Ablation of atrial tachycardias in children by non fluoroscopic 3-D mapping

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The sensor-based biomechanical risk assessment at the base of the need for revising of standards for human ergonomics

Due to the epochal changes introduced by “Industry 4.0”, it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human–robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative “direct instrumental evaluations” and “rating of standard methods”, allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers’ awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities

Elderly and Children Are Not The Only Victims of Foreign Body Airway Obstruction in Italy (A National Media-Based Survey)

Choking is a relevant public health problem. Data in medical literature are scarce and fatal events are dramatically under-reported.The aim of this manuscript is to give a real estimation of this problem and to raise awareness about this topic.Materials and methods. All deaths caused by choking reported by Italian Mass Media over a two years period were collected. Suspected sudden infant death syndrome was an exclusion criteria.Results. 76 deaths due to foreign body airway obstruction were identified, 51% during 2018 and 49% in 2019, without identifiable time clusters. Choking affected every age, including pre-scholar children (25%), children 6 to 18 years old (3%), adults (38%), and elderly patients (34%). Witnessed cases were 61 (80%) but in almost half 26 cases (42%) the fatal event occurred before or without first aid maneuvers being performed.Conclusion. On the Italian territory, during a 2 years period, three cases per month of fatal choking due to foreign-body airway obstruction occurred, many of them in adult patients (38%). Italian people seem not to be educated to provide first aid in these settings

Left ventricular (LV) pacing in newborns and infants. Echo assessment of LV systolic function and synchrony at 5-year follow-up

Background: Small retrospective studies reported that left ventricular (LV) pacing is likely to preserve LV function in children with isolated congenital complete atrioventricular block (CCAVB). The aim of this study was to prospectively evaluate LV contractility and synchrony in a cohort of neonates/infants at pacemaker implantation and follow-up. Methods: Patients with CCAVB who underwent LV pacing were evaluated with electrocardiogram and echocardiogram in a single-center, prospective study. Data were collected at implantation, at 1-month and every year of follow-up, up to 5 years. LV ventricular dimensions (diameters and volumes), systolic function (ejection fraction [EF] and global longitudinal strain [GLS]), and synchrony were evaluated. Data are reported as median (25th-75th centiles). Results: Twenty consecutive patients with CCAVB underwent pacemaker implantation (12 single-chamber pacemaker [VVIR] and eight dual-chamber pacemaker [DDD]) with epicardial leads: 17 on the LV apex and three on the free wall. Age at implantation was 0.3 months (1 day-4.5 months). Patients showed good clinical status, normal LV dimensions, preserved systolic function, and synchrony at 60 (30-60) months follow-up. EF increased to normal values in patients with preimplantation EF <50%. Presence of antibodies and pacing mode (DDD vs VVIR) had no impact on the outcome. Conclusions: LV pacing preserved LV systolic function and synchrony in neonates and infants with CCAVB at 5-year follow-up. LV EF improved in patients with low preimplantation EF. Pacing mode or the presence of autoantibodies did not demonstrated an impact on LV contractility and synchrony

Пожилые люди и дети — не единственные жертвы обструкции дыхательных путей инородными предметами в Италии (Национальное исследование на основе анализа СМИ)

Choking is a relevant public health problem. Data in medical literature are scarce and fatal events are dramatically under-reported.The aim of this manuscript is to give a real estimation of this problem and to raise awareness about this topic.Materials and methods. All deaths caused by choking reported by Italian Mass Media over a two years period were collected. Suspected sudden infant death syndrome was an exclusion criteria.Results. 76 deaths due to foreign body airway obstruction were identified, 51% during 2018 and 49% in 2019, without identifiable time clusters. Choking affected every age, including pre-scholar children (25%), children 6 to 18 years old (3%), adults (38%), and elderly patients (34%). Witnessed cases were 61 (80%) but in almost half 26 cases (42%) the fatal event occurred before or without first aid maneuvers being performed.Conclusion. On the Italian territory, during a 2 years period, three cases per month of fatal choking due to foreign-body airway obstruction occurred, many of them in adult patients (38%). Italian people seem not to be educated to provide first aid in these settings.Асфиксия (удушье) является серьезной проблемой общественного здравоохранения. Данные медицинской литературы по этой проблеме скудны, а сообщения о смертельных исходах резко занижены.Цель публикации — оценить реальную частоту асфиксии и повысить осведомленность о ней.Материалы и методы. Собрали все случаи смерти от асфиксии, о которых итальянские СМИ сообщали в течение двух лет. Критерием исключения было подозрение на синдром внезапной детской смерти.Результаты. Выявили 76 смертей вследствие обструкции дыхательных путей инородным телом — 51% в 2018 году и 49% в 2019 году ото всех случаев асфиксии, без каких-либо определенных временных предпочтений по накоплению случаев в течение года. Асфиксию наблюдали среди лиц всех возрастов, включая детей дошкольного возраста (25%), детей от 6 до 18 лет (3%), взрослых (38%) и пожилых пациентов (34%). В присутствии свидетелей произошел 61 случай (80%), при этом почти в половине смертельных случаев (26, что составило 42%) смерть наступила до или без проведения мероприятий по оказанию первой помощи.Заключение. На территории Италии в течение двух лет ежемесячно происходило по три случая смертельной асфиксии вследствие обструкции дыхательных путей посторонними предметами, много случаев обнаружено в когорте пациентов зрелого возраста (38%). Такие данные СМИ свидетельствуют о том, что население Италии не обучено оказывать первую помощь, необходимую в таких случаях

Non-adrenergic vasopressors in patients with or at risk for vasodilatory shock. A systematic review and meta-analysis of randomized trials

Introduction: Hypotensive state is frequently observed in several critical conditions. If an adequate mean arterial pressure is not promptly restored, insufficient tissue perfusion and organ dysfunction may develop. Fluids and catecholamines are the cornerstone of critical hypotensive states management. Catecholamines side effects such as increased myocardial oxygen consumption and development of arrhythmias are well known. Thus, in recent years, interest in catecholamine-sparing agents such as vasopressin, terlipressin and methylene blue has increased; however, few randomized trials, mostly with small sample sizes, have been performed. We therefore conducted a meta-analysis of randomized trials to investigate the effect of non-catecholaminergic vasopressors on mortality. Methods: PubMed, BioMed Central and Embase were searched (update December 31st, 2014) by two independent investigators. Inclusion criteria were: random allocation to treatment, at least one group receiving a non-catecholaminergic vasopressor, patients with or at risk for vasodilatory shock. Exclusion criteria were: crossover studies, pediatric population, nonhuman studies, studies published as abstract only, lack of data on mortality. Studied drugs were vasopressin, terlipressin and methylene blue. Primary endpoint was mortality at the longest follow-up available. Results: A total of 1,608 patients from 20 studies were included in our analysis. The studied settings were sepsis (10/20 studies [50%]), cardiac surgery (7/20 [35%]), vasodilatory shock due to any cause (2/20 [19%]), and acute traumatic injury (1/20 [5%]). Overall, pooled estimates showed that treatment with non-catecholaminergic agents improves survival (278/810 [34.3%] versus 309/798 [38.7%], risk ratio = 0.88, 95%confidence interval = 0.79 to 0.98, p = 0.02). None of the drugs was associated with significant reduction inmortality when analyzed independently. Results were not confirmed when analyzing studies with a low risk of bias. Conclusions: Catecholamine-sparing agents in patients with or at risk for vasodilatory shock may improve survival. Further researches on this topic are needed to confirm the finding

A decade of insertable cardiac monitors with remote monitoring in pediatric patients

Background: Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients. Methods: Single centre, retrospective analysis of patients who underwent ICM implantation in 2010–2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease. Results: A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2–19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%). Conclusions: In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease

Concurrent chemoradiation in anal cancer patients delivered with bone marrow-sparing imrt: Final results of a prospective phase ii trial

We investigated the role of the selective avoidance of haematopoietically active pelvic bone marrow (BM), with a targeted intensity-modulated radiotherapy (IMRT) approach, to reduce acute hematologic toxicity (HT) in anal cancer patients undergoing concurrent chemo-radiation. We designed a one-armed two-stage Simon’s design study to test the hypothesis that BM-sparing IMRT would improve by 20% the rate of G0–G2 (vs. G3–G4) HT, from 42% of RTOG 0529 historical data to 62% (α = 0.05; β = 0.20). A minimum of 21/39 (54%) with G0–G2 toxicity represented the threshold for the fulfilment of the criteria to define this approach as ‘promising’. We employed18 FDG-PET to identify active BM within the pelvis. Acute HT was assessed via weekly blood counts and scored as per the Common Toxicity Criteria for Adverse Effects version 4.0. From December 2017 to October 2020, we enrolled 39 patients. Maximum observed acute HT comprised 20% rate of ≥G3 leukopenia and 11% rate of ≥G3 thrombocytopenia. Overall, 11 out of 39 treated patients (28%) experienced ≥G3 acute HT. Conversely, in 28 patients (72%) G0–G2 HT events were observed, above the threshold set. Hence,18 FDG-PET-guided BM-sparing IMRT was able to reduce acute HT in this clinical setting