Photometric and spectroscopic study of the intermediate age open cluster NGC 3960

We present CCD UBVI photometry and high-resolution spectroscopy of the intermediate age open cluster NGC 3960. The colour - magnitude diagrams (CMDs) derived from the photometric data and interpreted with the synthetic CMD method allow us to estimate the cluster parameters. We derive: age = 0.9 or 0.6 Gyr (depending on whether or not overshooting from convective regions is included in the adopted stellar models), distance (m-M)0 = 11.6 +/- 0.1, reddening E(B-V) = 0.29 +/- 0.02, differential reddening Delta E(B-V) = 0.05 and approximate metallicity between solar and half of solar. We obtained high resolution spectra of three clump stars, and derived an average [Fe/H] = -0.12 (rms 0.04 dex), in very good agreement with the photometric determination. We also obtained abundances of alpha-elements, Fe-peak elements, and of Ba. The reddenings toward individual stars derived from the spectroscopic temperatures and the Alonso et al. calibrations give further support to the existence of significative variations across the cluster.Comment: Accepted for publication on MNRAS; fig. 3, 4, 5, 6 at degraded resolutio

Tailoring antiplatelet therapy in older patients with coronary artery disease

The older population represents a unique subset of patients due to a higher rate of comorbidities and risk factors, which can lead to a higher rate of ischemic and bleeding events. As a result, older adults are mainly underrepresented or excluded from randomized trials. Although the advancement in the percutaneous coronary intervention field with the development of new technologies, techniques, and potent antiplatelet therapy led to a reduction of ischemic risk, there is still a concern regarding bleeding hazards. Apart from the global utilization of less invasive trans-radial approach and proton pump inhibitors to reduce bleeding risk, proper tailoring of antiplatelet therapy in the older person is imperative. So far, several antiplatelet drugs have been introduced in different clinical scenarios, with dual antiplatelet therapy (combination of acetylsalicylic acid and P2Y12 inhibitor) recommended after percutaneous coronary intervention. The decision on the choice of antiplatelet drug and the DAPT duration is challenging and should be based on the relationship between ischemia and bleeding with the purpose of reducing ischemic events but not at the expense of increased bleeding complications. This is particularly important in the older population, where the evidence is obscure. The main objective of this review is to summarize the available evidence on contemporary antiplatelet therapy and different approaches of de-escalation strategies in older patients after percutaneous coronary intervention.What is the context?The older population represents a unique subset of patients due to a higher rate of comorbidities, risk factors, and unfavorable prognostic features, which can lead to a higher rate of ischemic and bleeding events. They are either excluded or underrepresented in most randomized clinical trials, which is why guidelines recommendation should be taken cautiously. Thus, the decision on the choice of antiplatelet therapy and its duration after percutaneous coronary intervention in older adults is challenging and should be tailored to a particular patient to avoid bleeding complications but not at the expense of increased ischemic events.What is new?In this review, we summarize all available evidence on contemporary antiplatelet therapy and different approaches of de-escalation strategies in older patients after percutaneous coronary intervention. In particular, several recommended approaches in patients with high bleeding risk, are thoroughly discussed in this review: De-escalation strategies with discontinuation of one antiplatelet drugDe-escalation strategy with switching between P2Y12 inhibitorsDe-escalation strategy based on dose reductionFinally, based on the current knowledge on factors contributing to high bleeding risk and the aforementioned antiplatelet modification approaches, in this review, we propose antiplatelet algorithm after percutaneous coronary intervention in older adults.What is the impact?The review provides comprehensive knowledge on antiplatelet therapy in older population and may help in tailoring antiplatelet therapy in this unique subset of patients

The New Transverse-Facial Artery Musculomucosal Flap for Intraoral Reconstructions

Head/neck cancer resections often require reconstruction to restore form and function. Small-to-medium size intraoral defects can be successfully reconstructed by local pedicled flaps, such as the facial artery musculomucosal (FAMM) flap,1 which encompasses different layers: cheek mucosa and submucosa, the underlying layer of the buccinator muscle, a portion of the orbicularis oris close to the labial commissure, and the facial artery.2 The flap is usually outlined longitudinally over the facial artery course, and average size is 5 × 2.5 cm. We describe here an innovative flap design and dissection, apt to treat larger defects than the usual ones. Go to: METHODS In a 50-year-old patient with squamous carcinoma of the soft palate involving also surrounding oral soft tissue, after oncological resection, we designed on the cheek mucosa an 8 × 3 cm flap with a squamous carcinoma orientation. The flap axis was crossing about 90 degrees the projection of the facial vessels. Dissection was carried out in anteroposterior direction and the facial artery skeletonized in continuity 3.5 cm superiorly and inferiorly the flap entrance (Fig. ​(Fig.1).1). Once the vascular pedicles had been mobilized and the labial artery ligated, the transverse (t)-FAMM flap was transposed superoposteriorly and sutured to the residual mucosa of the hard palate. A contralateral t-FAMM flap was harvested and transposed. The whole soft palate was then reconstructed by suturing the 2 flaps together

SUGAMMADEX versus neostigmine after ROCURONIUM continuous infusion in patients undergoing liver transplantation

Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation. Methods: The TOF-Watch SX\uae, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software\uae, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times\ub1SD of 9.4 \ub1 4.6 min and 34.6 \ub1 24.9 min, respectively (p < 0.0001). Conclusion: Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice. Trial registration: ClinicalTrials.gov NCT02697929 (registered 3rd March 2016)

Differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years following acute coronary syndromes: a prospective multicentre study

\ua9 Author(s) (or their employer(s)) 2023.Objective This study describes the differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years presenting with acute coronary syndrome (ACS) and undergoing invasive management. Methods A large-scale cohort study of patients with ST-elevation/non-ST-elevation myocardial infarction (MI)/unstable angina underwent coronary angiography (January 2015-December 2019). Patients were classified as older (≥75 years) and younger (≤74 years). Regression analysis was used to yield adjusted risks of mortality for older versus younger patients (adjusted for history of heart failure, hypercholesterolaemia, peripheral vascular disease, chronic obstructive pulmonary disease, ischaemic heart disease, presence of ST-elevation MI on presenting ECG, female sex and cardiogenic shock at presentation). Results In total, 11 763 patients were diagnosed with ACS, of which 39% were aged ≥75 years. Percutaneous coronary intervention was performed in fewer older patients than younger patients (81.2% vs 86.2%, p&lt;0.001). At discharge, older patients were prescribed less secondary-prevention medications than younger patients. Median follow-up was 4.57 years. Older patients had a greater risk of in-hospital mortality than younger patients (adjusted OR (aOR) 2.12, 95% CI 1.62 to 2.78, p&lt;0.001). Older patients diagnosed with ST-elevation MI had greater adjusted odds of dying in-hospital (aOR 2.47, 95% CI 1.79 to 3.41, p&lt;0.001). Older age was not an independent prognostic factor of mortality at 1 year (adjusted HR (aHR) 0.95, 95% CI 0.82 to 1.09, p=0.460) and at longer term (aHR 0.98, 95% CI 0.87 to 1.10, p=0.684). Conclusions Older patients are discharged with less secondary prevention. Patients aged ≥75 years are more likely to die in-hospital than younger patients

Phantom model and scoring system to assess ability in ultrasound-guided chest drain positioning

Background: Chest tube positioning is an invasive procedure associated with potentially serious injuries. In the last few years, we have been running a project directed at developing a practical simulator of a surgical procedure taught on our medical training program. The phantom model reconstructs the pleural anatomy, visible by lung ultrasound, used for the assessed performance of the Seldinger technique. The aim of the present study was to investigate the validity of this simulation technology for assessing residents in anesthesia and intensive care medicine; specifically, their skill in positioning a US-guided chest tube drain was tested using the simulator device. The second aim of the paper was to evaluate the learning curve of our residents over their 5-year study course and validate the phantom scoring system. Methods: This was a prospective, single-blinded observational study. Participants were recruited from residents in anesthesia and intensive care medicine and divided into two groups: \u2018Novice\u2019 and \u2018Expert,\u2019 based on the course year attended (years 1, 2, and 3 vs. years 4 and 5, respectively). We asked them to position a chest tube drain in a phantom model, guided by ultrasound, to drain a simulated pleural effusion. Each subject performed two tests that simulated pleural effusions of 4 and 2\ua0cm, respectively. Every step of the maneuver was constantly monitored and the performance scored by the investigators. We then performed a Spearman correlation analysis to evaluate the effect of experience level on the performance of the two groups of residents. Results: Thirty-one residents were included in this study: 20 in the Novice group and 11 in the Expert group. The mean performance rating score was 0.75\ua0\ub1\ua04.38 for the Novice Group and 5.91\ua0\ub1\ua03.75 for the Expert group (p\ua0=\ua00.0026). The Spearman correlation analysis examining the relationship between year of residency and performance rating score confirmed a positive correlation (r\ua0=\ua00.58, p\ua0=\ua00.0006). Post-test trend analysis revealed a statistically significant linear trend for skill growth across time, i.e., course year (p\ua0=\ua00.0022). Conclusions: Our simulated procedure using a phantom model of lung anatomy can accurately and reliably be used to assess the skill levels of operators in their ability to drain pleural effusion