Locoregional versus general anesthesia in carotid surgery: Is there an impact on peri-operative myocardial ischemia? Results of a prospective monocentric randomized trial.

PURPOSE: The incidence of cardiac morbidity and mortality in patients who undergo carotid surgery ranges from 0.7% to 7.1%, but it still represents almost 50% of all perioperative complications. Because no data are available in literature about the impact of the anesthetic technique on such complications, a prospective randomized monocentric study was undertaken to evaluate the role of local anesthesia (LA) and general anesthesia (GA) on cardiac outcome. METHODS: From November 1995 to February 1998, 107 patients were classified by the cardiologist as cardiac patients (IHD; history of myocardial infarction, previous myocardial revascularization procedures, or myocardial ischemia documented by means of positive electrocardiogram [ECG] stress test results) or noncardiac patients (NIHD; no history of chest pain or negative results for an ECG stress test). The patients were operated on after the randomization for the type of anesthesia (general or local). Continuous computerized 12-lead ECG was performed during the operative procedure and 24 hours postoperatively. The end points of the study were ECG modifications (upsloping or downsloping more than 2 mm) of the sinus tachycardia (ST) segment. RESULTS: Fifty-five patients were classified as IHD, and 52 were classified as NIHD. Twenty-seven of the 55 IHD patients (49%) and 24 of 52 NIHD patients (46%) were operated on under GA. Thirty-six episodes of myocardial ischemia occurred in 22 patients (20.5%). Episodes were slightly more frequent (58%) and longer in the postoperative period (intraoperative, 10 +/- 5 min; postoperative, 60 +/- 45 min; P <. 001). As expected, the prevalence of myocardial ischemia was higher in the group of cardiac patients than in noncardiac group (15 of 55 patients [27%] vs 7 of 52 patients [13%]; P <.02). By comparing the two anesthetic techniques in the overall population, we found a similar prevalence of patients who had myocardial ischemia (GA, 12 of 52 [23%]; LA, 10 of 55 [18%]; P = not significant) and a similar number of ischemic episodes per patient (GA, 1.5 +/- 0.4; LA, 1.8 +/- 0.6; P = not significant). Episodes of myocardial ischemia were similarly distributed in intraoperative and postoperative periods in both groups. It is relevant that under GA, IHD patients represent most of the population who suffered myocardial ischemia (83%). On the contrary, in the group of patients operated on under LA, the prevalence was equally distributed in the two subpopulations. CONCLUSION: The results confirm the different hemodynamic impact of the two anesthetic techniques. Patients who received LA had a rate of myocardial ischemia that was half that of patients who had GA. The small number of cardiac complications do not permit us to make any definitive conclusion on the impact of the two anesthetic techniques on early cardiac morbidity, but the relationship between perioperative ischemic burden and major cardiac events suggests that LA can be used safely, even in high-risk patients undergoing carotid endarterectomy

Frontal Alpha Asymmetry and Theta Oscillations Associated With Information Sharing Intention

Social media has gained increasing importance in many aspects of everyday life, from building relationships to establishing collaborative networks between individuals worldwide. Sharing behavior is an essential part of maintaining these dynamic networks. However, the precise neural factors that could be related to sharing behavior in online communities remain unclear. In this study, we recorded electroencephalographic (EEG) oscillations of human subjects while they were watching short videos. The subjects were later asked to evaluate the videos based on how much they liked them and whether they would share them. We found that, at the population level, subjects watching videos that would not be shared had higher power spectral density (PSD) amplitudes in the theta band (4–8 Hz), primarily over the frontal and parietal sites of the right hemisphere, than subjects watching videos that would be shared. Previous studies have associated task disengagement with an increase in scalp-wide theta activation, which can be interpreted as a mind-wandering effect. This might suggest that the decision to not share the video may lead to a more automatic/effortless neural pattern. We also found that watching videos that would be shared was associated with lower PSD amplitudes in the alpha band (8–12 Hz) over the central and right frontal sites, and with more negative scores of frontal alpha asymmetry (FAA) index scores. These results may be related to previous work linking right-sided frontal EEG asymmetry to the pursuit of social conformity and avoidance of negative outcomes, such as social isolation. Finally, using support vector machine (SVM) algorithms, we show that these EEG parameters and preference rating scores can be used to improve the predictability of sharing information behavior. The information sharing-related EEG pattern described here could therefore improve our understanding of the neural markers associated with sharing behavior and contribute to studies about stimuli propagation

Caratterizzazione ambientale delle acque del Golfo dell’Asinara (Sardegna) attraverso l’uso di spettrofluorimetria laser e immagini telerilevate

The general objective of this research (financed by L.R. 7 of the Autonomous Region of Sardinia for the period May 2010 –May 2012) is to calibrate bio-optical algorithm for more accurate estimates of phytoplanktonic Chl-a in the Asinara Gulf (Northern Sardinia, Italy) using remote sensing data and in situ measurements. The “sea truth” values of Chl-a were obtained with the new laser spectrofluorometric apparatus CASPER (Compact and Advanced laser SPEctrometeR – Patent ENEA). CASPER permitted not only to quantify values of Chl-a but also to detect other algal pigments (phycoerythrin, phycocyanin), chromophoric dissolved organic matter (CDOM), proteins-like components (tyrosine, tryptophan), and qualitative data on the presence of hydrocarbons and oil pollution. At the moment “sea truth” data of Chl-a were just compared to standard chlorophyll products of MODIS OC3 algorithm. In order to reach better results, the bio-optical algorithm is going to be recalibrated according to the measurements of CASPER during the next year, thus providing new estimates of phytoplanktonic Chl-a in the Asinara Gulf

An Innovative and high-speed technology for sweater monitoring of Asinara Gulf (Sardinia- Italy)

Laser induced fluorescenze technique for sea water monitoring allows no-time consuming, non-invasive and non-destructive controls. In this study, the performance of the new shipboard laser spectrofluorometric CAS-PER (Compact and Advanced Laser Spectrometer –ENEA Patent) for monitoring phytoplankton community composition was examined. The prototype CASPER is based on double laser excitation of water samples in the UV (266 nm) and visible (405 nm) spectral region and a double water filtration in order to detect both quantitative data, such as choromophoric dissolved organic matter (CDOM), proteins-like components (tyrosine, tryptophan), algal pigments (chlorophylls a and b, phycoerythrin, phycocyanin, different pigments of the carotenoid groups) and qualitative data on the presence of hydrocarbons and oil pollutants. Sea water samples from different depths have been collected and analyzed from August 2010 through November 2011 in the Gulf of Asinara (N-W Sardinia). Several sampling stations were selected as sites with different degree of pollution. The accuracy and the reliability of data obtained by CASPER have been evaluated comparing the results with other standard measurements such as: Chlorophyll a (Chl a) data obtained by spectrophotometric method and total phytoplankton abundance in terms of density and class composition. Spectral deconvolution technique was developed and integrated with CASPER system to assess and characterize a marker pigments and organic compounds in situ and in vivo. Field studies confirmed CASPER system capability to effectively discriminate characteritistic spectra of fluorescent water constituents, contributing to decrease the time-consuming manual analysis of the water samples in the laboratory

Left ventricle remodelling by double-patch sandwich technique

BACKGROUND: The sandwich double-patch technique was adopted as an alternative method for reconstruction of the left ventricle after excision of postinfarction dysfunctional myocardium to solve technical problems due to the thick edges of the ventricular wall. METHODS: Over a 5-year period, 12 of 21 patients with postinfarction antero-apical left ventricular aneurysm had thick wall edges after wall excision. It was due to akinetic muscular thick tissue in 6 cases, while in the other 6 with classic fibrous aneurysm, thick edges remained after the cut of the border zone. The ventricular opening was sandwiched between two patches and this is a technique which is currently used for the treatment of the interventricular septum rupture. In our patients the patches are much smaller than the removed aneurysm and they were sutured simply by a single row of single stitches. However, in contrast to interventricular septum rupture where the patches loosen the tension of the tissues, in our patients the patches pull strongly and restrain the walls by fastening their edges and supporting tight stitches. In this way they could narrow the cavity and close the ventricle. RESULTS: The resected area varied from 5 × 4 to 8 × 8 cm. Excision was extended into the interventricular septum in 5 patients, thus opening the right ventricle. CABG was performed on all patients but two. Left ventricular volumes and the ejection fraction changed significantly: end-systolic volume 93.5 ± 12.4 to 57.8 ± 8.9 ml, p < 0.001; end-diastolic volume 157.2 ± 16.7 to 115.3 ± 14.9 ml, p < 0.001; ejection fraction 40.3 ± 4.2 to 49.5 ± 5.7%, p < 0.001. All patients did well. One patient suffered from bleeding, which was not from the wall suture, and another had a left arm paresis. The post-operative hospital stay was 5 to 30 days with a mean 10.5 ± 7.5 days/patient. At follow-up, 9 to 60 months mean 34, all patients were symptom-free. NYHA class 2.5 ± 0.8 changed to 1.2 ± 0.4, p < 0.001. CONCLUSION: The double-patch sandwich technique (bi-patch closure) offers some advantages and does not result in increased morbidity and mortality. In the case of excising a left ventricular aneurysm, this technique in no way requires eversion of the edges, felt strips, buttressed and multiple sutures, all of which are needed for longitudinal linear closure. Moreover, it does not require purse string sutures, endocardial scar remnant to secure the patch or folding the excluded non-functional tissue, all of which are needed for endoventricular patch repair

Modulation by context of a scene in monkey anterior inferotemporal cortex during a saccadic eye movement task

We investigated the effect of a scene on the activity of cells in the anterior inferotemporal (AIT) cortex while the monkey performed a saccadic eye movement (SEM) task with and without the context of a scene (gray frame). Most neurons did not code for the presence of a scene when it appeared alone (monkey free viewing) or when the monkey was fixating. Nevertheless, when a peripheral target was turned on and the monkey had to make a SEM to it, some cells were capable of differentially coding the presence of the scene before and after the saccade