Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases

Atrial natriuretic Peptide expression in human articular cartilage

This immunohistochemical study aims to investigate the Atrial natriuretic peptide (ANP)-presence and localization in human articular cartilage. Fragments of articular cartilage covering the femoral head were removed from patients submitted to surgical operation after femoral neck fracture without joint disease. The samples were immunostained with anti-ANP antibody. The results demonstrate that ANP is present in chondrocytes in all the three zones of the articular cartilage. Superficial chondrocytes show strong ANP-immunopositivty. The presence of ANP in the articular cartilage suggests that ANP may play a role in cartilage metabolism by regulating transport of molecules through the different zones of the articular cartilage and in maintenance of its homeostasis; probably ANP could be also involved in the regulation of the balance between synovial fluid and the other body fluids

Il trattamento chirurgico laparoscopico delle cisti idatidee epatiche: tecnica personale

Il trattamento delle cisti idatidee epatiche è ancor oggi ampiamente dibattuto. Alle modalità di trattamento tradizionali, quali le terapie mediche antiparassitarie, le procedure radiologiche e gli interventi chirurgici a cielo aperto, si è di recente affiancata la procedura laparoscopica. Molti aspetti riguardanti il trattamento laparoscopico delle cisti idatidee rimangono a tutt’oggi controversi. L’utilizzo dell’approccio mini-invasivo proposto in letteratura da alcuni autori è gravato da un’incidenza di recidive dallo 0 al 9%, in follow-up da 3 a 49 mesi. Inconvenienti della tecnica laparoscopica sono le difficoltà di controllo dello “spillage” e la disseminazione peritoneale, nonché l’incompleta aspirazione delle cisti a contenuto denso. Gli Autori hanno rivisto i dati della letteratura e descrivono una tecnica personale al fine di evitare gli inconvenienti descritti e di ridurre l’incidenza delle recidive postchirurgiche

A real-time commercial aggregator for distributed energy resources flexibility management

With the transition to a more decentralized electricity sector, Distribution System Operators (DSOs) are facing new challenges, as well as new opportunities, deriving from the growing penetration of Distributed Energy Resources (DERs). In fact, an increasing penetration of DERs in Low Voltage (LV) grids likely pushes the system to congestion conditions more easily but also adds additional flexibility potential to the power system. Currently, the demand response solutions implemented in a significant number of countries do not consider aggregation of customers/prosumers at LV level but typically focus on fewer resources of greater individual size (i.e. industrial loads) connected to Medium and High Voltage levels. Hence the system requires a new actor to manage the resources connected at LV level in the most efficient way. The paper describes the implementation of a real-time Commercial Aggregator, that pools the generation and/or consumption flexibility offered by its customers to provide energy and services to actors within the system. Results of the emulations carried out in the scope of the FP7 European project IDäL are presented, highlighting the effects of the participation of DERs and Microgrids to the congestion management by offering flexibility products through the involvement of the Commercial Aggregator (CA).The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement n 608860.Peer ReviewedObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No ContaminantPostprint (published version

Electrical Distribution Substation Remote Diagnosis and Control System

This paper presents the conception, design, set up and realization of a prototype system for telemanagement of a MV/LV substation. The prototype has been developed according to the current standards. This system allows to monitor the status of the MV/LV substation box, of the medium voltage equipment, of the transformer and of the low voltage equipment. In particular, the system acts when some specified events occur. The prototype has been realized by using a DAQ; the software that implement the telemanagement system has been developed in LabVIEW environment. The system allows a remote monitoring of the quantities of interest that is carried out using the TeamViewer software able to establish a web connection between the user and the operations center. Moreover the developed telemanagement system has been set up and tested on a test bench for this purpose built. The test bench allows to inject some faults and, consequently, to verify if the prototype detect the anomalous working condition. The realized telemanagement system, based on appropriate sensors, has been easily integrated into an electrical substation because it uses commercially and normally installed devices

Characterization of the Magnetic Induction Field produced by Secondary Substations

The aim of this paper is to develop a methodology for measuring the magnetic field distribution around the prefabricated secondary substations in vibrated reinforced concrete, as well as the definition of a methodology to determining the maximum value of magnetic induction produced by the substations in correspondence to nominal current of the transformer. As proposed has been developed in conformity with laws and standards and can be applied to active and passive secondary substations. The experimental validation of the proposed methodology, carried out by a measurements campaign whose results are reported, confirms the validity and returns a versatile and simple tool for the verification of the quality targets required by current legislation

Koolen-de Vries Syndrome: Preliminary Observations of Topiramate Efficacy

We describe the case of a baby-girl affected by the Koolen-de Vries syndrome (KdVS), with epilepsy. Our patient has microdeletions in the 17q21.31 region (array CGH). Therapy with Levetiracetam showed a relatively lack of efficacy, while adding a low dose of Topiramate in the therapy allowed the complete seizures control. KdVS is a rare syndrome and its epilepsy features and seizures treatment are not well known by pediatric neurologists. However, with broader use of array CGH, an increasing number of cases are likely to be identified and their description, including response to specific medications, can facilitate recognition and treatment. The complex treatment of epilepsy should be part of the global management and counseling in these composite patients

Left ventricular diastolic and systolic function in normotensive obese subjects: influence of degree and duration of obesity.

The present study was carried out to evaluate systolic and diastolic parameters in overweight and moderately obese, but otherwise healthy subjects, and in a lean control group, to determine whether degree and duration of obesity can influence left ventricular function. A total of 27 subjects, 17 overweight or with moderate obesity and 10 lean, healthy subjects were included. Patients were divided into three groups according to their body mass index (BMI) and to Garrow's criteria as follows: lean control group (BMI less than 25 kg.m-2); overweight subjects (BMI from 25 to 30 kg.m-2); moderately obese subjects (BMI greater than 30 less than 40 kg.m-2). Systolic and diastolic parameters were measured using blood pool gated radionuclide angiography. Left ventricular (LV) ejection fraction (EF), peak ejection rate (PER), time to PER (tPER), peak filling rate (PFR) and time to PFR (tPFR) were evaluated. PER and PFR values were normalized for end-diastolic volume (EDV). EF and PFR were significantly lower (P less than 0.05) both in moderately obese and in overweight subjects and tPFR was significantly (P less than 0.05) prolonged in both groups in comparison to lean controls. Only in moderately obese subjects was PER significantly (P less than 0.05) decreased and tPER significantly (P less than 0.05) prolonged in comparison to lean controls. As compared to overweight individuals, moderately obese subjects were characterized by a significant decrease (P less than 0.05) in LVEF and PER and by a significant increase (P less than 0.05) in tPER, without relevant change in PFR and in tPF

Antihypertensive efficacy and effects of nitrendipine on cardiac and renal hemodynamics in mild to moderate hypertensive patients: randomized controlled trial versus hydrochlorothiazide.

In this study antihypertensive efficacy, safety, and the effects of short-term nitrendipine administration on central and renal hemodynamics were evaluated in mild to moderate hypertensives. Our final goal was to ascertain whether the reduction in blood pressure induced by nitrendipine treatment was associated with maintained renal function. After a run-in period with placebo, 26 hypertensives without cardiac or renal disease were randomly assigned to a double-blind 8-week controlled trial with nitrendipine (N) 20 mg once a day (13 pts) or hydrochlorothiazide (HCT) 25 mg once a day (13 pts). Renal hemodynamic measurements included effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) by radionuclide study using I-131 hippuran and Tc-99m, according to the methods described by Schlegel and Gates, respectively. Effective renal blood flow [ERBF = ERPF/(1-Ht)], filtration fraction (FF = GFR/ERPF), and renal vascular resistance (RVR = MBP x 80/ERBF) were also calculated. Other hemodynamic measurements included cardiac index (CI), left ventricular (LV) ejection fraction (EF), and total peripheral resistance (TPR) measured by the first-pass radionuclide angiography technique. At the end of N or HCT administration significant decreases (p less than 0.001) in SBP, DBP, and MBP vs. baseline values were observed in both hypertensive groups. In the N group a significant decrease (p less than 0.01) in TPR and RVR, and significant increases (p less than 0.05) in CI, ERPF, and ERBF were observed. In the HCT group a significant decrease (p less than 0.05) in RVR was found without significant changes in other hemodynamic parameters. No important side effects were observed with either therapy. In conclusion, nitrendipine was effective in reducting blood pressure in mild to moderate hypertensive patients and exerted favorable effects on cardiac and renal function