Surgery for anomalous aortic origin of coronary arteries : a multicentre study from the European Congenital Heart Surgeons Association

OBJECTIVES: We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS: We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS: We collected 156 surgical patients (median age 39.5 years, interquartile range 15-53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1-5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class CONCLUSIONS: Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle.Peer reviewe

Anomalous aortic origin of coronary arteries : Early results on clinical management from an international multicenter study

Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinicalmulticenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), inwhomAAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p b 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA Conclusions: Surgery for AAOCA is safe andwith low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA. (C) 2019 The Authors. Published by Elsevier B.V.Peer reviewe

Industrial Internet of Things and job characteristics in production lines: an empirical analysis

Industrial Internet of Things (IIoT) technologies are producing radical changes in the automation of industrial manufacturing and logistics. Considering the case of production lines, this research aims to identify which job characteristics are affected by the introduction of IIoT technologies. The developed framework investigates a set of 11 different constructs: systematic problem solving, proactive work behaviour, task variety, job demand, job enlargement, task interdependence, feedback from the job, job complexity, job engagement, physical engagement, and job autonomy. The framework was tested through a survey, conducted on a sample of 104 workers and 24 foremen of 12 leading manufacturing companies

Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association.

OBJECTIVES We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS We collected 156 surgical patients (median age 39.5 years, interquartile range 15-53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1-5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class ≤ II, but symptoms persisted in 14.2%; 48.1% of them returned to sport activity. On Kaplan-Meier analysis, event-free survival at follow-up was 74.6%. Morbidity was not significantly different among age classes, anatomical variants and types of surgical procedures. Furthermore, return to sport activity was significantly higher in younger patients who participated in sports preoperatively. CONCLUSIONS Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

BACKGROUND: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. METHODS: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. RESULTS: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). CONCLUSIONS: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.status: publishe

COVID-19 ICU mortality prediction: a machine learning approach using SuperLearner algorithm

Background: Since the beginning of coronavirus disease 2019 (COVID-19), the development of predictive models has sparked relevant interest due to the initial lack of knowledge about diagnosis, treatment, and prognosis. The present study aimed at developing a model, through a machine learning approach, to predict intensive care unit (ICU) mortality in COVID-19 patients based on predefined clinical parameters. Results: Observational multicenter cohort study. All COVID-19 adult patients admitted to 25 ICUs belonging to the VENETO ICU network (February 28th 2020-april 4th 2021) were enrolled. Patients admitted to the ICUs before 4th March 2021 were used for model training (“training set”), while patients admitted after the 5th of March 2021 were used for external validation (“test set 1”). A further group of patients (“test set 2”), admitted to the ICU of IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, was used for external validation. A SuperLearner machine learning algorithm was applied for model development, and both internal and external validation was performed. Clinical variables available for the model were (i) age, gender, sequential organ failure assessment score, Charlson Comorbidity Index score (not adjusted for age), Palliative Performance Score; (ii) need of invasive mechanical ventilation, non-invasive mechanical ventilation, O2 therapy, vasoactive agents, extracorporeal membrane oxygenation, continuous venous-venous hemofiltration, tracheostomy, re-intubation, prone position during ICU stay; and (iii) re-admission in ICU. One thousand two hundred ninety-three (80%) patients were included in the “training set”, while 124 (8%) and 199 (12%) patients were included in the “test set 1” and “test set 2,” respectively. Three different predictive models were developed. Each model included different sets of clinical variables. The three models showed similar predictive performances, with a training balanced accuracy that ranged between 0.72 and 0.90, while the cross-validation performance ranged from 0.75 to 0.85. Age was the leading predictor for all the considered model

Long-term clinical outcomes of patients with drug-induced type 1 Brugada electrocardiographic pattern: A nationwide cohort registry study

Background: There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). Objective: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. Methods: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. Results: A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0-122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. Conclusion: In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years

Cronache meridionali. A. III, n.1-12 (1956)

N. 1-2 (gennaio-febbraio 1964): Appello del Comitato nazionale per la rinascita del Mezzogiorno, 1 ; Sereni, E., La lotta per la conquista aella terra nel Mezzogiorno, P. 4 ; Viviani, L., Le condizioni di lauoro delle maestre, P. 23 ; Valenza, P., Venosa e la disoccupazione in Lucania, P. 33 ; Silipo, L., La legge speciale per la Calabria, P. 38 ; Cardia, U., La crisi del bacino carbonifero del Sulcis, P. 43 ; La distensione internazionale e lo sviluppo economico del Mezzogiorno, P. 53 ; Il II Congresso dell'Associazione dei contadini del Mezzogiorno, P. 67 ; Pirastu, I., Un convegno regionale dei pastori sardi, P. 68 ; Felicetti, N., I Comuni abruzzesi e molisani per il petrolio, P. 72 ; Pinna, G. L'attuazione dello Statuto regionale in Sardegna, P. 76 ; La commissione parlamentare d'inchiesta nelle fabbriche, P. 88 ; Sansone, N., Danilo Dolci: Banditi a Partinico, P. 95 ; Ricci, P., Alberto Consiglio: Antologia di poeti napoletani, P. 97 ; Mastroianni, G., Fausto Nicolini: Saggi vichiani, P. 101 ; Chiaromonte, G., Ferdinando Ventriglia : Panorami industriali, P. 104 ; Villari, R.,Giuseppe Coniglio: Il viceregno di Napoli nel secolo XVII, P. 106 ; Scibilia, A., Virgilio Titone: La Sicilia dalla dominazione spagnola all'unità d'Italia, P. 107 ; Natale, F., Gianvito Resta: Pascoli a Messina, P. 108 ;Giuseppe Garibaldi: La liberazione di Napoli, P. 110.N. 3 (marzo 1956): Basta con gli eccidi!, P. 113 ; Are, G., La crisi agricola in Sardegna, P. 115 ; Ovazza, M., L'attuazione della riforma agraria in Sicilia, P. 138 ; Alinovi, A., Savoia, C., Mariani, N., Scappini, R., Bianco, M., Mancini, G., e I. Pirastu (a cura di), Le conseguenze del maltempo, P. 145 ; Il Convegno degli ingegneri per la industrializzazione, P. 173 ; Cimino, M., Il cedimento di Alessi, P. 175 ; Chiaromonte, G., Gli «effetti economici» della Cassa, P. 179 ; Valenzi, M., Agostino Degli Espinosa: Il regno del Sud, P. 187 ; Villari, M., Pasquale Villani: Giuseppe Zurlo e la crisi dell'àntico regime nel regno di Napoli, P. 190 ; Sansone, N., Tommaso Fiore: Il cafone all'inferno, P. 191.N. 4 (aprile 1956): Le elezioni amministrative, P. 193 ; Il processo Dolci, P. 197 ; I soprusi prefettizi contro le amministrazioni Democratiche, P. 229 ; Matera, A., Il diritto all'assistenza, P. 234 ; Misefari, E., I comuni meridionali e la S. M. E., P. 237 ; Cassese, A., Eboli, P. 243 ; Cardaci, G., Mazzarino, P.248 ; Mafai, M., Pescara, 255 ; Ziccardi, A., Irsina, P. 259 ; Messinetti, S., Crotone, P. 261 ; Un dibattito sull'edilizia scolastica, P. 266 ; Villari, R.,Editore Passerin D'Entrèves: L'ultima battaglia politica di Cavour, P. 277 ; Formiggini, G., Leonardo Sciascia: Le parrocchie di Regalpetra, P. 280 ; Villari, P., Disordine amministrativo nelle province meridionali; Le ragioni di' un malcontento, Gli errori del governo, 283.N. 5 (maggio 1956): Le elezioni amministrative nel Mezzogiorno continentale, P. 289 ;Occhionero, L., Recenti libri sul petrolio italiano, P. 310 ; Spezzano, F., e R. Agostino, Sulla proroga della legge Sila, P. 324 ; Romano, A., Giampiero Carocci: Agostino Depretis e la politica interna italianadal 1876 al 1887, P. 337 ; Scibilia, A., Movimento operaio, P. 354 ; Villari, R., Giacobini italiani a cura di Delio Cantimori, P. 356 ; Dalla stampa 358.N. 6 (giugno 1956): Sereni, E., Capitale finanziario nelle campagne italiane, P. 361 ; Fortunato, G., Note sulle reazioni di Pontelandolio e Casalduni, P. 381 ; Alinovi, A., Il uoto di Napoli, P. 395 ;Avolio, G., Sui risultati elettorali nelle zone di riforma, P. 404 ; Sotgiu, G., Corrado Alvaro, P. 414 ; Locoratolo, L., Il P.S.I. nel Mezzogiorno, P. 418 ; Chiaromonte, G., Un dibattito sull'industrializzazione, P. 425 ; Amore, S., Alcuni esempi di «relazioni umane» nelle fabbriche napoletane, P. 432 ; Villari, R., G. Carano Donvito: Economisti di Puglia, P. 438.N. 7-8 (luglio-agosto 1956): Una minaccia contro la pace, P. 441 ; Il «secondo ciclo» della politica meridionale, P. 443 ; Incoronato, L., I minatori di Manoppello, P. 448 ; Napolitano, G., Prospettive dell'industrializzazione e linee di un intervento dell' I.r.i., P. 455 ; Cimino, M., La crisi del governo Alessi, P. 469 ; Lapiccirella, R., Un dibattito al Consiglio comunale di Napoli, P. 476 ; La formazione delle giunte comunali e provinciali, P. 483 ; Maglietta, C., Le ispezioni del lavoro, P. 494 ; Vitale, G., Problemi attuali degli enti di riforma, P. 496 ; Chiaromonte, G., Le variazioni nella distribuzione della proprietà fondiaria, P. 501 ; Di Lillo, G, “L. Piccardi R. Morghen. G. Calogero, L Borghi, H. Zanotti-Bianco, Dibattito sulla scuola”, P. 505 ; Villari, R., La «Statistica » del Regno di Napoli del 1811. Relazioni sulla provincia di Salerno. A cura di L. Cassese, P. 509 ; Ricci, P., Antologia, della canzone napoletana, P. 510 ; Franchetti, L., Capitali e agricoltura nel Mezzogiorno, P. 514 ; Franchetti, L., Contadini e proprietari, P. 517.N. 9 (settembre 1956): Unificazione socialista e rinascita del Mezzogiorno, P. 521 ; Renda, F., Il piano quinquennale per lo sviluppo economico e sociale della Sicilia, P. 524 ; Villari, R., Questione agraria e sviluppo, del capitalismo nel Risorgimento, P. 536 ; Vella, N., L'approvvigionamento idrico dell'Irpinia e del Sannio, P. 543 ; Nunziante, G., La situazione edilizia napoletana, P. 553 ; Granati, F., La difesa del prezzo del pomodoro nel Salernitano, P. 556 ; Napolitano, G., Natura e limiti del programma di Vanoni, P. 570 ; Chiaromonte, G., Le finanze comunali net Mezzogiorno, P. 576 ; Villari, R., Sull'evoluzione d'ella proprietà fondiaria privata in Italia, P. 579 ; Chiaromonte, G., Campilli, Malvestiti, Moro, Pella, Piccioni, Porzio, Scelba, Segni, Spataro, Togni, Tridente: Il dialogo continua alIa Fiera del Levante e la politica meridionalistica, P. 584 ; Sonnino, S., L'alienazione dei bent demaniali ed ecclesiastici in Sicilia, P. 587.N. 10 (ottobrebre 1956): Chiaromonte, G., Per la pace e per la libertà, P. 593; Montalbano, G., Corte costituzionale e Alta Corte siciliana, P. 596 ; Raucci, E., L'Ente Regione strumento di democrazia e di progresso, P. 612 ; Corbi, B., Problemi di economia e politica agraria nel Fucino, P. 646 ; Gigliotti, A., L'opera Sila ela riforma fondiaria in Calabria, P. 650 ; Chiaromonte, G., Il convegno di Sorrento e il carattere « settoriale » della questione meridionale, P. 661 ; Il Mezzogiorno al Congresso di Trento, P. 665 ; Santarelli, G., Giampiero Carocci, Giovanni Amendola nella crisi della Stato italiano, P. 669 ; Villari, R., René Bouvier e Andrè Laffargue, La vie napolitaine au XVIIIe siècle, P. 671.N. 11 (novembre 1956): Ingrao, P., Per una politica di amicizia col mondo arabo, P. 673 ; Vitale, G.,Il movimento democratico e la riforma agraria, P. 679 ; Cimino, M., Personaggi ed eventi della crisi politica siciliana, P. 690 ; Felicetti, N., L'emigrazione dall'Abruzzo, P. 695 ; Gallo, N., l patti colonici nei bergamotteti del Reggino, P. 706 ; Rossi, C., Le finanze delle province meridionali, P. 723 ; La Cassa per il Mezzogiorno a metà strada, P. 727 ; Renda, F., Ed Reid, La mafia, P. 732 ; Villari, R., Giuliano Procacci, Le elezioni del 1874 e l'opposizione meridionale, P. 735 ; Ricci, P., Vincenzo Dattilo, Castel dell'Ovo, P. 737 ; L'Inchiesta agraria (dalla Rassegna settimanale). 740.N. 12 (dicembre 1956): Napolitano, G., La crisi della politica meridionale e la legge di proroga della Cassa, P. 745 ; Chiaromonte, G., Le regioni arretrate ID Jugoslavia, P. 754 ; Conte L., Effetti della meccanizzazione nell'agricoltura del Foggiano, P. 766 ; Faletra, G., La cassa per il Mezzogiorno in Sicilia, P. 773 ; Levrero, S., La posizione dei lavoratori sullo sviluppo :industriale di Napoli, P. 793 ; Villari, L., Studi in onore di Antonio Genovesi nel bicentenario della istituzione della cattedra di economia, P. 799 ; La questione sociale in Italia (dalla Rassegna settimanale), P. 804

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys