Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approache

Assessing the potential effects of Climate Changes on landslide phenomena affecting pyroclastic covers in Nocera area (Southern Italy)

The effects of Climate Changes (CC) on natural hazardsinduced byweather forcing representan issue which has beenwidely debated inthe last years. Climate projections allowed to detect clear indications about the future trend of the main atmospheric forcing although affected by significant uncertainties concerning the magnitude. However, the crucial role played by the specific geomorphological contexts makes much more challenging understanding how such variations could affect occurrence and magnitude of landslide hazards. These factors help understanding because it is often unreliable carrying out assessments on large areas but is often necessary trying to evaluate the potential effects of CC on geo-hydrological hazards at slope scale. The main aim of this paper is the definition of a framework for the evaluation of potential variations of occurrences of landslide events affecting slopes of NoceraInferiore (Southern Italy) under the effect of CC. Such slopeshave been affected in recent years, inseveral occasions, by flowslide phenomena inducing large economic lossesand fatalities. The framework, consisting of two macro components, is tested to check its predictive capability of landslide behavior. It is then applied to provide a prediction of "potential" events for near and long time horizon scenarios. The study highlightspotential variations (increases) in triggering frequency under the effect of different concentration scenarios and time horizons

Potential Biomechanical Overload on Skeletal Muscle Structures in Students During Walk with Backpack

Although a very large number of students in the world use uncomfortable and heavy backpacks, their negative musculoskeletal effects on gait and posture are still not well investigated. Aim of the paper has been the study of differences affecting the kinematic gait parameters during free walk and walk with backpack to evaluate their potential influence on skeletal-muscle disorders. Gait recordings in both conditions on 50 healthy volunteers participating students have been performed by a G-WALK inertial system calculating the main kinematic parameters namely Propulsion index and Initial Double Support, Stance and Swing Phases. ANOVA results between both walking conditions showed that all gait cycle studied values are significantly negatively affected by walking with backpack supposing a potential biomechanical overload on skeletal muscle structures in students exposed to these prolonged conditions

Evaluation of the effects of climate changes on landslide activity of Orvieto clayey slope

Forthcoming climate changes, recognized by the international scientific community, are inducing a modification of the hydrological cycles with a direct impact on the piezometric regime of natural slopes and thus on their stability conditions. Particularly regarding active landslides in fine grained soils, the experience based on several well documented cases suggests an evident connection between landslide activity and rainfalls cumulated over some months. As a consequence, the observed change of the rainfall features should provoke variations on the kinematic features of such phenomena. Its role could be not negligible in a landslide risk assessment. Thanks to the availability of a considerable database related to the well documented Orvieto case, regarding precipitations and displacements of an active slide in clay, monitored since 1982, and to a climate projection occurring in the concerned area, provided by a reliable Regional Climate Model, the present paper gives a likely prediction of the long-term scenario of the landslide behavior. According to our results, local climate effects should be responsible of a slow decrease in the displacement rate

Mountain tourism facing climate change. Assessing risks and opportunities in the Italian Alps

The Alps are an interesting case for studying the relationship between tourism and climate change. Despite a growing number of studies, the climate change impacts on the tourism sector remain uncertain, when the regional and local scale or seasonality are considered. This article presents a risk methodology to assess the spatial distribution of the main challenges and opportunities for winter and summer tourism due to climate change at the sub-regional level on a 2021-2050 scenario. This methodology has been tested on an Italian Alpine area, which consists of very different landscapes from plain to high mountains. The results show that high-altitude municipalities will face the stronger risks for winter touristic activities, due to reduced snow cover duration, but also opportunities to attract in summer tourists escaping from the hotter temperatures of the plain. At the same time, climate change could have secondary negative effects in these areas, as it will increase the frequency and the magnitude of extreme events. The results show that impacts of CC cannot be generalised, even in a limited area; same hazards due to changes in temperature and precipitation patterns can generate very different risk scores, because of local conditions related to exposure and vulnerability factors