Risk factors for primary ventricular fibrillation during a first myocardial infarction: Clinical findings from PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during firST myocardIal iNfArcTION)

Background: Few studies prospectively assessed risk factors for ventricular fibrillation (VF) during a first myocardial infarction (MI). We designed a nation-wide study aiming to identify clinical and genetic characteristics associated with primary VF; and report here about clinical features. Methods: PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) is an Italian case-control, prospective multicentre study. Cases are patients aged 18–80 years with a first MI and at least one VF episodes occurring within 24 h of symptoms onset, before reperfusion. Cases and controls are paired 1: 2 by gender and age (±5 years). Results: Among 1026 patients enrolled between 2007 and 2017, 970 entered the primary analysis: 375 cases and 595 controls (mean age 59 years, 85% males). Multivariable analysis identified 5 independent predictors of primary VF: systolic blood pressure (OR 0.982, 95% CI: 0.98–0.99 for each mm Hg) and K+ levels <3.5 mEq/L at presentation (OR 2.28, 95% CI: 1.6–3.3), family history of sudden death (OR 1.80, 95% CI: 1.1–3.0), physical inactivity (OR 1.73, 95% CI: 1.1–2.8) and anterior MI (OR 1.52, 95% CI: 1.1–2.1). Excluding K+ levels obtained after VF, the OR associated with K+ levels <3.5 mEq/L was1.99 (95 CI 1.22–3.21). Conclusions: The present study identified 5 independent predictors of primary VF: familiarity, anterior MI, low systolic blood pressure, physical inactivity and hypokalaemia. Importantly, the last two risk factors are modifiable and, especially in the presence of a family history of sudden death, they should be avoided as much as possible

Profile section equipped with sealing systems for making a pressurised hydraulic circuit utilizable for the cultivation of photosynthetic organisms under controlled conditions

A solution is described that enables a pressurised hydraulic circuit to be made inside the channels of an alveolar panel; the panel can be made of a transparent plastic material that enables the liquid to be irradiated by external light; the panel in a transparent material can be used as a light exposure apparatus of a photobioreactor destined to the cultivation of various types of organisms; the organisms produced can be used in the fields of energy generation, pharmaceutics, nutrition

Comparison of ECMO vs ECpella in patients with non post-pericardiotomy cardiogenic shock: An updated meta-analysis

Introduction: The impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS. Methods: All studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes. Results: Of 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6\u201359.9) in the VA-ECMO group and 58.3% (53.5\u201363.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9\u201326.5) and 33.1% (25.9\u201341.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0\u201322.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039\u20133.159). Conclusion: Our data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates

Profile section equipped with sealing systems for making a pressurised hydraulic circuit utilizable for the cultivation of photosynthetic organisms under controlled conditions

A solution is described that enables a pressurised hydraulic circuit to be made inside the channels of an alveolar panel; the panel can be made of a transparent plastic material that enables the liquid to be irradiated by external light; the panel in a transparent material can be used as a light exposure apparatus of a photobioreactor destined to the cultivation of various types of organisms; the organisms produced can be used in the fields of energy generation, pharmaceutics, nutrition

The Digital Revolution and Sustainable Development: Opportunities and Challenges. Report prepared by the World in 2050 initiative

The Digital Revolution, including technologies such as virtual and augmented reality, additive manufacturing or 3D-printing, (general purpose) artificial intelligence, or the Internet of Things, has entered the public discourse in many countries. Looking back, it is almost impossible to believe that digitalization is barely featured in the 2030 Agenda or the Paris Agreement. It is increasingly clear that digital changes, we refer to them as the Digital Revolution, are becoming a key driving force in societal transformation. The transformation towards sustainability for all must be harmonized with the threats, opportunities and dynamics of the Digital Revolution, the goals of the 2030 Agenda and the Paris Agreement. At the same time, the digital transformation will radically alter all dimensions of global societies and economies and will therefore change the interpretation of the sustainability paradigm itself. Digitalization is not only an ‘instrument’ to resolve sustainability challenges, it is also fundamental as a driver of disruptive change. This report that focuses on the Digital Revolution is the second one by The World in 2050 (TWI2050) that was established by the International Institute for Applied Systems Analysis (IIASA) and other partners to provide scientific foundations for the 2030 Agenda. This report is based on the voluntary and collaborative effort of more than 50 authors and contributors from about 20 institutions, and some 100 independent experts from academia, business, government, intergovernmental and non-governmental organizations from all the regions of the world, who met four times at IIASA to develop science-based strategies and pathways toward achieving the Sustainable Development Goals (SDGs). Presentations of the TWI2050 approach and work have been made at many international meetings such as the United Nations Science, Technology and Innovation Forums and the United Nations High-level Political Forums. In 2018, the first report by TWI2050 on Transformations to Achieve the Sustainable Development Goals identified Six Exemplary Transformations needed to achieve the SDGs and long-term sustainability to 2050 and beyond: i) Human Capacity &amp; Demography; ii) Consumption &amp; Production; iii) Decarbonization &amp; Energy, iv) Food, Biosphere &amp; Water; v) Smart Cities and vi) Digital Revolution. The focus of this report is the Sixth Transformation, The Digital Revolution. Although it is arguably the single greatest enabler of sustainable development, it has, in the past, helped create many negative externalities like transgression of planetary boundaries. Progress on the SDGs will be facilitated if we can build and implement detailed science, technology and innovation (STI) roadmaps at all levels that range from local to global. STI is a forceful driver of change connected to all 17 SDGs. The Digital Revolution provides entirely new and enhanced capacities and thus serves as a major force in shaping both the systemic context of transformative change and future solutions; at the same time it potentially carries strong societal disruptive power if not handled with caution, care, and innovativeness. This report assesses all the positive potential benefits digitalization brings to sustainable development for all. It also highlights the potential negative impacts and challenges going forward, particularly for those impacted by the ‘digital divide’ that excludes primarily people left behind during the Industrial Revolution like the billion that go hungry every night and the billion who do not have access to electricity. The report outlines the necessary preconditions for a successful digital transformation, including prosperity, social inclusion, environmental sustainability and good governance. Importantly it outlines some of the dramatic social implications associated with an increasingly digital future. It also covers a topic that so far has not been sufficiently dealt with in the cross-over discussions between sustainability and the Digital Revolution, that is, the considerations about related governance aspects

Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: Insights fromthe EYESHOT study

Aims Patients with acute coronary syndromes (ACSs) whoare managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients withACS enrolled in the prospective, multicentre, nationwideEYESHOT(EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units) registry.Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P, 0.0001 and 50 vs. 33, P, 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did