men and >460 in women) or JTBazett(330 ms for men and > 340 ms for women);long T peak to T end interval (Tp-e)( >89 ms). An ERS ≥ 4was considered high risk for all-cause or cardiovascular mortality.We calculated retrospectively the pre-procedure ERS in 40 TAVR patients after one year of follow-up. Results: In the follow up the all-cause and cardiovascular mortality were respectively 25% and 15%.None of survivors reported ERS ≥ 4,moreover, the ERS was the strongest predictor of all-cause (odd ratio 3.73, 95% CI: 1.44-9.66, p<0.05) or cardiovascular (odd ratio 3.95, 95% CI: 1.09-14.27, p<0.05) mortality.ROC curves showed that ERS had the widest significant sensitivity-specificity area under the curve (auc) predicting all-cause (auc: 0.855, p<0.05) or cardiovascular mortality (auc: 0.908, p<0.05). Conclusions:In this pivotal study, ERS resulted an useful tool to stratify the risk of mortality in one-year follow-up TAVR patients. Obviously, it is necessary to confirm these data in large prospective studies

Contextual blindness in implicature computation

In this paper, I defend a grammatical account of scalar implicatures. In particular, I submit new evidence in favor of the contextual blindness principle, assumed in recent versions of the grammatical account. I argue that mismatching scalar implicatures can be generated even when the restrictor of the universal quantifier in a universal alternative is contextually known to be empty. The crucial evidence consists of a hitherto unnoticed oddness asymmetry between formally analogous existential sentences with reference failure NPs. I conclude that the generation of mismatching scalar implicatures does not require contextual access

Eribulin in male patients with breast cancer: The first report of clinical outcomes

Background. Evidence on the management and treatment of male breast cancer is scant. We report the analysis of a multicenter Italian series of patients with male breast cancer treated with eribulin. To our knowledge, this is the first report on the use or eribulin in this setting. Patients and Methods. Patients were retrospectively identified in 19 reference centers. All patients received eribulin treatment, according to the standard practice of each center. Data on the identified patients were collected using a standardized form and were then centrally reviewed by two experienced oncologists. Results. A total of 23 patients (median age, 64 yearsrange, 42–80) were considered. The median age at the time of diagnosis of breast cancerwas 57 years (range, 42–74).HER2 status was negative in 14 patients (61%), and 2 patients (9%) had triple-negative disease. The most common metastatic sites were the lung (n 5 1461%) and bone (n 5 1356%). Eribulin was administered for a median of 6 cycles (range, 3–15). All patients reported at least stable diseasetwo complete responses (9%) were documented. Eribulin was well-tolerated, with only four patients (17%) reporting grade 3 adverse events and two (9%) with treatment interruptions because of toxicity. Eight subjects (35%) did not report any adverse event during treatment. For patients with a reported fatal event, the median overall survival from the diagnosis of metastatic disease was 65 months (range, 22–228). Conclusion. Although hampered by all the limitations of any retrospective case series, the results of the present study suggest, for the first time, the use of eribulin as therapy for male breast cancer

Trattato teorico-prattico di ballo,

This manual represents one of the most important sources on dance technique for the second half of the eighteenth century and is a critical link between Baroque dance and early romantic ballet. Part one is divided into sixty sections describing various aspects of dance beginning with a statement on the utility of dance, and feet positions. The manual continues with descriptions of many steps, for example, four types of battemens, nine types of pas de bourrée, balloté, fouetté, and twenty-three types of cabriole. Also included is extensive information on late eighteenth-century grotesque style, especially important for the study of Italian pantomime. Part two discusses the responsibilities of a dancing master and manner of performing the minuet. The manual concludes with instructions for thirty-nine contradanze (contredanses), including one dance that is arranged for thirty-two performers.The engraved plates consist of diagrammed dances, most with accompanying dance music, which was composed by Magri, De Dominicis, Di Gennaro, Giuliano, A. Montoro, F. Piombanti, G. Rava, Sangro di S. Severo, and Scotti

Functional versus structural changes in the pathophysiology of acute ischemic renal failure in aging rats

Functional versus structural changes in the pathophysiology of acute ischemic renal failure in aging rats. The aim of the study was to gain further insight into the greater susceptibility to acute ischemic renal failure (ARF, 30min of renal arteries clamping) of old rats (O, 18 months) as against young rats (Y, 3 months). All the rats ate a hypoproteic diet (14% of casein) to avoid age-related glomerulosclerosis in O. Basal renal dynamics was similar in O and Y (Groups CON). One day after ARF, the decrease in GFR was more severe in O than in Y (-82% and -57% vs. respective CON, P<0.05), due to a greater rise of RVR in O (+258%) than in Y (+104%). The histologic renal damage after ischemia was comparable in the two groups with ARF. Five days after ARF, the recovery of renal function was characterized by a slower rise of GFR in O than in Y. In two further groups, two different scavengers of oxygen-free radicals, dimethylthiourea (DMTU) and superoxide dismutase (SOD), were administered at the time of arterial occlusion. DMTU had protective effects in Y but not in O (ΔGFR was -28% and -72%, respectively); in contrast, SOD was more effective in O (ΔGFR = -58%) than in Y rats (ΔGFR = -40%). To test the hypothesis that such a difference was related to the capacity of SOD to increase the levels of nitric oxide (NO), four more groups of Y and O rats were pretreated with L-arginine (ARG), precursor of NO, in tap water (1.5%). No difference in renal dynamics was detected in basal conditions. However, after ARF, while in Y no change was observed, in O rats, ARG led to a lesser decrease of GFR (-57% vs. CON) like in SOD-O. Concomitant administration of a NO synthase inhibitor, N-nitro-L-arginine-methyl-ester (50 mg/liter in tap water), prevented the beneficial effects of ARG. In conclusion, this study suggests that: (a) ischemic ARF is worse in O than Y rats even in absence of age-related glomerulosclerosis; (b) the greater renal impairment following ARF in O rats is likely related to reduced NO levels

Planned versus provisional rotational atherectomy for severe calcified coronary lesions. insights from the ROTATE multi-center registry

OBJECTIVES: We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions. BACKGROUND: Limited data are available addressing the benefits of planned RA compared to provisional RA. METHODS: Between 2002 and 2013, all patients with calcified lesions treated by RA were enrolled. Of these, patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients). RESULTS: In-hospital major adverse cardiovascular events (MACE) were tended to be better in the planned RA group (unadjusted OR: 0.76; 95% CI: 0.44-1.31, P = 0.32, and adjusted OR: 0.59; 95% CI: 0.33-1.05, P = 0.07). The number of pre-dilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.60 vs. 1.47 ± 0.76, P &lt; 0.001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time; 65.2 ± 36.8min vs. 84.4 ± 43.1min, P &lt; 0.001, fluoroscopy time; 33.1 ± 22.9min vs. 51.2 ± 29.6min, P &lt; 0.001, and contrast volume; 232.9 ± 141.6ml vs. 302.9 ± 150.3ml, P &lt; 0.001). The incidence of MACE at 1-year was significantly higher amongst the unadjusted population, whereas the difference was less marked between groups after propensity-score adjustment (unadjusted HR: 1.78; 95% CI: 1.16-2.74, P = 0.01, and adjusted HR: 1.44; 95% CI: 0.92-2.26, P = 0.11). CONCLUSIONS: Planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of pre-dilation balloon catheters used. If there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy