Tranexamic acid therapy in pediatric cardiac surgery:a single center study

Background: We conducted a retrospective study of cyanotic and acyanotic patients undergoing cardiopulmonary bypass to determine the effect of tranexamic acid on blood loss and blood products administered during the operation in pediatric cardiac surgery. Methods: From January 2008 to December 2011, during 2 different periods, a total of 231 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (123 cyanotic, 108 acyanotic) were included in this study. A total of 104 patients were in the antifibrinolytic group and exclusively treated with tranexamic acid that was given as a bolus of 20 mg/kg-1 after anesthetic induction and 20 mg/kg-1 after protamine. The other 127 patients were in the control group. We analyzed intraoperative and postoperative outcomes of tranexamic acid administration. Results: There were no differences in mortality or operative time, but blood loss in 48 hours was greater in the control group (p = 0.0012). A significant difference was found in the amount of intraoperative erythrocyte concentrate transfused (140 ± 55 vs 170 ± 78 mL, p = 0.0011) but not in number. The number and amount of erythrocyte concentrate transfused in the first 48 postoperative hours were also greater in the control group (45 vs 77 patients, p = 0.012; 100 ± 40 vs 120 ± 55 mL, p = 0.0022). There were not many differences in the effect of tranexamic acid between the cyanotic and acyanotic subgroup. Conclusions: This retrospective study provides evidence that tranexamic acid may be used in the field of congenital cardiac surgery effectively

First experience with sildenafil after Fontan operation: short-term outcomes.

Background We conducted a retrospective study to determine the effect of oral sildenafil administrated as monotherapy after Fontan operation in single ventricle physiology. Methods From January 2008 to March 2012, during two different periods, a total of 30 pediatric patients undergoing Fontan operation by extracardiac conduit were included in this study. Thirteen patients were in the sildenafil group and exclusively treated with sildenafil given at the dose of 0.35 mg/kg through a nasogastric tube and then orally every 4 h, at the start of cardiopulmonary bypass and for the first postoperative week; then we reduced and discontinued the therapy. The other 17 patients were in the control group. No other vasodilator was administered in both groups. We analyzed intraoperative and postoperative outcomes of sildenafil administration. Results There were no differences in mortality or operative time. The total and relative drainage loss was lower in the sildenafil group (PU0.0003 and 0.0045). The hemodynamic parameters showed a better condition in the sildenafil group, with a lower mean pulmonary artery pressure (mPAP) (PU0.0001) and better mPAP to mean systemic blood pressure (mSBP) ratio (PU0.0043), whereas there was no difference in peripheral oxygen saturation (PU0.31). The sidenafil group patients showed other additional positive differences as well as lower inotropic score (PU0.0005) and intubation time (PU0.0004). No complications related to the use of sildenafil were noted in any of the children studied. Conclusion This initial experience provides evidence that sildenafil may be used in postoperative Fontan operation with positive effectiveness

Identification and Characterisation of a Novel Acylpeptide Hydrolase from Sulfolobus Solfataricus: Structural and Functional Insights

A novel acylpeptide hydrolase, named APEH-3Ss, was isolated from the hypertermophilic archaeon Sulfolobus solfataricus. APEH is a member of the prolyl oligopeptidase family which catalyzes the removal of acetylated amino acid residues from the N terminus of oligopeptides. The purified enzyme shows a homotrimeric structure, unique among the associate partners of the APEH cluster and, in contrast to the archaeal APEHs which show both exo/endo peptidase activities, it appears to be a “true” aminopeptidase as exemplified by its mammalian counterparts, with which it shares a similar substrate specificity. Furthermore, a comparative study on the regulation of apeh gene expression, revealed a significant but divergent alteration in the expression pattern of apeh-3Ss and apehSs (the gene encoding the previously identified APEHSs from S. solfataricus), which is induced in response to various stressful growth conditions. Hence, both APEH enzymes can be defined as stress-regulated proteins which play a complementary role in enabling the survival of S. solfataricus cells under different conditions. These results provide new structural and functional insights into S. solfataricus APEH, offering a possible explanation for the multiplicity of this enzyme in Archaea

Detached breakwaters, yes or not? A modelling approach to evaluate and plan their removal

Detached breakwaters have been widely employed as a measure against beach erosion and for coastal protection. However, this type of structures may cause different critical issues, and the advantages are not always evident. Water stagnation, rip currents development in the gaps between multiple structures, and obstruction of the natural panorama are well-recognised issues. However, their removal is always problematic because it is generally associated with rapid erosion of the beach and high costs. This work proposes a modelling approach to obtain a preliminary evaluation of a theoretical removal intervention and discusses its possible consequences. The study case is the Moneglia beach, a tourist beach located on the eastern Ligurian coast, NW Italy. The beach is characterised by the presence of three detached breakwaters, arranged over the entire length of the beach. A dataset consisting of LiDAR data, multibeam data, single-beam data and DGPS data was used to obtain an accurate digital elevation model (DEM) of the study area. Subsequently, the XBeach model was used to simulate three scenarios: i) state-of-the-art scenario (S0), ii) detached breakwaters removal scenario (S1), iii) detached breakwaters removal scenario + nourishment (S1N). The S1 scenario was implemented to evaluate the beach morphodynamic response in the case of a removal intervention. S1N was implemented to simulate a beach recovery plan through a beach nourishment intervention. Once the S1N final scenario was obtained, XBeach was implemented to get a comparison with the sea flooding hazard in the S0 and S1 scenarios. The sea flooding hazard assessment was performed considering storm events with a return time of 50 and 100 years, respectively. The results showed both the potential of the XBeach model as a tool and the sustainability of a theoretical detached breakwater removal intervention

Validazione del software Xbeach attraverso l'utilizzo di immagini da webcam.

Le mareggiate costituiscono una delle maggiori minacce per i centri urbani costieri e in particolare la costa ligure, per le sue caratteristiche geomorfologiche e per l'elevato grado di urbanizzazione, presenta un'elevata vulnerabilit\ue0, soprattutto nei tratti di costa bassa. Negli ultimi anni, l'impatto di eventi ad alta energia sulle aree urbane costiere \ue8 stato ampiamente discusso ed \ue8 emersa la necessit\ue0 di sviluppare metodi di analisi in grado di prevedere ed individuare le porzioni di territorio potenzialmente esposte alle tempeste e poter conseguentemente avviare una pronta attuazione delle strategie di mitigazione ed adattamento (Godschalk et al. 1989). Generalmente le potenziali aree suscettibili ad inondazioni sono individuate attraverso la determinazione della risalita del moto ondoso (o \u201crun up\u201d in terminologia anglosassone), ovvero la massima penetrazione del moto ondoso sulla spiaggia, attraverso modelli parametrici che prendono in considerazione le caratteristiche del moto ondoso e la morfologia della spiaggia (e.g. Mase, 1989; Stockdon et al., 2005). L'obbiettivo di questo lavoro \ue8 quello di determinare la quota massima di run-up mediante l'utilizzo del modello Xbeach (Roelvink et al., 2010) e successivamente tarare e validare i risultati confrontandoli con il run-up determinato con le immagini riprese da una webcam afferente alla rete di video monitoraggio costiero realizzata nell'ambito delle attivit\ue0 del progetto Resmar (azione di sistema A) e con le caratteristiche del moto ondoso desunte dalla boa ondametrica di ARPA Liguria situata al largo di Capo Mele. Xbeach (eXtreme Beach) \ue8 un programma open-source per lo studio del impatto di eventi estremi su spiaggia, che rientra nel Progetto Morphos-3D avviato da USACE-ERDC (Engineer Research and Development Center \u2013 U.S. Army Corps of Engineers) e testato in ambiente oceanico, quindi in condizioni meteomarine differenti da quelle mediterranee. Il modello include waves breaking, surf e swash zone processes, overwashing e breaching (Roelvink, 2009). Per lo studio del clima ondoso sono stati utilizzati i dati d'onda al largo prodotti dal progetto MeteOcean HINDCAST del DICCA (Dip. di Ingegneria Civile, Chimica e Ambientale, Universit\ue0 di Genova, Mentaschi et al., 2013). Per avere una stima realistica dei parametri d'onda nell'area costiera \ue8 stato quindi applicato il modello SWAN (Booij et al., 1999), in grado di fornire i dati d'onda di ingresso necessari per l'implementazione di XBeach nella zona costiera. L'acquisizione e l'elaborazione delle immagini webcam \ue8 stata effettuata con il software Beachkeeper Plus (Brignone et al., 2012), il quale permette, oltre che georeferenziare e rettificare le immagini, di effettuare elaborazioni in grado di facilitare l'individuazione della quota di massima risalita delle onde. I risultati ottenuti dalla simulazione sono stati confrontati con i dati acquisiti dalle immagini della webcam e dalla boa ondametrica, utilizzando gli indicatori statistici di errore: Scatter Index (NRMSE), Normalized BIAS (NBI) e Correlation coefficient (CORR). L' area studio presa in considerazione \ue8 la spiaggia di Alassio (Savona), situata nella riviera ligure di ponente, in prossimit\ue0 della gi\ue0 citata boa ondametrica di Capo Mele (ARPAL). Il litorale \ue8 costituito da una spiaggia sabbiosa ampia circa 30 metri e limitata superiormente dal centro abitato. questo tratto di costa, grazie alla sua orientazione ed alla presenza del promontorio di Capo Mele, \ue8 protetto dalle agitazioni ondose principali provenienti da SW (mari di Libeccio), mentre le agitazioni secondarie provenienti da SE (mari di Scirocco) lo raggiungono frontalmente (Bowman et al., 2007). quindi l'area risulta essere particolarmente idonea all'applicazione ed alla taratura della metodologia. Il software Xbeach ha prodotto buoni risultati per l'individuazione della quota del run-up, e quindi \ue8 da ritenere affidabile per lo studio della vulnerabilit\ue0 fisica sulle coste basse anche in ambiente mediterraneo

Cavity detection using a pseudo-3D electric resistivity tomography at the Palaeolithic/Neolithic site of Scaloria Cave, Apulia, Italy: integrated assessment of synthetic and field data sets

A pseudo-3D electrical resistivity tomography (ERT) survey has been carried out to detect cavities at the Neolithic/Palaeolithic site of Grotta Scaloria, close to Manfredonia, Apulia, Italy. Scaloria Cave has a rich history of archaeological research of more than 80 years and is one of the most important Neolithic complexes in the Mediterranean. Synthetic data modelling allowed to check the adequacy of the geophysical method and to develop a proper experimental setup at the survey design stage. Indeed, the results of the field data inversion revealed high resistivity anomalies which can be related to cavities and provided a good definition of the main geological structures and boundaries. Moreover, the results suggest that unknown and speleological unexplored cavities are still present at the Scaloria Cave study site. These findings may provide further insights on pseudo-3D ERT applicability, particularly for cavity detection. Furthermore, the approach used in this study yields fruitful information for further archaeological survey design and for the interpretation of ERT investigations targeting similar geological features and structures

Assessment of Subsurface Neolithic/ Palaeolithic sites in the Southern Gargano Area, Apulia, Italy using a 3D geo-electric resistivity approach

Caves are important sediment traps both for sediment formed inside and for sediments transported from outside into the caves. The stratigraphic reconstruction of the cave\u2019s deposits combined with the study of the archaeological and biological contents (remains of plants or animals) provides an excellent record of the climatic changes happened in the cave and offers information about landscape evolution. Since the study area close to Manfredonia, Southern Gargano, Italy is characterized by important archaeological sites (Occhiopinto Cave) we investigated the area north of Manfredonia in order to get an idea of cavities and their spatial distribution in the ground.In a previous work we tested a 2D approach based on 8 transects. In the present study we used a parallel setting of transects in order to perform a 3D model of the underground structures. Therefore three different arrays were tested, Dipol-Dipol; Wenner and Schlumberger. Schlumberger array is said to be superior in distinguishing lateral from vertical variations in resistivity in respect to Wenner. Whereas Dipol-Dipol array is especially useful for measuring lateral resistivity changes. The utilized electrode spacing for the surface transects was 2m. In order to calibrate and validate the analys is we made 2 core drillings yielding information on the stratigraphy and cavities in the underground. With the given value ranges and the respective electric resistivity arrays we were able to identify the location and depth of the major cavities in 3D fora ca. 25 ha test plot are