319 research outputs found
Optimal Site for Proximal Optimization Technique in Complex Coronary Bifurcation Stenting: A Computational Fluid Dynamics Study
Background/purpose: The optimal position of the balloon distal radio-opaque marker during the post optimization technique (POT) remains debated. We analyzed three potential different balloon positions for the final POT in two different two-stenting techniques, to compare the hemodynamic effects in terms of wall shear stress (WSS) in patients with complex left main (LM) coronary bifurcation. Methods/materials: We reconstructed the patient-specific coronary bifurcation anatomy using the coronary computed tomography angiography (CCTA) data of 8 consecutive patients (6 males, mean age 68.2± 18.6 years) affected by complex LM bifurcation disease. Subsequently a virtual bench test was performed in each patient using two different double stenting techniques represented by the DK and Nano crush using the reconstruction of Orsiro stents (Biotronik IC, Bulack, Switzerland). Results: A significant reduction in the mean WSS values in all the lesion's sites was observed when the final POT was performed 1 mm distally the carina cut plane in both techniques. Moreover, a significant improvement in the mean WSS values of the entire SB (e.g. LCX) was obtained performing the POT 1 mm distally to the carina cut plane. The proximal POT resulted in larger area of lower WSS values at the carina using both the Nano crush and the DK crush techniques. Conclusions: In patients with complex LM bifurcation disease the use of a final POT performed 1 mm distally to the carina cut plane might results in more favorable WSS patterns (i.e. higher WSS values) along all stented segments and, especially, along the entire LCX lesions
Biomechanical Evaluation of Different Balloon Positions for Proximal Optimization Technique in Left Main Bifurcation Stenting
Background: Proximal optimization technique (POT) is a key step during left main (LM) bifurcation stenting. However, after crossover stenting, the ideal position of POT balloon is unclear. We sought to evaluate the biomechanical impact of different POT balloon positions during LM cross-over stenting procedure. Methods: We reconstructed the patient-specific LM bifurcation anatomy, using coronary computed tomography angiography data of 5 consecutive patients (3 males, mean age 66.3 ± 21.6 years) with complex LM bifurcation disease, defined as Medina 1,1,1, evaluated between 1st January 2018 to 1st June 2018 at our center. Finite element analyses were carried out to virtually perform the stenting procedure. POT was virtually performed in a mid (marker just at the carina cut plane), proximal (distal marker 1 mm before the carina) and distal (distal marker 1 mm after the carina) position in each investigated case. Final left circumflex obstruction (SBO%), strut malapposition, elliptical ratio and stent malapposition were evaluated. Results: The use of both proximal and distal POT resulted in a smaller LM diameter compared to the mid POT. SBO was significantly higher in both proximal and distal configurations compared to mid POT: 38.3 ± 5.1 and 29.3 ± 3.1 versus 18.3 ± 3.6%, respectively. Similarly stent malapposition was higher in both proximal and distal configurations compared to mid POT: 1.3 ± 0.4 and 0.82 ± 1.8 versus 0.78 ± 1.2, respectively. Conclusions: Mid POT offers the best results in terms of LCx opening maintaining slightly smaller but still acceptable LM and LAD diameters compared to alternative POT configuration
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Thermoresponsive Host Polymer Matrix for Self-Healing Luminescent Solar Concentrators
© 2019 American Chemical Society. Luminescent solar concentrators (LSCs) are a promising solar energy technology for reducing architectural barriers to the integration of photovoltaic systems into the built environment. In this work, the first demonstration of thin-film LSCs based on a thermally reversible cross-linked host polymer is presented. This smart material is obtained via a dynamic-chemistry approach based on the Diels-Alder (DA) reaction between a furan-functionalized acrylic copolymer and an aliphatic bismaleimide to obtain optically clear, cross-linked systems capable of healing mechanical damage upon heat treatment. By carefully tuning the concentration of a perylene-based luminophore dopant, an optical efficiency as high as 4.9% can be achieved with this DA-based LSC. In addition, full recovery of device efficiency is demonstrated after complete thermal healing of mechanically induced surface damages as a result of the embedded DA functionality. The approach presented here paves the way to the development of highly efficient multifunctional thermoresponsive smart LSC systems.European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 818762
Neuroenhancer use amongst Italian medical students: a survey
Introduction.
Increasing use of substances by university students to improve cognitive performance ('neuroenhacement')
has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco,
but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy.
Aims.
To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their
attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil)
used for this purpose.
Methods
An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio
Emilia. Valid response rate was 83.8% (N=363).
Results
271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%,
N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco
(10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2
students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3% ) students mentioned
concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group
in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p =
0.036).
Conclusions
Italian medical students use many substances as cognitive enhancers, but this seems not to apply to
psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other
Countries, which warrants further research
Apple or pear? A cross sectional study on the association between body shape and symptoms of anxiety and depression in primary care female patients
INTRODUCTION - "Apple" body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for
cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders,
especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence
that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint
assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far.
AIM - To explore the association between WHR and symptoms of anxiety and depression in a female
primary care sample.
METHODS - Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in
a Northern Italy Practice. Exclusion criteria: age 80; use of antidepressants or antipsychotics;
previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS
(Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA.
RESULTS - 125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score
(β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In
particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC
was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were
found in older groups.
CONCLUSION - 'Pear” body shape (WHR<1), with a peripheral distribution of fat, is inversely associated to
symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple”
model, with a central fat distribution, could explain the lack of correlations in women >60 years
Association between anxiety and depressive symptoms with metabolic syndrome in primary care: Results of an Italian cross-sectional study involving outpatients
Background: Metabolic syndrome (MetS) is a heterogeneous entity
represented by the coexistence of multiple alterations: abdominal adiposity, impaired glucose tolerance, hypertriglyceridemia, HDL
hypocolesterolemia and hypertension. Symptoms of anxiety and
depression are frequently comorbid with MetS. Aim of the present
study was to measure the association between symptoms of anxiety
and depression with the five criteria of MetS in outpatients attending
GPs' practices.
Method: This is a cross-sectional study, involving male and female
patients aged 40–80 attending five GPs' practices within one month
in Modena, Northern Italy approved by the local Ethical Committee.
All patients were screened for the presence of MetS and depressive/
anxiety symptoms, using the Hospital Anxiety and Depression Scale.
Exclusion criteria: age b40 or N80; use of antidepressants or
antipsychotics; previous stroke, heart attack or cardiovascular
disease; diagnosed psychotic or mood disorder (according to the
DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to
obesity. All data were adjusted for socio-demographic confounders.
Multiple logistic analysis performed with STATA 13.0.
Results: 128 subjects were enrolled in the study (55 men and 73
women), 48 presented with MetS (ATP-III-Revised criteria). MetS
was associated with depression only in the female group (OR =6.33,
p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS
was not associated with anxiety in both males and females, and with
depression in men. Among the individual components of MetS,
only waist circumference was associated with anxiety in the female
group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34,
p=0.04).
Conclusion: Women aged between 40 and 60, presenting with MetS
and attending the primary care services should been regularly
screened for the presence of depression. Chronic systemic inflammation
could represent the biological link between MetS and
psychological symptoms. Further researches are needed to better
clarify this possible relation
Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study
Background: Metabolic syndrome (MetS) is a heterogeneous entity
represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL
hypocolesterolemia and hypertension. Symptoms of anxiety and
depression are frequently comorbid with MetS. Aim of the present
study was to measure the association between symptoms of anxiety
and depression with the five criteria of MetS in outpatients attending
GPs' practices.
Method: This is a cross-sectional study, involving male and female
patients aged 40–80 attending five GPs' practices within one month
in Modena, Northern Italy approved by the local Ethical Committee.
All patients were screened for the presence of MetS and depressive/
anxiety symptoms, using the Hospital Anxiety and Depression Scale.
Exclusion criteria: age b40 or N80; use of antidepressants or
antipsychotics; previous stroke, heart attack or cardiovascular
disease; diagnosed psychotic or mood disorder (according to the
DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to
obesity. All data were adjusted for socio-demographic confounders.
Multiple logistic analysis performed with STATA 13.0.
Results: 128 subjects were enrolled in the study (55 men and 73
women), 48 presented with MetS (ATP-III-Revised criteria). MetS
was associated with depression only in the female group (OR =6.33,
p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS
was not associated with anxiety in both males and females, and with
depression in men. Among the individual components of MetS,
only waist circumference was associated with anxiety in the female
group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34,
p=0.04).
Conclusion: Women aged between 40 and 60, presenting with MetS
and attending the primary care services should been regularly
screened for the presence of depression. Chronic systemic inflammation
could represent the biological link between MetS and
psychological symptoms. Further researches are needed to better
clarify this possible relation
Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting
Background: Recent researches exploring the relationship between
impaired glucidic tolerance, hyperglycemia or frank type II diabetes
mellitus and symptoms of anxiety and depression, mostly conducted
on in-patients or highly selected samples and on foreign populations,
have reported conflicting results. Nevertheless, these medical and
mental conditions are often comorbid in clinical practice. Chronic
and systemic inflammation could represent the trait d\'union
between these conditions. Primary care represents an interesting
setting for exploring this comorbidity, given the high prevalence of
psychiatric symptoms displayed by patients. The aims of this
research was to measure the association between hyperglycemia
and symptoms of anxiety and/or depression in out-patients, and to
fill the lack of studies on comorbidity between depression and
anxiety disorders and medical conditions in Primary Care services.
Method: The present was a cross-sectional study. We evaluated all
consecutive patients undergoing a GP consultation in a Northern
Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants
or antipsychotics medication; psychosis (schizophrenia, schizoaffective,
bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major
depression; pregnancy; previous stroke or heart attack; type I diabetes
mellitus. The psychometric assessment was done by HADS (Hospital
Anxiety and Depression Scale). Blood Glucose measurements (BM) in
the last 6 months were considered in our analysis. Hyperglycemia cutoff:
blood glucose N100 mg/dl. The statistical analysis was performed
using STATA with multiple linear regressions.
Results: 209 subjects were recruited in our study (84 men and
125 women). Of those, 48 (22.9%) were affected by hyperglycemia:
22 were men and 26 women. Hyperglycemia was related to HADS-D
score in the men sample (β = .44, p = .01). No association was
found between hyperglycemia and HADS-A, either in men or in
women.
Conclusion: The presence of hyperglycemia, well-known cardiovascular
risk factor, may have a clinical value in predicting the presence
of depressive symptoms, especially in men. Further studies should
examine whether our results are generalizable to other populations
and whether they are applicable to clinical depression. Molecular
researches could focus on clarifying the pathophysiological reasons
for such association, also exploring reasons for sex differences
Selectra 3D- guided conduction system pacing: single-center experience
Abstract
Background
Conduction system pacing (CSP)is becoming increasingly popular thanks to the ability to both maintain physiological electrical activation in patients with narrow QRS and restore ventricular synchrony in patients with bundle branch block (BBB). The Selectra3D introducer is a new tool able to support the correct positioning and screwing of the catheter on the bundle of His (HBP) or on the left branch (LBBP). It does exist in 3 different shapes: S, M, L (Fig. 1) based on the radius of main curvature. The internal diameter of 7.3 Fr allows it to support both the 3830 lumen-less catheter historically used for CSP, as well as standard 6Fr stylet-driven leads.
Objective
To evaluate the effectiveness of the Selectra3D introducer for CSP (including both HBP and LBBP), considering the procedural success rate and the lead stability (stability of electrical parameters or need for implant revision) in the medium-term follow-up.
Methods and results
The Selectra3D introducer was used in 56 patients' candidates for CSP (mean age 80±6 years). Pacing indications included A-V block in 21 patients, AF with slow ventricular response in 9 patients; SND in 8 patients and HF and severe ventricular dysfunction in 18 patients (of which 4 were PICM). The mean baseline EF was 40±15%. A PM was implanted in 40 patients and an ICD in 16. A standard stylet-driven lead was used in 48 cases, a fixed exposed screw lead was used in 8 patients. HBP was obtained in 21 cases and LBBP in 30 cases, while in 5 cases (8.9%) neither HBP nor LBBP could be obtained. Implants were performed via a left-sided approach in 55 cases and a right-sided approach in 1 case. The baseline QRS duration was 144±38 ms and the paced QRS duration was 118±21 ms. The electrical parameters were optimal with sensing 8.7±8 mV; impedance 625±276 ohm; threshold 1±0.5 V. During follow-up, 2 lead dislodgement (3.9%) (1 HBP and 1 LBBP) were recorded, both within 7 days after implantation. All the others showed stability of the electrical parameters at a mean follow-up of 8.4±4.2 months.
Conclusions
The new Selectra3D introducer supports effectively and safely the lead implant on conduction system catheters (HBP and LBBP), allowing the implant of both exposed fixed screw leads and standard stylet-driven leads, leading to procedural success>90%. The electrical parameters were optimal at implantation and remained stable during follow-up.
Funding Acknowledgement
Type of funding sources: None. Figure
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