Case report of a patient who survived after cardiac arrest and cardiogenic shock by anaphylactic reaction to gadolinium during magnetic resonance imaging

We report the case of a young adult which survived to anaphylactic shock caused by gadolinium-based contrast agent (GBCA) contrast agent infusion. The patient had no comorbidities and previous history of allergic reactions to contrast agents and underwent elective magnetic resonance imaging (MRI) for parotid swelling. Seven years before he received intravenous GBCA administration during an MRI, which exact chemical composition is unknown, without any allergic reaction. After intravenous injection of GBCA for MRI the patient developed anaphylactic shock, causing respiratory failure, cardiac arrest, and cardiogenic shock after return of spontaneous circulation. Because of the rarity of the described event, this report has the aim to raise awareness in the healthcare personnel of the possibility of these life-threatening adverse reactions from GBCAs also in a patient without history of allergy to contrast agents and suggest a possible clinical management of these patients

Deep sternal infections after in situ bilateral internal thoracic artery grafting for left ventricular myocardial revascularization: predictors and influence on 20-year outcomes

Background: The incidence and potential factors influencing deep sternal wound infection (DSWI) in a cohort of patients undergoing coronary artery bypass grafting (CABG) using skeletonized bilateral internal thoracic artery (BITA) was explored. Furthermore, we studied influence of DSWI on long-term survival, major adverse cardiac events (MACEs) and repeat coronary revascularization (RCR).Methods: The study cohort consisted of 1,325 consecutive patients who were divided in two groups: patients experiencing DSWI (n=33, group 1) and those who did not have sternal infection (n=1,292, group 2). A logistic regression model was employed to find predictors of DSWI whereas Cox regression and a competing risk models were carried out to test predictors of late death, MACE and RCR, respectively. Follow up was 100% complete and ranged from 1 to 245 months. Median follow-up was 103 months (IQR, 61 to 189 months). Cumulative follow-up was 16,430 patient years.Results: The incidence of DSWI was 2.4%. Multivariable logistic regression analysis found any single independent predictor of DSWI. However, the association of peripheral vascular disease (PVD) and diabetes increased the risk by 1.4 and 1.6 times. When DM was associated with obesity the risk increased by 2.1 and 2.6 times compared to the single factors, respectively. Obese female patients were at a 1.6-fold higher risk when compared to the association of DM with obesity. DSWI was not an independent predictor of long-term survival (HR, 2.31; 95% CI: 0.59–9.12), RCR (SHR, 2.89; 95% CI: 0.65–10.12), or MACE (SHR, 1.98; 95% CI: 0.44–8.56).Conclusions: With an accurate patient selection (i.e., exclusion of obese diabetic females) and strict DM control BITA represents a first choice for most of CABG patients, even at high risk for DSWI. The occurrence of DSWI does not influence long-term survival and late outcomes. Our findings should be confirmed by further larger research.</br

On the Investigation of Energy Efficient Torque Distribution Strategies through a Comprehensive Powertrain Model

In electric vehicles with multiple motors, the torque at each wheel can be controlled independently, offering significant opportunities for enhancing vehicle dynamics behaviour and system efficiency. This paper investigates energy efficient torque distribution strategies for improving the operational efficiency of electric vehicles with multiple motors. The proposed strategies are based on the minimisation of power losses, considering the powertrain efficiency characteristics, and are easily implementable in real-time. A longitudinal dynamics vehicle model is developed in Simulink/Simscape environment, including energy models for the electrical machines, the converter, and the energy storage system. The energy efficient torque distribution strategies are compared with simple distribution schemes under different standardised driving cycles. The effect of the different strategies on the powertrain elements, such as the electric machine and the energy storage system, are analysed. Simulation results show that the optimal torque distribution strategies provide a reduction in energy consumption of up to 5.5% for the case-study vehicle compared to simple distribution strategies, also benefiting the battery state of charge

NGC 1275: An Outlier of the Black Hole-Host Scaling Relations

The active galaxy NGC 1275 lies at the center of the Perseus cluster of galaxies, being an archetypal BH-galaxy system that is supposed to fit well with the M-BH-host scaling relations obtained for quiescent galaxies. Since it harbors an obscured AGN, only recently our group has been able to estimate its black hole mass. Here our aim is to pinpoint NGC 1275 on the less dispersed scaling relations, namely the M-BH-sigma(*) and M-BH - L-bul planes. Starting from our previous work (Ricci et al., 2017a), we estimate that NGC 1275 falls well outside the intrinsic dispersion of the M-BH-sigma(*) plane being 1.2 dex (in black hole mass) displaced with respect to the scaling relations. We then perform a 2D morphological decomposition analysis on Spitzer/IRAC images at 3.6 mu m and find that, beyond the bright compact nucleus that dominates the central emission, NGC 1275 follows a de Vaucouleurs profile with no sign of significant star formation nor clear merger remnants. Nonetheless, its displacement on the M-BH - L-3.6,L-bul plane with respect to the scaling relation is as high as observed in the M-BH-sigma(*). We explore various scenarios to interpret such behaviors, of which the most realistic one is the evolutionary pattern followed by NGC 1275 to approach the scaling relation. We indeed speculate that NGC 1275 might be a specimen for those galaxies in which the black holes adjusted to its host

Human papillomavirus infection and risk factors in a cohort of Tuscan women aged 18-24: results at recruitment

<p>Abstract</p> <p>Background</p> <p>There is conclusive evidence that human papillomavirus (HPV) infections of the cervix are a necessary cause of cervical cancer. In Italy there are consistent data of HPV prevalence in women aged 25 - 64 years, but there is limited data for younger women. The objective of this on-going 3-year prospective cohort study is to investigate the prevalence, acquisition, clearance and persistence of HPV infections in young Tuscan women and the risk factors correlated with such events.</p> <p>Methods</p> <p>One thousand and sixty-six women aged between 18 and 24 years were enrolled and received an initial HPV test. They were asked to return to the clinic over the study period for further tests every 12 months, if their HPV HR result was negative, or every 6 months, if positive. Additionally, women with an HPV positive result were given a cytological examination and if the cytological diagnosis was ASC-US or more severe, only women with HPV HR, were referred for colposcopy.</p> <p>Results</p> <p>We present here data for the enrolment phase of the study. At baseline, within the study sample, just under 30% of women were infected by HPV and 19.3% of women were infected with oncogenic types. A relationship was highlighted between HPV infection, number of sexual partners (in particularly in the last 3 years) and the lifetime number of partner's partners. Condom use showed a slight protective effect in univariate analysis but these data were not statistically significant in multivariate analysis. The association between HPV infection and demographic and behavioural variables were tested by crude odds ratio (OR). Multivariate logistic regression was applied to compute the adjusted odds ratios.</p> <p>Conclusions</p> <p>The prevalence of oncogenic HPV types was high in young Tuscan women. The 3-year follow-up of this cohort may provide a better understanding of the processes of acquisition, clearance and persistence of infection and the correlated risk factors.</p

BH mass scaling relations: the case of local AGN2

Black hole mass and bulge luminosity relation in type 2 AG

New Constraints on the Evolution of the Inner Northern Apennines by K-Ar Dating of Late Miocene-Early Pliocene Compression on the Island of Elba, Italy

The Northern Apennines (NA) orogenic wedge formed during Oligocene-Miocene convergence and westward subduction of Adria beneath the European Plate. Extension ensued in the Mid-Late Miocene in response to Adria roll-back, causing opening of the back-arc Northern Tyrrhenian Sea. Whether extension continues uninterrupted since the Mid-Late Miocene or it was punctuated by short-lived compressional events, remains, however, uncertain. We used the K-Ar method to date a set of brittle-ductile and brittle deformation zones from the Island of Elba to contribute to this debate. We dated the low-angle Zuccale Fault (ZF), the Capo Norsi-Monte Arco Thrust (CN-MAT), and the Calanchiole Shear Zone (CSZ). The CN-MAT and CSZ are moderately west dipping, top-to-the-east thrusts in the immediate footwall of the ZF. The CSZ slipped 6.14&nbsp;±&nbsp;0.64&nbsp;Ma (&lt;0.1&nbsp;μm fraction) and the CN-MAT 4.90&nbsp;±&nbsp;0.27&nbsp;Ma ago (&lt;0.4&nbsp;μm fraction). The ZF, although cutting the two other faults, yielded an older age of 7.58&nbsp;±&nbsp;0.11&nbsp;Ma (&lt;0.1&nbsp;μm fraction). The ZF gouge, however, contains an illitic detrital contaminant from the Paleozoic age flysch deformed in its hanging wall and the age thus is a maximum faulting age. Removal of ~1% of a 300-Ma-old contaminant brings the ZF faulting age to &lt;4.90&nbsp;Ma. Our results provide the first direct dating of brittle deformation in the Apennines, constraining Late Miocene-Early Pliocene regional compression. They call for a refinement of current NA geodynamic models in the framework of the Northern Tyrrhenian Sea extension

Technology and technique for left ventricular assist device optimization: A Bi-Tech solution

Background We investigated the synergistic effect of the new cone-bearing design of Jarvik 2000 (Jarvik Heart Inc., NY) together with a minimally-invasive approach to outcomes of LVAD patients. Methods We retrospectively reviewed all patients from 5 institutions involved in the Jarvik 2000 Italian Registry, from October 2008 to October 2016. Patients were divided into three groups according to pump design and implantation technique: pin-bearing design and conventional approach (Group 1); cone-bearing and conventional approach (Group 2); cone-bearing and minimally-invasive implantation (Group 3). Results A total of 150 adult patients with end-stage heart failure were enrolled: 26 subjects in Group 1, 74 in Group 2, and 50 in Group 3. Nineteen patients (73%) in Group 1, 51 (69%) in Group 2, and 36 (72%) in Group 3 were discharged. During follow-up, 22 patients underwent transplantation, while in 3 patients the LVAD was explanted. The overall 1-year survival was 58 +/- 10%, 64 +/- 6%, and 74% +/- 7% in Groups 1, 2, and 3, respectively (p = 0.034). The competing-risks-adjusted cumulative incidence rate for adverse events was 42.1 [27-62.7] per 100 patient-years in Group 1, 35.4 [25.3-48.2] in Group 2, and 22.1 [12.4-36.4] in Group 3 (p = 0.046 for Group 1 vs. 3). Conclusions The association of the modern cone-bearing configuration of Jarvik 2000 and minimally invasive surgery improved survival and minimized the risk for cardiovascular events, as a result of combining technology and technique

Biomarkers expression, treatment and disease burden in a cohort of Italian patients affected by severe asthma : a sub analysis of the ISAR EVEREST study

Peer reviewe

The effect of bars on the M*- e relation: offset, scatter and residuals correlations

We analyse a set of collisionless disc galaxy simulations to study the consequences of bar formation and evolution on the M•-σe relation of supermassive black holes (SMBHs). The redistribution of angular momentum driven by bars leads to a mass increase within the central region, raising the velocity dispersion of the bulge, σe, on average by ˜12 per cent and as much as ˜20 per cent. If a disc galaxy with an SMBH satisfying the M•-σe relation forms a bar, and the SMBH does not grow in the process, then the increase in σe moves the galaxy off the M•-σe relation. We explore various effects that can affect this result including contamination from the disc and anisotropy. The displacement from the M•-σe relation for individual model barred galaxies correlates with both the bulge-to-total stellar mass ratio, M(B)/M(B + D), and the 2D anisotropy, βφ(B + D), both measured within the effective radius of the bulge. Overall, this process leads to an M•-σe for barred galaxies offset from that of unbarred galaxies, as well as an increase in its scatter. We assemble samples of observed unbarred and barred galaxies with classical bulges and find tentative hints of an offset between the two consistent with the predicted. Including all barred galaxies, rather than just those with a classical bulge, leads to a significantly larger offset, which is mostly driven by the significantly larger offset of pseudo bulge