Bridging aortic valve surgery to 21st century. what can a surgeon do

Aortic valve stenosis is the most clinically relevant valvular heart disease in the elderlies. Surgical aortic valve replacement (SAVR) represented, for decades, the standard of care for the treatment of severe aortic stenosis. Although SAVR still represents a valid option in this clinical scenario, transcatheter aortic valve implantation proved to be superior to medical therapy and comparable to SAVR in several randomized trials in patients at high or intermediate operative risk. At the same time, the growing aging population carrying on greater morbidities and high risk profiles has led to the development of minimally invasive technologies, as rapid deployment aortic valve replacement or Sutureless, to minimize surgical impact on patients. The Heart Team is nowadays tasked to determine the best option tailored for each patient considering patient-related factors and mastering all the surgical options in terms of both different techniques and types of available valves. Nevertheless, some open issues need to be already answered as: which has the longest durability, which the lower complication rate and the lower overall mortality. The aim of this review is to briefly resume the main features of these different options and explore what kind of open questions these newer-generation prosthetic valves and delivery devices carry

Soft failure localization during commissioning testing and lightpath operation

In elastic optical networks (EONs), effective soft failure localization is of paramount importance to early detection of service level agreement violations while anticipating possible hard failure events. So far, failure localization techniques have been proposed and deployed mainly for hard failures, while significant work is still required to provide effective and automated solutions for soft failures, both during commissioning testing and in-operation phases. In this paper, we focus on soft failure localization in EONs by proposing two techniques for active monitoring during commissioning testing and for passive in-operation monitoring. The techniques rely on specifically designed low-cost optical testing channel (OTC) modules and on the widespread deployment of cost-effective optical spectrum analyzers (OSAs). The retrieved optical parameters are elaborated by machine learning-based algorithms running in the agent’s node and in the network controller. In particular, the Testing optIcal Switching at connection SetUp timE (TISSUE) algorithm is proposed to localize soft failures by elaborating the estimated bit-error rate (BER) values provided by the OTC module. In addition, the FailurE causE Localization for optIcal NetworkinG (FEELING) algorithm is proposed to localize failures affecting a lightpath using OSAs. Extensive simulation results are presented, showing the effectiveness of the TISSUE algorithm in properly exploiting OTC information to assess BER performance of quadrature-phase-shift-keying-modulated signals, and the high accuracy of the FEELING algorithm to correctly detect soft failures as laser drift, filter shift, and tight filtering.Peer ReviewedPostprint (published version

Dai balconi ai parchi urbani: buone pratiche per un giardinaggio consapevole

Prodotto nell’ambito del progetto LIFE15 GIE/IT/001039 “Alien Species Awareness Program”(ASAP), è un opuscolo di tipo tecnico-pratico che intende fornire alcune informazioni di base sulle piante esotiche invasive presenti in Italia nonché, seguendo le buone pratiche dettate nel Codice di condotta definito nell’ambito della Convenzione di Berna, proporre un numero non esaustivo di specie native da utilizzare in alternativa alle piante esotiche invasive inserite nella Lista di Rilevanza Unionale e per le quali vi è divieto di importazione, commercio, possesso, riproduzione, trasporto, utilizzo e rilascio in natura. E’ indirizzato a tutti coloro che sono coinvolti direttamente o indirettamente nella produzione, commercializzazione e impiego delle piante ornamentali: aziende florovivaistiche importatori di piante e tutti coloro che svolgono un ruolo nella progettazione e realizzazione di aree verdi quali gli Architetti paesaggisti, i Dottori Forestali, i Dottori Agronomi e a tutti gli appassionati di giardinaggio. La scelta di utilizzare specie autoctone nel verde urbano risponde anche all’esigenza di garantire una migliore tutela e conservazione della biodiversità negli spazi urbani

Resuscitation with supplementary oxygen induces oxidative injury in the cerebral cortex

6sireservedIsoprostanes, neuroprostanes, isofurans, and neurofurans have all become attractive biomarkers of oxidative damage and lipid peroxidation in brain tissue. Asphyxia and subsequent reoxygenation cause a burst of oxygen free radicals. Isoprostanes and isofurans are generated by free radical attacks of esterified arachidonic acid. Neuroprostanes and neurofurans are derived from the peroxidation of docosahexanoic acid, which is abundant in neurons and could therefore more selectively represent oxidative brain injury. Newborn piglets (age 12-36h) underwent hypoxia until the base excess reached -20mmol/L or the mean arterial blood pressure dropped below 15mm Hg. They were randomly assigned to receive resuscitation with 21, 40, or 100% oxygen for 30min and then ventilation with air. The levels of isoprostanes, isofurans, neuroprostanes, and neurofurans were determined in brain tissue (ng/g) isolated from the prefrontal cortex using gas chromatography-mass spectrometry (GC/MS) with negative ion chemical ionization (NICI) techniques. A control group underwent the same procedures and observations but was not submitted to hypoxia or hyperoxia. Hypoxia and reoxygenation significantly increased the levels of isoprostanes, isofurans, neuroprostanes, and neurofurans in the cerebral cortex. Nine hours after resuscitation with 100% oxygen for 30min, there was nearly a 4-fold increase in the levels of isoprostanes and isofurans compared to the control group (P=0.007 and P=0.001) and more than a 2-fold increase in neuroprostane levels (P=0.002). The levels of neuroprostanes and neurofurans were significantly higher in the piglets that were resuscitated with supplementary oxygen (40 and 100%) compared to the group treated with air (21%). The significance levels of the observed differences in neuroprostanes for the 21% vs 40% comparison and the 21% vs 100% comparison were P<0.001 and P=0.001, respectively. For neurofurans, the P values of the 21% vs 40% comparison and the 21% vs 100% comparison were P=0.036 and P=0.025, respectively. Supplementary oxygen used for the resuscitation of newborns increases lipid peroxidation in brain cortical neurons, a result that is indicative of oxidative brain damage. These novel findings provide new knowledge regarding the relationships between oxidative brain injury and resuscitation with oxygen.mixedSolberg, R.; Longini, M.; Proietti, F.; Vezzosi, P.; Saugstad, O.D.; Buonocore, G.Solberg, R.; Longini, M.; Proietti, F.; Vezzosi, P.; Saugstad, O. D.; Buonocore, G

The first report of the Italian Migraine Registry (I-GRAINE)

Italian Migraine Registry (I-GRAINE) is a multicenter (n = 38), prospective, observational, non-interventional study aimed at providing big data on migraine to ensure proper clinical disease management, according to scientific, and sustainability criteria. We enrolled consecutive patients affected by episodic or chronic migraine according to the systematic random method. Information on sociodemographic characteristics, lifestyle, migraine features, patient's journey, and healthcare resource use were gathered using face-to-face interviews.On the date of 31 December 2021, we enrolled 231 patients at 12 headache centers. Most of them were women (84.4%), with high migraine frequency (9.6 ± 6.9 days/month) and severe disability (MIDAS score: 43.0 ± 40.8; HIT-6 score: 60.4 ± 10.6). Only a minority of patients (38.1%) had previously visited a headache center.A clear-cut difference emerged in the proportion of responders to nonspecific acute treatments (43.5-66.7%) compared to triptans (76.3%) and in responders to unspecific prophylaxis (5.4-35%) compared to anti-CGRP monoclonal antibodies (69.2-78.6%). Most patients underwent ≥ 1 specialist visit (66.9%) or diagnostic investigation (77.4%) over the last 3 years-mostly subsidized by our national health system-inappropriate in 64.9% and 25% of the cases, respectively.The I-GRAINE registry is expected to provide a large and exponentially increasing collection of clinical, biological, and epidemiologic information and will contribute to moving migraine out of the shadow cone of marginalization, which has been often relegated up to now

Type A Chronic Aortic Dissection in 40-Years Old Smeloff-Cutter Aortic Valve

We report the case of a 60-year-old man undergone an aortic valve replacement with a Smeloff- Cutter prosthesis 40 years ago. The patient underwent a redo aortic valve and ascending aorta replacement for ascending aorta aneurysm that intraoperatively appeared as a chronic Type A aortic dissection. The Smeloff-Cutter prosthesis looked intact and functionally normal. The ascending portion of the aorta appeared dissected two centimeters above the sino-tubular junction, between the non-coronary and the left coronary valsalva sinuses: we speculate that Smeloff-Cutter prosthesis may contribute, due to its rheology and features, to the determinism of aortic dilatation and subsequently dissection

BRAF status of follicular variant of papillary thyroid carcinoma and its relationship to its clinical and cytological features

Background: The cytological discrimination between benign and malignant follicular-patterned lesions of the thyroid can represent a diagnostic challenge, even for experienced pathologists. To attempt to clarify this diagnostic problem, we analyzed the BRAF status of thyroid tumors in a group of patients with follicular variant of papillary thyroid carcinoma (FVPTC) and its correlation with cytomorphological features. Methods: The BRAF status was evaluated in a total of 187 patients in whom FVPTC was consecutively diagnosed by histology between January 2006 and January 2009. Each case had a previous fine-needle aspiration diagnosis classified according to the British Thyroid Association Guidelines categorized as inadequate (Thy1) (n = 19), benign (Thy2) (n = 19), follicular lesion and follicular lesion with atypia (Thy3) (n = 109), suspicious of PTC (Thy4) (n = 29), or malignant (Thy5) (n = 11). The first 68 cases were selected for a morphological study by a quantitative analysis of four cytological features (grooves, intranuclear cytoplasmatic inclusions, number of cells per high power field (400x), and mean nuclear diameter) of the carcinomas. Results: The BRAF status of each tumor was correlated with the cytological classes. 54.5% and 27.6% of Thy5 and Thy4, respectively, were BRAF-mutated, against 12.1% of follicular lesions and 9.3% of follicular lesion with atypia (Thy3). This comparison was statistically significative (p = 0.0017). Among the 68 cases selected for the cytomorphological study, the BRAF status frequency was similar to that of the total case series. No significant differences were found correlating the cytological classes with the number of cells, the number of grooves, and the mean cell diameters. Only the number of intranuclear cytoplasmatic inclusions were associated (p < 0.05) with the Thy5 cytological class. Conclusions: BRAF is mutated in a low percentage of FVPTC, and most of these mutated cases are suspicious or positive on fine-needle aspiration. BRAF analysis is of limited value in the preoperative diagnosis of FVPTC