Surgical Treatment of Atrial Fibrillation

Atrial fibrillation represents the most common supraventricular arrhythmia above all in patients undergoing cardiac surgery and is associated to an augmented risk of thromboembolic stroke, heart failure, and cardiovascular mortality. That is the reason why cardiac surgeons began to address their attention to how to surgically treat fibrillating patients according to pathophysiological models describing mechanisms of arrhythmia induction and maintenance. A new branch of cardiac surgery was born, leading to a progressive development of adapted surgical ablation techniques, applicable both to lone or concomitant arrhythmia treatment. Historical evolution and current available surgical treatment options are described, beginning from the first pure surgical maze, going through all its modifications in source ablation energies and lesion sets and finishing with current mini-invasive hybrid treatment of lone atrial fibrillation. Indications, patients’ selection, technical options with respective advantages and disadvantages, surgical technique details, complications, and results are fully illustrated. Relationship between pathophysiologic arrhythmia mechanisms and the consequent ablation tailored procedure choice is highlighted, allowing a customized procedural offer to every single patient, resulting in a success rate ranging from 60 to 90%

Hypothesis test on the ratio between two measurement uncertainties

Peer Reviewe

COVID-19 and schools: what is the risk of contagion? Results of a rapid-antigen-test-based screening campaign in Florence, Italy

INTRODUCTION: in the COVID-19 era, the debate around the risk of contagion at school, is intense in Italy. The Department of Welfare and Wealth of Florence promoted a screening campaign with antigen rapid tests for all the students and school personnel. The aim of this study is to assess the SARS-Cov2 circulation in the school setting by means of a mass screening conducted in every primary and middle school of Florence. METHODS: All the students attending primary and middle schools of Florence and the school personnel were asked to take part. The campaign started on 16(th) November 2020 and was completed on 12(th) February 2021. If the antigen rapid test resulted positive, a molecular test was provided to confirm the result. RESULTS: 18,414 subjects were tested with 15,233 students (82.7%) and 3,181 members of the school personnel (17.3%). Only in 27 cases (0.15%) the rapid test gave a positive result. Moreover, only 14 of the 27 positive rapid tests were confirmed as positive by the molecular test. These results show a very low number of SARS-CoV-2 cases among the people tested (0.08% of the total). CONCLUSIONS: These results show that the spread of SARS-CoV-2 infection at school, during the months of the screening and with the respect of strict preventive measures was low

Genetic diversity of dinitrogen-fixing bacterial communities in soil amended with olive husks

The industrial production of olive oil is accompanied by the accumulation of large quantities of by-products from the olive milling industry that are commonly dispersed as fertilisers, which are nowadays suspected to have potential toxic effects on is omicroflora. The aim of this work has been the investigation of the genetic diversity of bacterial communities present in soil treated with olive husks focusing on the dinitrogen-fixing bacteria.nifH genes were amplified from total soil DNA using universal primers, cloned and typed by restriction analysis and sequencing of representative haplotypes. On the same samples, DGGE analysis on amplified 16S rDNA was performed aiming at monitoring modifications in the total community pattern. Results showed a high genetic diversity ofnifH genes within the community, which was well in agreement with the total community profiles obtained by DGGE on 16SrDNA. Most of thenifH gene fragments (19 out of 32) were found to be similar to sequences related with clostridia

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy

The oral health state plays an important role in the concept of ‘elderly frailty’, since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set—Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health

Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: Transapical implantation of an Edwards Sapien-XT in a dysfunctional mitral bioprosthesis in a critical patient

Background: Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in high-surgical-risk patients with failing aortic bioprosthesis. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) is a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViV- TAVR and -TMVR have been reported but only few were performed in critical hemodynamic conditions. Case presentation: We report the case of a patient underwent balloon-expandable transapical mitral valve-in-valve implantation in an emergency setting due to a severe stenosis of a bioprosthesis in mitral position. The procedure was successfully performed, with no residual mitral regurgitation or paravalvular leaks, and uneventful. Conclusion: Transcatheter transapical mitral valve-in-valve implantation could represent a feasible and effective strategy even in critical setting

Peptidyl-prolyl isomerases : A full cast of critical actors in cardiovascular diseases

Peptidyl-prolyl cis-trans-isomerases are a highly conserved family of immunophilins. The three peptidyl-prolyl cis-trans-isomerase subfamilies are cyclophilins, FK-506-binding proteins, and parvulins. Peptidyl-prolyl cis-trans-isomerases are expressed in multiple human tissues and regulate different cellular functions, e.g. calcium handling, protein folding, and gene expression. Moreover, these subfamilies have been shown to be consistently involved in several cardiac and vascular diseases including heart failure, arrhythmias, vascular stenosis, endothelial dysfunction, atherosclerosis, and hypertension. This review provides a concise description of the peptidyl-prolyl cis-trans-isomerases and presents an incisive selection of studies focused on their relationship with cardiovascular diseases