Arrhythmogenic Right Ventricular Cardiomyopathy: Characterization of Left Ventricular Phenotype and Differential Diagnosis With Dilated Cardiomyopathy

Background This study assessed the prevalence of left ventricular (LV) involvement and characterized the clinical, electrocardiographic, and imaging features of LV phenotype in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Differential diagnosis between ARVC-LV phenotype and dilated cardiomyopathy (DCM) was evaluated. Methods and Results The study population included 87 ARVC patients (median age 34\ua0years) and 153 DCM patients (median age 51\ua0years). All underwent cardiac magnetic resonance with quantitative tissue characterization. Fifty-eight ARVC patients (67%) had LV involvement, with both LV systolic dysfunction and LV late gadolinium enhancement (LGE) in 41/58 (71%) and LV-LGE in isolation in 17 (29%). Compared with DCM, the ARVC-LV phenotype was statistically significantly more often characterized by low QRS voltages in limb leads, T-wave inversion in the inferolateral leads and major ventricular arrhythmias. LV-LGE was found in all ARVC patients with LV systolic dysfunction and in 69/153 (45%) of DCM patients. Patients with ARVC and LV systolic dysfunction had a greater amount of LV-LGE (25% versus 13% of LV mass; P<0.01), mostly localized in the subepicardial LV wall layers. An LV-LGE 6520% had a 100% specificity for diagnosis of ARVC-LV phenotype. An inverse correlation between LV ejection fraction and LV-LGE extent was found in the ARVC-LV phenotype (r=-0.63; P<0.01), but not in DCM (r=-0.01; P=0.94). Conclusions LV involvement in ARVC is common and characterized by clinical and cardiac magnetic resonance features which differ from those seen in DCM. The most distinctive feature of ARVC-LV phenotype is the large amount of LV-LGE/fibrosis, which impacts directly and negatively on the LV systolic function

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients &gt;17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p &lt; 0.001) and be vaccinated (37% vs. 12.7%, p &lt; 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at &lt;20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p &lt; 0.001) and immune suppressed (66.4% vs. 35.2%, p &lt; 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Measurement of the very rare K+→π+ννˉK^+ \to \pi^+ \nu \bar\nu decay

The decay K+→π+νν¯ , with a very precisely predicted branching ratio of less than 10−10 , is among the best processes to reveal indirect effects of new physics. The NA62 experiment at CERN SPS is designed to study the K+→π+νν¯ decay and to measure its branching ratio using a decay-in-flight technique. NA62 took data in 2016, 2017 and 2018, reaching the sensitivity of the Standard Model for the K+→π+νν¯ decay by the analysis of the 2016 and 2017 data, and providing the most precise measurement of the branching ratio to date by the analysis of the 2018 data. This measurement is also used to set limits on BR(K+→π+X ), where X is a scalar or pseudo-scalar particle. The final result of the BR(K+→π+νν¯ ) measurement and its interpretation in terms of the K+→π+X decay from the analysis of the full 2016-2018 data set is presented, and future plans and prospects are reviewed

Recent results from the NA62 experiment at CERN

NA62 is a fixed target experiment located at the CERN SPS which aims to perform flavour physics studies in the charged kaon sector with an unprecedented precision. Due to the abundance of kaon decays with a po in the final state, NA62 is also a perfect environment to measure the neutral pion characteristics. NA62 collected a large sample of charged kaon decays with a highly efficient trigger for decays into electrons in 2007. We report about the measurement of the po electromagnetic transition form factor slope parameter in the time-like region. Between 2008 and 2014 the NA62 apparatus underwent an intense upgrade phase to improve the physics sensitivity of the experiment to precisely measure the Br (K+ !p+n ¯ n). NA62 took data in pilot runs in 2014 and 2015 reaching the final designed beam intensity. The quality of data acquired in view of the final measurement is presented

Search for K+ → π+νν̅ at NA62

Flavour physics is one of the most powerful fields for the search of new physics beyond the Standard Model. The kaon sector with the rare decay K+ → π+νν̅ provides one of the cleanest and most promising channels. NA62, a fixed target experiment at the CERN SPS, aims to measure BR (K+ → π+νν̅) with 10% precision to test the Standard Model validity up to an energy scale of hundreds of TeV. NA62 had dedicated data taking for the K+ → π+νν̅ measurement in 2016 and 2017 and will continue in 2018. Here preliminary results on a fraction of 2016 dataset are presented. The analysis of the complete 2016 data sample is expected to achieve the SM sensitivity

The NA62 hadron calorimeter

NA62 is a fixed target experiment located in the north area of CERN. The ambitious aim of the experiment is the measurement of the branching ratio ($Br$) of the very rare decay $K^{+} \to \pi^{+} \nu \bar{\nu}$ within 10% precision using a decay-in-flight technique. The branching ratio of this decay is very well calculated in the standard model as $(9.11 \pm 0.72) \times 10^{11}$ and the measurement of this channel represents one of the most promising fields for the search of new physics beyond the standard model. The presence of just one detectable track in the final state is an enormous challenge for any experiment. The decay is fully reconstructed, which leads to a strong background suppression. Still the detector resolution, combined with the tiny branching ratio of the signal, makes the $K^{+} \to \mu^{+}\nu$ decay (whose $Br$ is 0.64) a critical source of background. The NA62 detector was therefore designed to perform an excellent $\pi / \mu$ separation using a very efficient particle identification system. A major role is played by the calorimeters that provides a muon rejection factor of the order of $10^{5}$ through the measurement of energy and shape of the hadronic showers. The calorimetric system consists of an electromagnetic calorimeter filled with liquid krypton and a hadron calorimeter. This presentation, after illustrating the HAC structure, reports on the calibration procedure of the detector response and preliminary results of the performance of the hadronic energy reconstruction

Particle Identification with Calorimeters for the Measurement of the Rare Decay K+→π+ννˉK^{+} \to \pi^{+}\nu\bar\nu at NA62

Flavour physics is one of the most powerful fields in the search of new physics beyond the Standard Model. The kaon sector with the rare decay $K^{+}\rightarrow\pi^{+}\nu\bar{\nu}$ provides one of the cleanest and most promising channels. NA62, a fixed target experiment at the CERN SPS, aims to measure $\pi\nu\nu$ branching ratio with $10\%$ precision to test the Standard Model up to an energy scale of hundreds of TeV. The rejection of the muon background is a crucial task for the measurement of the $K^{+}\rightarrow\pi^{+}\nu\bar{\nu}$ decay. The information from the Cherenkov and the Muon Veto detectors are not sufficient to achieve the required $\mathcal{O}(10^{7})$ muon suppression and an additional factor of $10^2$ has to be reached with a purely calorimetric particle identification. The calibration of the hadron calorimeter (HAC) represents an important challenge, which requires the development of innovative techniques. Since electrons and photons are absorbed by the electromagnetic calorimeter (LKr), the response of the HAC to electromagnetic showers is calibrated by exploiting stopped high energy muons. The obtained HAC energy resolution meets all the demands. The information about energy and shape of the showers detected by the LKr and HAC are combined into a Boosted Decision Trees algorithm to classify the impinging particles as muons, pions or electrons. The particle identification algorithm allows a muon rejection of $10^5$ (including suppression from the muon veto detector) for $90\%$ pion efficiency

Particle Identification with Calorimeters for the Measurement of the Rare Decay K&#x207a → π&#x207a̅ at NA62

Flavour physics is one of the most powerful fields in the search of new physics beyond the Standard Model. The kaon sector with the rare decay K^+ ➝ π^+νν̅ provides one of the cleanest and most promising channels. NA62, a fixed target experiment at the CERN SPS, aims to measure K^+ ➝ π^+νν̅ branching ratio with 10% precision to test the Standard Model up to an energy scale of hundreds of TeV. The rejection of the muon background is a crucial task for the measurement of the K^+ ➝ π^+νν̅ decay. The information from the Cherenkov and the Muon Veto detectors are not sufficient to achieve the required O(10^7) muon suppression and an additional factor of 10^2 has to be reached with a purely calorimetric particle identification. The calibration of the hadron calorimeter (HAC) represents an important challenge, which requires the development of innovative techniques. Since electrons and photons are absorbed by the electromagnetic calorimeter (LKr), the response of the HAC to electromagnetic showers is calibrated by exploiting stopped high energy muons. The obtained HAC energy resolution meets all the demands. The information about energy and shape of the showers detected by the LKr and HAC are combined into a Boosted Decision Trees algorithm to classify the impinging particles as muons, pions or electrons. The particle identification algorithm allows a muon rejection of 10^5 (including suppression from the muon veto detector) for 90% pion efficiency.Flavourphysik ist einer der Bereiche, in dem die Suche nach neuer Physik jenseits des Standardmodells am aussichtsreichsten ist. Mit dem seltenen Zerfall K^+ ➝ π^+νν̅ bietet der Kaonsektor einen der saubersten und vielversprechendsten Kanäle. Das Fixed-Target-Experiment NA62 am CERN SPS strebt eine Messung der K^+ ➝ π^+νν̅ Zerfallsrate mit einer Präzision von 10% an. Dies entspricht einem Test des Standardmodells bis zu einer Energieskala von einigen Hundert TeV. Die Elimination des Untergrunds aus Myonen ist dabei eine wesentliche Voraussetzung für die K^+ ➝ π^+νν̅ Messung. Da die Cherenkov- und Myonvetodetektoren nicht die komplette erforderliche Unterdrückung von O(10^7) leisten können, müssen die Kalorimeter eine zusätzliche Myonunterdrückung von O(10^2) erreichen. Die Kalibration des Hadronkalorimeters (HAC) ist daher eine wesentliche Aufgabe, welche die Entwicklung neuer, innovativer Techniken nötig macht. Da Elektronen und Photonen im elektromagnetischen Kalorimeter (LKr) absorbiert werden, wird das HAC mit Hilfe von elektromagnetischen Schauern von vollständig im Kalorimeter gestoppten, hochenergetischen Myonen kalibriert. Die damit erreichte Energieauflösung des Hadronkalorimeters erfüllt sämtliche Anforderungen. Die im LKr und HAC gemessenen Schauerprofile und -energien dienen als Input für einen sogenannten Boosted Decision Tree, der die einfallenden Teilchen als Myonen, Pionen oder Elektronen klassifiziert. Der Algorithmus zur Teilchenidentifikation erreicht dabei eine Unterdrückung von 10^5 (einschließlich der Information des Myonvetodetektors) bei einer Effizienz von 90% für Pionen

Disability and inclusion: Swimming to overcome social barriers

Nowadays all people can and must practice physical activity and engage themselves in various sports specialties. Among the various sports, swimming is ideal in all situations where the weight of the body is a problem, such as in cases of lower limbs disability (amputations, paralysis, etc.). The objective of this study is to investigate if disabled and not-disabled athletes can derive performance benefits and if it is possible to reduce the gap between the competition times between athletes, through a single, performance and training activity. The sample is made up of 12 athletes, including 6 disabled, belonging to the S2 category, and 6 not-disabled athletes skilled in the back. After an anamnesis and a careful initial valuation, it was proposed to all the athletes to do the HIIT method (for 4 weeks), Tabata method (for 4 weeks), and Pilates one (for 8 weeks). Moreover, to the disabled athletes were given physiotherapy sessions to increase joint ROM for 8 weeks. The aim is to promote social inclusion for disabled athletes, often marginalized by the group, to break down those who are the pillars of difference

Ruolo della chemioembolizzazione intra-arteriosa (TACE) con microsfere a rilascio di Irinotecano (DEBIRI) nel trattamento delle metastasi epatiche da melanoma dell\u2019uvea

Scopo: Il 50% circa dei pazienti con melanoma dell\u2019uvea (UV) svilupper\ue0 metastasi, in prevalenza epatiche. La prognosi dei melanomi uveali metastatici (mUM) \ue8 severa e, ad oggi, non vi \ue8 una terapia standard. Materiali e metodi: Sono stati analizzati in modo prospettico i dati di 141 pazienti con mUM sottoposti, come approccio iniziale, a TACE con DEBIRI (12,1%), terapia sistemica (39,7%), entrambe (33,3%) o nessuna delle due (14,9%) da Settembre 1990 a Settembre 2013. Risultati: Il tempo medio libero da malattia \ue8 stato di 23,1 mesi, la sopravvivenza media dei pazienti in IV stadio \ue8 stata di 18,1 mesi. La percentuale di coinvolgimento epatico (RR 1.3), la presenza di malattia multi organo (RR 2.0), l\u2019incremento dei livelli di LDH (RR 1.8) ed un performance status secondo i criteri WHO pari a 1 (RR 1.6) o 2-3 (RR 4,7) sono stati associati ad una prognosi peggiore. In presenza di lunghi intervalli liberi da malattia (RR 0.9), il ricorso a TACE con DEBIRI nel trattamento delle metastasi epatiche ha determinato un incremento della sopravvivenza (22,6 mesi) rispetto alle sole chemioterapie sistemiche (14.4 mesi). In particolare la combinazione di DEBIRI TACE con fotemustina per via sistemica ha determinato il maggiore incremento della sopravvivenza (RR 0,5). Conclusioni: La prognosi dei melanomi uveali metastatici \ue8 influenzata da: percentuale di coinvolgimento epatico, presenza di malattia multiorgano, livelli di LDH, performance status, intervallo libero da malattia e dalla terapia loco regionale con DEBIRI