Surgical Treatment of Aortic Valve Stenosis: Role of new technologies

Nell’ultima decade, lo spettro terapeutico del trattamento chirurgico della stenosi aortica si e’ ampliato significativamente. Sono state sviluppate nuove protesi valvolai e nuovi approcci allo scopo di ridurre il rischio legato alla chirurgia. Oggi e’ possibile e giustificato trattare pazienti precedentemente giudicati inoperabili proponendogli efficaci trattamenti alternativi come le protesi transcatetere (TAVI) e le bioprotesi Sutureless. L’Heart Team e’ il gruppo multispecialistico che ha la responsabilita’ di decidere il percorso piu’ idoneo per questi pazienti. La TAVI (Transcathether Aortic Valve Inserction) e’ il campo di punta nelle alternative alla chirurgia convenzionale. Ma anche le nuove generazioni di protesi chirurgiche come le sutureless e l’estensione delle applicazioni degli approcci miniinvasivi nonche' dei circuiti miniaturizzati per la Circolazione ExtraCorporea consentono di rendere la chirurgia realmente competitiva nei pazienti ad alto rischio. Negli ultimi anni sono usciti diversi studi per meglio definire i confini delle indicazioni tra le varie procedure, ma servono ancora piu’ dati per validare l’estensione dell’applicazione della tecnologia transcatetere a categorie di pazienti a rischio intermedio/basso.In the last decade, the therapeutical spectrum of the surgical treatment of the aortic stenosis widened consistently. New valve prosthesis and new approaches have been developed in order to reduce the surgical risk. Not only now was it feasible and justifiable to treat formerly inoperable patients, this new treatment options also made it possible to shift patients with very high operative risk and expected poor outcome to alternative ways of aortic valve implantation as transcatheter (TAVI) and Sutureless prostheses. The previous decision of performing conventional surgery in a very high risk patient or leaving him with a very bad quality of life suddenly had a third option. TAVI (Transcathether Aortic Valve Inserction) is the leading field in the alternative options to conventional surgery, but the new generation of sutureless aortic valve prostheses, a better management and knowledge of miniinvasive surgical techniques and Minimized Extracorporeal Circulation Circuits (MECC) produced a further improvement of the results of conventional surgery. In the last years, many studies have been published in this field, but they could not definitively answer the question which option is better for high risk patients in the long run. In the European countries where TAVI is reimbursed on a rather lucrative scale, patients who were formerly left unoperated upon are now being aggressively treated, resulting in approximately one third of all aortic valve replacements being performed with this technique. With the broad acceptance of this therapy and recent advances in technology and techniques, there is now an increasing push to expand the indication to intermediate and low risk patients

A family nurse-led intervention for reducing health services’ utilization in individuals with chronic diseases : The ADVICE pilot study

Objectives Intensive health services’ utilization is common in older individuals affected by chronic diseases. This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services’ use (readmissions and/or emergency service access) among older people affected by chronic conditions. Methods This is a non-randomized before-after pilot study. A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months. Standard home care was provided during the first four months’ period (months 1–4), followed by the educational intervention until the end of the study (months 5–8). The intervention, based on the teach-back method, consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment, potential complications, medication adherence, and health behaviours. Rates of health services’ use were collected immediately before (T0), and after the interventions (T1). Differences in utilization rates were examined by the McNemar’s test. Potential factors associated with the risk of health services’ use were explored with a Cox proportional hazard regression model. Results The sample (n = 78) was predominantly female (n = 50, 64.1%), and had a mean age of 76.2 (SD = 4.8) years. Diabetes mellitus was the most frequent disease (n = 27, 34.6%). McNemar’s test indicated a significant reduction in health services’ use at T1 (McNemar χ2 = 28.03, P < 0.001). Cox regressions indicated that time and patient education, as well as their interaction, were the only variables positively associated with the probability of health services’ use. Conclusion A teach-back intervention led by a family nurse practitioner has the potential to reduce health services’ use in older patients with chronic diseases

B-Pol: Detecting Primordial Gravitational Waves Generated During Inflation

B-Pol is a medium-class space mission aimed at detecting the primordial gravitational waves generated during inflation through high accuracy measurements of the Cosmic Microwave Background (CMB) polarization. We discuss the scientific background, feasibility of the experiment, and implementation developed in response to the ESA Cosmic Vision 2015-2025 Call for Proposals.Comment: Experimental Astronomy - The original publication is available at http://www.springerlink.co

Could ischemic colitis be the first manifestation of COVID-19? A case report

We report on a case of SARS-CoV-2-infected patient with clinical and histologic features mimicking ischaemic colitis. This case provides evidence that SARS-CoV-2 may compromise the microvascular blood flow in the intestinal wall, with a parallel activation of the inflammatory cascade, either in the absence, or earlier of any pulmonary involvement

Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry.

Background Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome

Quantitative MRI Harmonization to Maximize Clinical Impact: The RIN-Neuroimaging Network

Neuroimaging studies often lack reproducibility, one of the cardinal features of the scientific method. Multisite collaboration initiatives increase sample size and limit methodological flexibility, therefore providing the foundation for increased statistical power and generalizable results. However, multisite collaborative initiatives are inherently limited by hardware, software, and pulse and sequence design heterogeneities of both clinical and preclinical MRI scanners and the lack of benchmark for acquisition protocols, data analysis, and data sharing. We present the overarching vision that yielded to the constitution of RIN-Neuroimaging Network, a national consortium dedicated to identifying disease and subject-specific in-vivo neuroimaging biomarkers of diverse neurological and neuropsychiatric conditions. This ambitious goal needs efforts toward increasing the diagnostic and prognostic power of advanced MRI data. To this aim, 23 Italian Scientific Institutes of Hospitalization and Care (IRCCS), with technological and clinical specialization in the neurological and neuroimaging field, have gathered together. Each IRCCS is equipped with high- or ultra-high field MRI scanners (i.e., ≥3T) for clinical or preclinical research or has established expertise in MRI data analysis and infrastructure. The actions of this Network were defined across several work packages (WP). A clinical work package (WP1) defined the guidelines for a minimum standard clinical qualitative MRI assessment for the main neurological diseases. Two neuroimaging technical work packages (WP2 and WP3, for clinical and preclinical scanners) established Standard Operative Procedures for quality controls on phantoms as well as advanced harmonized quantitative MRI protocols for studying the brain of healthy human participants and wild type mice. Under FAIR principles, a web-based e-infrastructure to store and share data across sites was also implemented (WP4). Finally, the RIN translated all these efforts into a large-scale multimodal data collection in patients and animal models with dementia (i.e., case study). The RIN-Neuroimaging Network can maximize the impact of public investments in research and clinical practice acquiring data across institutes and pathologies with high-quality and highly-consistent acquisition protocols, optimizing the analysis pipeline and data sharing procedures

Planck intermediate results XXIV : Constraints on variations in fundamental constants

Any variation in the fundamental physical constants, more particularly in the fine structure constant, a, or in the mass of the electron, me, affects the recombination history of the Universe and cause an imprint on the cosmic microwave background angular power spectra. We show that the Planck data allow one to improve the constraint on the time variation of the fine structure constant at redshift z - 10(3) by about a factor of 5 compared to WMAP data, as well as to break the degeneracy with the Hubble constant, H-0. In addition to a, we can set a constraint on the variation in the mass of the electron, me, and in the simultaneous variation of the two constants. We examine in detail the degeneracies between fundamental constants and the cosmological parameters, in order to compare the limits obtained from Planck and WMAP and to determine the constraining power gained by including other cosmological probes. We conclude that independent time variations of the fine structure constant and of the mass of the electron are constrained by Planck to Delta alpha/alpha = (3.6 +/- 3.7) x 10(-3) and Delta m(e)/m(e) = (4 +/- 11) x 10(-3) at the 68% confidence level. We also investigate the possibility of a spatial variation of the fine structure constant. The relative amplitude of a dipolar spatial variation in a (corresponding to a gradient across our Hubble volume) is constrained to be delta alpha/alpha = (-2.4 +/- 3.7) x 10(-2).Peer reviewe

Planck Intermediate Results. XXXVI. Optical identification and redshifts of Planck SZ sources with telescopes at the Canary Islands Observatories

We present the results of approximately three years of observations of Planck Sunyaev-Zeldovich (SZ) sources with telescopes at the Canary Islands observatories as part of the general optical follow-up programme undertaken by the Planck collaboration. In total, 78 SZ sources are discussed. Deep-imaging observations were obtained for most of these sources; spectroscopic observations in either in long-slit or multi-object modes were obtained for many. We effectively used 37.5 clear nights. We found optical counterparts for 73 of the 78 candidates. This sample includes 53 spectroscopic redshift determinations, 20 of them obtained with a multi-object spectroscopic mode. The sample contains new redshifts for 27 Planck clusters that were not included in the first Planck SZ source catalogue (PSZ1).Comment: 15 pages, 14 figures, accepted for publication in A&

VizieR Online Data Catalog: Planck high-z source candidates catalog (PHZ) (Planck+, 2016)

We present in this work the Planck List of Highredshift Source Candidates (the "PHZ"), which includes 2151 sources distributed over 26% of the sky, with redshifts likely to be greater than 2. (2 data files)