Critical Issues and Opportunities for Producing Biomethane in Italy

Nowadays, most Italian biogas produces electricity even though recent political incentives are promoting biomethane from biogas by “upgrading” it. The aim of this paper is to focus on the regulatory framework for producing biomethane from new or already-existent anaerobic digestion plants. The complexity and lack of knowledge of the regulations on biofuel production and of anaerobic digested biomethane from waste and by-products create difficulties of both interpretation and application. Consequently, the aim of this paper is to analyze the regulations for producing biomethane, underline the critical issues and opportunities, and evaluate whether an electrical plant built in the last 10 years in Italy can really be converted to a biomethane plant, thereby lengthening its lifespan. Three case studies were considered to look more closely into applying Italian biomethane incentives and to simulate the types of incentivization in agriculture with examples based on certain fuel types typical of a standard biomethane plant of 500 standard cubic meter per hour. All the considered cases put in evidence that biomethane is a further opportunity for development with a high level of efficiency for all biogas producers, especially for many biogas plants whose incentivization period is about to finish

Psychopathology in children and adolescents with Tourette's syndrome : a controlled study

Objective: Few controlled studies have considered, in paediatric subjects, associations between Tourette's syndrome (TS) and psychiatric/behavioural disorders. We conducted a case-control study to verify the reproducibility of the few data published on this topic to date. Method: Clinicians' impression (i.e. structured interviews and usual history taking), standardized psychiatric and behavioural rating scales (CBCL, TAI, CDI, CRS-R:L, Y-GTSS, CY-BOCS) were used to investigate these associations in 17 youngsters with TS and in 17 age- and sex-matched controls. Results: The clinician's diagnoses revealed TS alone in 23.5% of the patients (4/17), TS plus attention-deficit/hyperactivity disorder (ADHD) in 11.8% (2/17), TS plus obsessive-compulsive disorder (OCD) in 41.2% (7/17), and TS plus ADHD and OCD in 23.5% (4/17). No control subject presented ADHD and/or OCD. These clinical findings were confirmed by Child Behaviour Check List (CBCL) results. The TS group, compared with the controls, recorded significantly higher CBCL scores in scales relating to the main comorbid conditions. No significant differences emerged on the Children's Depression Inventory or Test Anxiety Inventory. Conclusion: TS patients have a high prevalence of psychiatric and behavioural problems compared with controls. The CBCL is a rapid and useful screening-diagnostic instrument for highlighting the main psychiatric and behavioural problems in TS

Fatty Acids Profile, Atherogenic (IA) and Thrombogenic (IT) Health Lipid Indices, of Raw Roe of Blue Fin Tuna (<i>Thunnus</i> <i>thynnus</i> L.) and Their Salted Product “Bottarga”

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Surgical treatment of hypertrophic obstructive cardiomyopathy in relatively elderly patients: Short- and long-term outcomes

OBJECTIVES: Our goal was to assess the short- and long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy in patients >= 65 years of age compared to patients < 65 years of age.METHODS: Sixty-four patients aged >= 65 years, surgically treated for symptomatic hypertrophic obstructive cardiomyopathy, were compared to a control group of 125 patients <65 years.RESULTS: Patients aged >65 years were less frequently male (36% vs 68%, P < 0.001) and had higher EuroSCORE II scores [1.4 (1.1-2.2) vs 0.8 (0.7-1.2), P < 0.001], lower risk of sudden death, higher pulmonary artery pressure [40 (30-50) vs 30 (30-43), P= 0.04) and more mitral annulus calcifications (44% vs 14%, P < 0.001) compared to younger patients.Hospital death was 1%, with no difference between the 2 groups (1.5% vs 0.8%, P = 0.9).Patients aged >= 65 years had more concomitant coronary bypass grafting (12% vs 5%, P= 0.05) and a higher incidence of blood transfusions (50% vs 17%, P < 0.001) and postoperative atrial fibrillation (19% vs 8%, P = 0.02).Follow-up was 98% complete [median 8.3 (5.3-12.8) years]. The 13-year survival in the group aged >= 65 was 54 (SD: 9) % vs 83 (SD: 5) % in the control group (P < 0.001), but it was comparable to that expected in the age-sex matched general national population.At 13 years, the cumulative incidence function of cardiac death in the elderly group was 19 (SD: 7)%, mostly unrelated to hypertrophic cardiomyopathy causes.At the last follow-up, 90% of patients were in New York Heart Association functional class I-II and 68% were in sinus rhythm.CONCLUSIONS: Selected elderly symptomatic patients with hypertrophic obstructive cardiomyopathy can benefit from surgery, with low hospital mortality and morbidity, relief of symptoms and late survival comparable to that expected in the age-sex matched general population

A simplified and reproducible method to size the mitral annulus: implications for transcatheter mitral valve replacement

Aims Transcatheter mitral valve replacement (TMVR) provides definitive valve replacement through a minimally invasive procedure. In the setting of TMVR, it remains unclear how relevant the differences between different mitral annular (MA) diameters are. We sought to define a simplified and reproducible method to describe the MA size. Methods and results Using cardiac computed tomography angiography (CTA) studies of 47 patients, 3D MA perimeter (P-3D) was annotated. The aorto-mitral continuity was excluded from MA contour either by manual annotation (yielding a saddle-shape model) or by simple truncation at the medial and lateral trigones (yielding a D-shape model). The method of the least squares was used to generate the projected MA area (A(proj)) and perimeter (P-proj). Intercommissural (IC) and septolateral (SL) diameters, D-mean = (IC diameter + SL diameter)/2, area-derived diameter (D-Area = 2 x root(A/p)) and perimeterderived diameter (D-Perimeter = P/pi) were measured. MA eccentricity, height, and calcification (MAC) were assessed. Thirty studies were re-read by the same and by another observer to test intra-and inter-observer reproducibility. Patients (age, 75 +/- 12 years, 66% males) had a wide range of mitral regurgitation severity (none-trace in 8%, mild in 55%, moderate-severe in 37%), MA size (area: 5-16 cm(2)), eccentricity (28-52%), and height (3-11 mm). MAC was seen in 11 cases, in whom MAC arc occupied 26 +/- 20% of the MA circumference. DArea (36.0 +/- 4.0 mm) and DPerimeter (37.1 +/- 3.8 mm) correlated strongly (R-2 = 0.97) and were not significantly different (P= 0.15). The IC (39.3+ 4.6 mm) and the SL (31.4 +/- 4.5 mm) diameters were significantly different from D-Area (P <0.001) while D-mean (35.4 +/- 4.0 mm) was not (P = 0.5). The correlation of D-Area was stronger with D-mean (R-2 = 0.96) than with IC and SL diameters (R-2 = 0.69 and 0.76, respectively). The average difference between D-Area and D-mean was + 0.6 mm and the 95% limits of agreement were 2.1 and 20.9 mm. Similar results were found when the D-shape model was applied. All MA diameters showed good reproducibility with high intraclass correlation coefficient (0.93-0.98), small average bias (0.37-1.1 mm), and low coefficient of variation (3-7%) for intra-and inter-observer comparisons. Reproducibility of D-Area was lower in patients with MAC. Conclusion MA sizing by CTA is readily feasible and reproducible. D-mean is a simple index that can be used to infer the effectiveMA siz

Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from TriValve Registry.

BACKGROUND Secondary or functional tricuspid regurgitation (STR) is the most common phenotype of tricuspid regurgitation (TR) with atrial STR (ASTR) and ventricular STR (VSTR) being recently identified as two distinct entities. Data on tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with STR according to phenotype (i.e. ASTR vs VSTR) are lacking. OBJECTIVES The aim of this study was to assess characteristics and outcomes of patients with ASTR vs VSTR undergoing T-TEER. METHODS Patients with STR undergoing T-TEER were selected from the TriValve (Transcatheter Tricuspid Valve Therapies) registry. ASTR was defined by 1) left ventricular ejection fraction ≥50%; 2) atrial fibrillation and 3) systolic pulmonary arterial pressure < 50 mmHg. Patients not matching these criteria were classified as VSTR. Patients with primary TR and cardiac implantable electronic device were excluded. Key end-points included procedural success and survival at follow-up. RESULTS Two-hundred-ninety-eight patients were enrolled in the study: 65 (22%) with ASTR and 233 (78%) with VSTR. Procedural success was similar in the two groups (80% vs 83% for ASTR and VSTR, respectively, p = 0.56) and TEER was effective in reducing TR in both groups (from 97% of patients with baseline TR ≥3+ to 23% in ASTR and to 15% in VSTR, all p = 0.001). At 12 months follow-up, survival was significantly higher in ASTR vs VSTR cohort (91% vs 72%, log rank p = 0.02), with VSTR being an independent predictor of mortality at multivariable analysis (hazard ratio 4.75). CONCLUSIONS In a real-world, multicenter registry, T-TEER was effective in reducing TR grade in both ASTR and VSTR. At 12-months follow-up, ASTR showed better survival than VSTR. This article is protected by copyright. All rights reserved