Optimal Site for Proximal Optimization Technique in Complex Coronary Bifurcation Stenting: A Computational Fluid Dynamics Study

Background/purpose: The optimal position of the balloon distal radio-opaque marker during the post optimization technique (POT) remains debated. We analyzed three potential different balloon positions for the final POT in two different two-stenting techniques, to compare the hemodynamic effects in terms of wall shear stress (WSS) in patients with complex left main (LM) coronary bifurcation. Methods/materials: We reconstructed the patient-specific coronary bifurcation anatomy using the coronary computed tomography angiography (CCTA) data of 8 consecutive patients (6 males, mean age 68.2± 18.6 years) affected by complex LM bifurcation disease. Subsequently a virtual bench test was performed in each patient using two different double stenting techniques represented by the DK and Nano crush using the reconstruction of Orsiro stents (Biotronik IC, Bulack, Switzerland). Results: A significant reduction in the mean WSS values in all the lesion's sites was observed when the final POT was performed 1 mm distally the carina cut plane in both techniques. Moreover, a significant improvement in the mean WSS values of the entire SB (e.g. LCX) was obtained performing the POT 1 mm distally to the carina cut plane. The proximal POT resulted in larger area of lower WSS values at the carina using both the Nano crush and the DK crush techniques. Conclusions: In patients with complex LM bifurcation disease the use of a final POT performed 1 mm distally to the carina cut plane might results in more favorable WSS patterns (i.e. higher WSS values) along all stented segments and, especially, along the entire LCX lesions

Biomechanical Evaluation of Different Balloon Positions for Proximal Optimization Technique in Left Main Bifurcation Stenting

Background: Proximal optimization technique (POT) is a key step during left main (LM) bifurcation stenting. However, after crossover stenting, the ideal position of POT balloon is unclear. We sought to evaluate the biomechanical impact of different POT balloon positions during LM cross-over stenting procedure. Methods: We reconstructed the patient-specific LM bifurcation anatomy, using coronary computed tomography angiography data of 5 consecutive patients (3 males, mean age 66.3 ± 21.6 years) with complex LM bifurcation disease, defined as Medina 1,1,1, evaluated between 1st January 2018 to 1st June 2018 at our center. Finite element analyses were carried out to virtually perform the stenting procedure. POT was virtually performed in a mid (marker just at the carina cut plane), proximal (distal marker 1 mm before the carina) and distal (distal marker 1 mm after the carina) position in each investigated case. Final left circumflex obstruction (SBO%), strut malapposition, elliptical ratio and stent malapposition were evaluated. Results: The use of both proximal and distal POT resulted in a smaller LM diameter compared to the mid POT. SBO was significantly higher in both proximal and distal configurations compared to mid POT: 38.3 ± 5.1 and 29.3 ± 3.1 versus 18.3 ± 3.6%, respectively. Similarly stent malapposition was higher in both proximal and distal configurations compared to mid POT: 1.3 ± 0.4 and 0.82 ± 1.8 versus 0.78 ± 1.2, respectively. Conclusions: Mid POT offers the best results in terms of LCx opening maintaining slightly smaller but still acceptable LM and LAD diameters compared to alternative POT configuration

Laparoscopic treatment of internal hernia following minimally invasive left hemicolectomy

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Regression and ratio estimators on two occasion.

Recent studies in sampling on two occasion have highlighted the preference for regression estimator in terms of precision and for ratio estimators in terms of economic convenience. These conclusions are valid until no cost constraint is considered. In this paper an efficiency comparison for fixed costs is performed: it is shown that artio estimator is always worse than regression estimator even if the efficiency loss is often small

Efficacy of adalimumab as second-line therapy in a pediatric cohort of crohn’s disease patients who failed infliximab therapy: The Italian society of pediatric gastroenterology, hepatology, and nutrition experience

Background: Adalimumab (Ada) treatment is an available option for pediatric Crohn’s disease (CD) and the published experience as rescue therapy is limited. Objectives: We investigated Ada efficacy in a retrospective, pediatric CD cohort who had failed previous infliximab treatment, with a minimum follow-up of 6 months. Methods: In this multicenter study, data on demographics, clinical activity, growth, laboratory values (CRP) and adverse events were collected from CD patients during follow-up. Clinical remission (CR) and response were defined with Pediatric CD Activity Index (PCDAI) score ≤10 and a decrease in PCDAI score of ≥12.5 from baseline, respectively. Results: A total of 44 patients were consecutively recruited (mean age 14.8 years): 34 of 44 (77%) had active disease (mean PCDAI score 24.5) at the time of Ada administration, with a mean disease duration of 3.4 (range 0.3–11.2) years. At 6, 12, and 18 months, out of the total of the enrolled population, CR rates were 55%, 78%, and 52%, respectively, with a significant decrease in PCDAI scores (P<0.01) and mean CRP values (mean CRP 5.7 and 2.4 mL/dL, respectively; P<0.01) at the end of follow-up. Steroid-free remission rates, considered as the total number of patients in CR who were not using steroids at the end of this study, were 93%, 95%, and 96% in 44 patients at 6, 12, and 18 months, respectively. No significant differences in growth parameters were detected. In univariate analysis of variables related to Ada efficacy, we found that only a disease duration >2 years was negatively correlated with final PCDAI score (P<0.01). Two serious adverse events were recorded: 1 meningitis and 1 medulloblastoma. Conclusion: Our data confirm Ada efficacy in pediatric patients as second-line biological therapy after infliximab failure. Longer-term prospective data are warranted to define general effectiveness and safety in pediatric CD patients

Paraoxonase-1 (PON-1) Arylesterase Activity Levels in Patients with Coronary Artery Disease: A Meta-Analysis

Aim: To review and compare the PON-1 arylesterase activity between coronary artery disease (CAD) and non-CAD patients. Methods: Data were obtained by searching MEDLINE and Scopus for all investigations published between January 1, 2000 and March 1, 2021 comparing PON-1 arylesterase activity between CAD and controls. Results: Twenty studies, based on 5417 patients, met the inclusion criteria and were included in the analysis. A random effect model revealed that PON-1 arylesterase activity was significantly lower in the CAD group compared to controls (SMD = -0.587, 95%CI = -0.776 to -0.339, p < 0.0001, I2 = 92.3%). In CAD patients, the PON-1 arylesterase activity was significantly higher among CAD patients without diabetes mellitus (DM) compared to those with diabetes (SMD: 0.235, 95% CI: 0.014 to 0.456, p = 0.03, I2 = 0%). Conclusions: PON-1 activity is significantly lower in CAD patients, and those without DM presented a significantly higher PON-1 arylesterase activity

[Pathology of chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the lung characterized by poorly reversible airflow limitation. It is not a unique disease entity but rather a complex of conditions which include emphysema, chronic bronchitis and, sometimes, asthma. Moreover, COPD is a progressive disease often associated with exacerbations. Cigarette smoking, which is the most important risk factor for the development of COPD, induces pathological changes involving lung parenchyma, peripheral airways and central airways. Since lung parenchyma and peripheral airways are the sites responsible for airflow limitation and central airways are the main site of mucus hypersecretion, pathological changes in these compartments may be relevant in the development of COPD

Assessment of disease activity with magnetic resonance enterography in pediatric Crohn's Disease

Objectives and study: Magnetic Resonance Enterography (MRE) is considered the imaging test of choice in children affected by Crohns Disease (CD) in order to study the small bowel. Few studies in literature analyze the correlation between disease activity evidenced by MRE and the standardized reference indices of activity in a pediatric population. The primary aim of our study was to determine whether MRE can be used to evaluate the activity of disease in a pediatric population affected by CD, studying the correlation between the activity index obtained by means of MRE and the standardized reference indices commonly used in clinical practice. We also compared MRE and endoscopy in their definition of disease localization. Methods: We recruited 39 CD pediatric patients who underwent 79 MRE at the time of diagnosis or during follow-up. At the same time of MRE, serum C-reactive protein (CRP), fecal calprotectin and the clinical activity index for pediatric CD (PCDAI) were performed. To evaluate the correlation of these parameters with disease activity on MRE, we applied a Pediatric Magnetic Resonance Index of activity, called P-CDMRI, which includes 11 parameters, for a total score ranging from 0, suggestive of remission, to 25, indicative of the maximal disease activity. Forty-five MRE performed within two months from a full endoscopic examination were used to evaluate the concordance on disease location and activity as detected by the two methods. The Simplified Endoscopic Score for Crohn\u2019s disease (SES-CD) was used to evaluate endoscopic activity. Spearman correlation coefficients have been calculated between P-CDMRI and PCDAI and CRP and fecal calprotectin levels. We also considered the correlations between PCDAI the two most important RME variables, using the Kruskal Wallis test. p 640,05 values were considered statistically significant. Correlation coefficient values were interpreted as follows: 0.0, not correlated; 0.2, weakly correlated; 0.5, moderately correlated; 0.8, strongly correlated; and 1.0, perfectly correlated. MRE and endoscopy concordance in disease localization was evaluated with Cohen k statistics. Results: the P-CDMRI significantly correlated with the clinical (PCDAI, r = 0,690, p<0,001), laboratory (CRP, r = 0,436 p<0,001; fecal calprotectin, r = 0,390 p=0,008) and endoscopic (SES-CD, r = 0,445 p=0,003) indexes of activity. We observed a good concordance in the localization of the involved gastrointestinal tracts between MRE and endoscopy (K= 0,630 p<0,001). However, some discrepancies were observed, probably due to a better sensibility of endoscopy in detection of superficial lesions and a more precise evaluation of transmural involvement by MRE. Conclusion: Our study suggests that P-CDMRI is a good indicator of disease activity in CD pediatric patients, with significant correlations with the most commonly used clinical, laboratory and endoscopic parameters; it may thus be used to evaluate CD activity during the follow-up as well as the response to therapy. However, studies with a larger population of patients should be warranted to confirm these results. Disclosure of interest: \u201cNone Declared\u201d