Efficacy of coronary sinus reducer implantation in patients with chronic total occlusion of the right coronary artery

Background: Clinical efficacy of coronary sinus reducer (CSR) in refractory angina (RA) patients with ischemia due to the chronic total occlusion (CTO) of the right coronary artery (RCA) remains unknown. Aims: To evaluate the efficacy of CSR implantation in RA patients with CTO RCA and compare them to CSR recipients with left coronary artery (LCA) ischemia. Methods: Consecutive patients with CTO RCA from 2 centres were prospectively included and compared to patients with LCA ischemia. All patients underwent evaluation of angina severity and quality of life (QOL) at baseline and after 12 months. In a subgroup of CTO RCA patients stress cardiac magnetic resonance (CMR) imaging was also performed. Results: Twenty-two patients with CTO RCA and predominant inferior and/or inferoseptal wall ischemia (CTO RCA group) were compared to 24 patients with predominant anterior, lateral and/or anteroseptal wall ischemia (LCA group). While Canadian Cardiovascular Society (CCS) angina score mean (SD) improved in CTO RCA group from 2.73 (0.46) to 1.82 (0.73) (P < 0.001) and in LCA group from 2.67 (0.57) to 1.92 (0.72) (P < 0.001), there was no intergroup difference (P = 0.350). Significant improvement in all Seattle Angina Questionnaire domains was observed. Stress CMR did not show significant reduction of ischemic inferior and/or inferoseptal segments, however improvements in transmurality index (P = 0.03) and myocardial perfusion reserve index in segments with inducible ischemia (P = 0.03) were observed in CTO RCA group. Conclusions: In CTO RCA patients CSR implantation alleviated angina symptoms and improved QOL. Extent of improvement was comparable to that observed in patients with LCA ischemia

Variazione dei valori di spirometria in cani anestetizzati e ventilati in modalità a controllo di volume

La presente tesi si propone di valutare come variano la compliance polmonare e i parametri di spirometria in cani sottoposti ad anestesia generale di durata maggiore ai 45 minuti e ventilati meccanicamente in modalità a controllo di volume con variabili respiratorie impostate, previa manovra di reclutamento alveolare a 30 cm/h20 per 40 secondi

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival

Old and New Calcineurin Inhibitors in Lupus Nephritis

Calcineurin inhibitors (CNIs) are drugs that inhibit calcineurin, a key phosphatase that dephosphorylates a transcription factor called the nuclear factor of activated T cells (NFAT), allowing its translocation into the nucleus of quiescent T cells. In the nucleus, NFAT activates interleukin 2, which stimulates the proliferation and differentiation of T-cells. CNIs can also stabilize the actin cytoskeleton of podocytes reducing proteinuria. Thanks to these characteristics, CNIs have been often used in the treatment of autoimmune diseases. However, the therapeutic index of CNIs is narrow, and their interactions with other drugs can increase toxicity or reduce efficacy. In lupus nephritis, cyclosporine and tacrolimus have been used both in induction and maintenance therapies. Observational studies and randomized controlled trials showed that both cyclosporine and tacrolimus can increase efficacy. Tolerance is satisfactory if low doses are used and the patient is carefully monitored. More recently, a new CNI, called voclosporin (VCS), has been approved by the Food and Drug Administration for use in lupus nephritis. VCS offers potential advantages over other CNIs. In two large multiethnic trials, VCS was not associated with adverse renal and metabolic events and obtained positive results despite a novel and rapid corticosteroid tapering regime

Kidney Involvement in Systemic Sclerosis

Background: Systemic sclerosis is a chronic multisystem autoimmune disease, characterized by diffuse fibrosis and abnormalities of microcirculation and small arterioles in the skin, joints and visceral organs. Material and Methods: We searched for the relevant articles on systemic sclerosis and kidney involvement in systemic sclerosis in the NIH library of medicine, transplant, rheumatologic and nephrological journals. Results: Half of patients with systemic sclerosis have clinical evidence of kidney involvement. Scleroderma renal crisis represents the most specific and serious renal event associated with this condition. It is characterized by an abrupt onset of moderate to marked hypertension and kidney failure. Early and aggressive treatment is mandatory to prevent irreversible organ damage and death. The advent of ACE-inhibitors revolutionized the management of scleroderma renal crisis. However, the outcomes of this serious complication are still poor, and between 20 to 50% of patients progress to end stage renal disease. Conclusions: Scleroderma renal crisis still represents a serious and life-threatening event. Thus, further studies on its prevention and on new therapeutic strategies should be encouraged

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Background. Delayed graft function is a frequent complication of kidney transplantation that requires dialysis in the first week posttransplant. Materials and Methods. We searched for the most relevant articles in the National Institutes of Health library of medicine, as well as in transplantation, pharmacologic, and nephrological journals. Results. The main factors that may influence the development of delayed graft function (DGF) are ischemia–reperfusion injury, the source and the quality of the donated kidney, and the clinical management of the recipient. The pathophysiology of ischemia–reperfusion injury is complex and involves kidney hypoxia related to the duration of warm and cold ischemia, as well as the harmful effects of blood reperfusion on tubular epithelial cells and endothelial cells. Ischemia–reperfusion injury is more frequent and severe in kidneys from deceased donors than in those from living donors. Of great importance is the quality and function of the donated kidney. Kidneys from living donors and those with normal function can provide better results. In the peri-operative management of the recipient, great attention should be paid to hemodynamic stability and blood pressure; nephrotoxic medicaments should be avoided. Over time, patients with DGF may present lower graft function and survival compared to transplant recipients without DGF. Maladaptation repair, mitochondrial dysfunction, and acute rejection may explain the worse long-term outcome in patients with DGF. Many different strategies meant to prevent DGF have been evaluated, but only prolonged perfusion of dopamine and hypothermic machine perfusion have proven to be of some benefit. Whenever possible, a preemptive transplant from living donor should be preferred

Combined Fuzzy and Genetic Algorithm for the Optimisation of Hybrid Composite-Polymer Joints Obtained by Two-Step Laser Joining Process

In the present work, genetic algorithms and fuzzy logic were combined to model and optimise the shear strength of hybrid composite-polymer joints obtained by two step laser joining process. The first step of the process consists of a surface treatment (cleaning) of the carbon fibre-reinforced polymer (CFRP) laminate, by way of a 30 W nanosecond laser. This phase allows removing the first matrix layer from the CFRP and was performed under fixed process parameters condition. In the second step, a diode laser was adopted to join the CFRP to polycarbonate (PC) sheet by laser-assisted direct joining (LADJ). The experimentation was performed adopting an experimental plan developed according to the design of experiment (DOE) methodology, changing the laser power and the laser energy. In order to verify the cleaning effect, untreated laminated were also joined and tested adopting the same process conditions. Analysis of variance (ANOVA) was adopted to detect the statistical influence of the process parameters. Results showed that both the laser treatment and the process parameters strongly influence the joint performances. Then, an uncertain model based on the combination of fuzzy logic and genetic algorithms was developed and adopted to find the best process parameters' set able to give the maximum joint strength against the lowest uncertainty level. This type of approach is especially useful to provide information about how much the precision of the model and the process varies by changing the process parameters