Coronary Revascularization in Diabetics: The Background for an Optimal Choice

Cardiovascular disease is ranked as the leading cause of death world wide, responsible for 17.1 million deaths globally each year. Such numbers are often difficult to comprehend. Heart disease kills one person every 34 seconds in the USA alone. Although the leading killer, the incidence of cardiovascular disease has declined in recent years due to a better understanding of the pathology, implementation of lipid lowering therapy new drug regimens including low molecular weight heparin and antiplatelet drugs such as glycoprotein IIb/IIIa receptor inhibitors and acute surgical intervention. The disease burden has a great financial impact on global healthcare systems and major economic consequences for world economies. This text aims to deliver the current understanding of coronary artery disease and is split into three main sections: 1. Epidemiology and pathophysiology of coronary artery disease 2. Coronary artery disease diagnostics and 3. Treatment regimens for coronary artery diseas

Hypereosinophilia with a pinch of salt and pepper

Unavailable

Early and mid-term outcome of patients with low-flow-low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Peer reviewe

Site fidelity of Hippocampus guttulatus Cuvier, 1829 at Mar Piccolo of Taranto (Southern Italy; Ionian Sea)

AbstractLack of detailed knowledge on ecological niche, life cycles, spatial distribution, reproductive biology and space use strongly affects the selection of useful tools and measures in the conservation of threatened marine species. Especially for sedentary and slow species, behaviour and movement capacities are supposed to be the most important functional traits. Indeed, behavioural variability concerning available space and the close presence of individuals is considered a crucial trait for the population dynamics assessments, especially when disturbances of various causes are present in the environment. The present study aimed to investigate the site fidelity and degree of movement of Hippocampus guttulatus, an emblematic and threatened Mediterranean seahorse species. With this aim, a number of seahorses were tagged and monitored throughout two years within a limited area of the lagoon of Mar Piccolo of Taranto (Southern Italy). The studied individuals were initially morphometrically measured for size, sex and life-cycle stage and subsequently monitored through repeated four-month surveys each year. Obtained results indicated high site fidelity regardless of habitat type. Movement pattern was in line with the data on congeneric species, although values were slightly higher. The analyses showed differences in movement degree among different sexes and life-cycle stages and indicated greater mobility of adult females compared to males and juveniles. The investigated parameters showed a great variability suggesting that even small-scale environmental factors can influence the species mobility. Finally, a change in the population structure has been observed, with the loss of large individuals in 2016 and reduced recruitment in 2017. These findings indicated the possible presence of stressors that could lead to the alteration of the seahorse population at Mar Piccolo of Taranto

SOURCE 3 Registry Design and 30-Day Results of the European Postapproval Registry of the Latest Generation of the SAPIEN 3 Transcatheter Heart Valve

BACKGROUND: The SOURCE 3 Registry (SAPIEN Aortic Bioprosthesis European Outcome) is a European multicenter, observational registry of the latest generation of transcatheter heart valve, the SAPIEN 3 (Edwards Lifesciences, Irvine, CA). Its purpose is to document outcomes of clinical safety and performance after European approval was given. METHODS: Here, we present the 30-day outcome of the SOURCE 3 Registry. All data are self-reported, and all participating centers have committed to support their consecutive experience with the SAPIEN 3 transcatheter heart valve, dependent on patient consent, before the start of the study. Adverse events are defined with Valve Academic Research Consortium 2 criteria and adjudicated by an independent clinical events committee. RESULTS: A total of 1950 patients from 80 centers in 10 countries were enrolled between July 2014 and October 2015. Of those, 1947 patients underwent transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (mean age, 81.6 +/- 6.6 years; 48.1% female). Main comorbidities included coronary artery disease (51.5%), renal insufficiency (27.4%), diabetes mellitus (29.5%), chronic obstructive pulmonary disease (16.0%), and a mean logistic EuroSCORE of 18.3 +/- 13.2. Transfemoral access was used in 87.1% (n=1695); nontransfemoral, in 252 patients. Conscious sedation was used in 59.9% of transfemoral procedures, and in 50% of patients, TAVI was performed without aortic balloon valvuloplasty. Implantation success (1 valve in the intended location) was 98.3%. Conversion to conventional surgery (0.6%) and use of cardiopulmonary bypass (0.7%) were rare. Adverse events were low, with site-reported 30-day all-cause mortality of 2.2%, cardiovascular mortality of 1.1%, stroke of 1.4%, major vascular complications of 4.1%, life-threatening bleeding of 5%, and post-TAVI pacemaker implantation of 12%. Moderate or greater paravalvular regurgitation was observed in 3.1% of reporting patients. CONCLUSIONS: Results from the SOURCE 3 Registry demonstrate contemporary European trends and good outcomes of TAVI in daily practice when this third-generation TAVI device is used.Peer reviewe

The "Brunella" project: preparation and study of a mysticete from the Early Pliocene of Tuscany

• A project is being carried out at Poggio alle Mura that will allow the preparation and study of a balaenopterid whale from the early Pliocene of Tuscany together with its associated biota. • Up to now, the project resulted in the preparation of 18 vertebrae, the skull and an ulna of the whale. • The associated biota includes 18 mollusk species, 2 sea urchin species, 10 shark teeth and thousands of fish remains from the sediment surrounding the skull. • A wealth of educational activities is being carried out at the laboratory of Poggio alle Mura that are directed to schools and citizens

In-hospital and thirty-day outcomes of the SAPIEN 3 Ultra balloon-expandable transcatheter aortic valve : the S3U registry

Aims: The aim of this study was to evaluate 30-day safety and efficacy outcomes of transcatheter aortic valve implantation (TAVI) performed with the SAPIEN 3 Ultra system. Methods and results: The S3U registry is a physician-led, post-approval, multicentre, observational registry of transfemoral TAVI with the SAPIEN 3 Ultra. New features include an improved sealing skirt, a 14 Fr expandable sheath and a new delivery catheter. Overall, 139 consecutive patients at nine participating centres were enrolled. Mean age was 81.4 +/- 8.3 years, average STS score 3.8 +/- 2.4%. The vast majority (97.2%) underwent TAVI with local anaesthesia (28.8%) or conscious sedation (68.3%). Balloon predilatation was performed in 30 patients (21.6%), post-dilatation in three (2.2%). In-hospital, there were no cases of death, stroke, or conversion to open heart surgery. Major vascular complications occurred in three patients (2.2%), as well as major or life-threatening bleedings in three patients (2.2%). There were two moderate (1.4%) and no moderate/severe paravalvular leaks. Median length of stay after TAVI was three days (IQR 3-5 days). At 30 days, there were no deaths, MI, or strokes, and the incidence of new permanent pacemaker implantation was 4.4%. Conclusions: This first multicentre international experience of transfemoral TAVI with the SAPIEN 3 Ultra transcatheter heart valve shows good in-hospital and 30-day clinical outcomes.Peer reviewe

Ruxolitinib – better prognostic impact in low-intermediate 1 risk score: evaluation of the ‘rete ematologica pugliese’ (REP) in primary and secondary myelofibrosis

We evaluated ruxolitinib in 65 patients with myelofibrosis according to age, sex, time of diagnosis, grade of fibrosis, prognostic score risk, Janus kinase (JAK) status, primary or secondary myelofibrosis, previous treatment, and dosage. Outcome measures were response rate, time to response, duration of response, and event-free survival and survival. Kaplan and Meier curves show a significant difference in event-free survival according to the prognostic score, in favor of patients with low int1 (p = 0.0009). The Cox stepwise model confirmed the result, the int2 high-risk score being the most powerful negative independent parameter (0.001), followed by JAK (0.008); other parameters, such as diagnosis more than 5 years earlier, grade III–IV fibrosis, and ruxolitinib dose have a negligible impact. Time to response was shorter (p = 0.001) in primary myelofibrosis. In conclusion, ruxolitinib is effective, with a better outcome in patients with a low-int1 risk score. This may suggest considering an earlier administration in the disease course