Inspiratory muscle training and its effect on indices of physiological and perceived stress during incremental walking exercise in normobaric hypoxia

This study evaluated the effects of inspiratory muscle training (IMT) on inspiratory muscle fatigue (IMF) and physiological and perceptual responses during trekking-specific exercise. An 8-week IMT program was completed by 21 males (age 32.4 ± 9.61 years, VO2peak 58.8 ± 6.75 mL/kg/min) randomised within matched pairs to either the IMT group (n = 11) or the placebo group [(P), n = 9]. Twice daily, participants completed 30 (IMT) or 60 (P) inspiratory efforts using a Powerbreathe initially set at a resistance of 50% (IMT) or used at 15% (P) of maximal inspiratory pressure (MIP) throughout. A loaded (12.5 kg) 39-minute incremental walking protocol (3–5 km/hour and 1–15% gradient) was completed in normobaric hypoxia (PIO2 = 110 mmHg, 3000 m) before and after training. MIP increased from 164 to 188 cmH2O (18%) and from 161 to 171 cmH2O (6%) in the IMT and P groups (P = 0.02). The 95% CI for IMT showed a significant improvement in MIP (5.21±43.33 cmH2O), but not for P. IMF during exercise (MIP) was*5%, showing no training effect for either IMT or P (P = 0.23). Rating of perceived exertion (RPE) was consistently reduced (*1) throughout exercise following training for IMT, but not for P (P = 0.03). The mean blood lactate concentration during exercise was significantly reduced by 0.26 and 0.15 mmol/L in IMT and P (P = 0.00), with no differences between groups (P = 0.34). Rating of dyspnoea during exercise decreased (*0.4) following IMT but increased (*0.3) following P (P = 0.01). IMT may attenuate the increased physiological and perceived exercise stress experienced during normobaric hypoxia, which may benefit moderate altitude expedition

Sac enlargement due to seroma after endovascular abdominal aortic aneurysm repair with the Endologix PowerLink device

A patient who had undergone endovascular repair of an abdominal aortic aneurysm with the Endologix PowerLink bifurcated system presented with delayed aortic aneurysm enlargement due to assumed endotension. He was treated with aortic sac evacuation and wrapping of the endograft. This is the first report of endotension and aneurysm sac enlargement after implantation of the PowerLink endograft

Transcriptional variation of sensory-related genes in natural populations of Aedes albopictus

BACKGROUND: The Asian tiger mosquito, Aedes albopictus, is a highly dangerous invasive vector of numerous medically important arboviruses including dengue, chikungunya and Zika. In four decades it has spread from tropical Southeast Asia to many parts of the world in both tropical and temperate climes. The rapid invasion process of this mosquito is supported by its high ecological and genetic plasticity across different life history traits. Our aim was to investigate whether wild populations, both native and adventive, also display transcriptional genetic variability for functions that may impact their biology, behaviour and ability to transmit arboviruses, such as sensory perception. RESULTS: Antennal transcriptome data were derived from mosquitoes from a native population from Ban Rai, Thailand and from three adventive Mediterranean populations: Athens, Greece and Arco and Trento from Italy. Clear inter-population differential transcriptional activity was observed in different gene categories related to sound perception, olfaction and viral infection. The greatest differences were detected between the native Thai and the Mediterranean populations. The two Italian populations were the most similar. Nearly one million quality filtered SNP loci were identified. CONCLUSION: The ability to express this great inter-population transcriptional variability highlights, at the functional level, the remarkable genetic flexibility of this mosquito species. We can hypothesize that the differential expression of genes, including those involved in sensory perception, in different populations may enable Ae. albopictus to exploit different environments and hosts, thus contributing to its status as a global vector of arboviruses of public health importance. The large number of SNP loci present in these transcripts represents a useful addition to the arsenal of high-resolution molecular markers and a resource that can be used to detect selective pressure and adaptive changes that may have occurred during the colonization process

The carotid wallstent for the endovascular treatment of carotid artery stenosis

Aim: To report a retrospective, 15-years single-center experience about Carotid Artery Stenting (CAS) using the Carotid Wallstent in high surgical risk patients. Methods: Primary outcomes were procedural success, 30-day mortality and cerebrovascular complications, and long-term survival, neurological complication and restenosis. P values< 0.05 were considered significant. Results: From January 2000 to June 2015, 560 patients underwent CAS using the Carotid Wallstent for either a symptomatic (22.6%) or an asymptomatic significant carotid stenosis. Primary success was achieved in 99.1% as 4 acute stent thrombosis occurred and in 1 case selective catheterization of the supra-aortic trunks was not possible due to extreme tortuosity. At 30 days, 7 TIAs and 9 strokes accounted for a 2.8% of neurological complication rate. There were 2 deaths unrelated to the procedure. At 10 years, survival was 71.2% +/- 2.5%. Freedom from cerebrovascular events (TIA/stroke) at 10 years was 91.2% +/- 1.9% for asymptomatic patients and 81.7% +/- 5% for symptomatic patients (P = 0.008). Freedom from a restenosis >30% was estimated to be of 93.9% +/- 1.3% at 10 years, being significantly affected by age (P = 0.01). Conclusion: In our experience the Carotid Wallstent was a safe and effective device for the treatment of both asymptomatic and symptomatic carotid stenosis in high surgical risk patients. Freedom from cerebrovascular events in the long term was worse in symptomatic patients

Transcriptional variation of sensory-related genes in natural populations of Aedes albopictus

BACKGROUND: The Asian tiger mosquito, Aedes albopictus, is a highly dangerous invasive vector of numerous medically important arboviruses including dengue, chikungunya and Zika. In four decades it has spread from tropical Southeast Asia to many parts of the world in both tropical and temperate climes. The rapid invasion process of this mosquito is supported by its high ecological and genetic plasticity across different life history traits. Our aim was to investigate whether wild populations, both native and adventive, also display transcriptional genetic variability for functions that may impact their biology, behaviour and ability to transmit arboviruses, such as sensory perception. RESULTS: Antennal transcriptome data were derived from mosquitoes from a native population from Ban Rai, Thailand and from three adventive Mediterranean populations: Athens, Greece and Arco and Trento from Italy. Clear inter-population differential transcriptional activity was observed in different gene categories related to sound perception, olfaction and viral infection. The greatest differences were detected between the native Thai and the Mediterranean populations. The two Italian populations were the most similar. Nearly one million quality filtered SNP loci were identified. CONCLUSION: The ability to express this great inter-population transcriptional variability highlights, at the functional level, the remarkable genetic flexibility of this mosquito species. We can hypothesize that the differential expression of genes, including those involved in sensory perception, in different populations may enable Ae. albopictus to exploit different environments and hosts, thus contributing to its status as a global vector of arboviruses of public health importance. The large number of SNP loci present in these transcripts represents a useful addition to the arsenal of high-resolution molecular markers and a resource that can be used to detect selective pressure and adaptive changes that may have occurred during the colonization process

Ruptured hemiarch and descending thoracic aorta aneurysm : hybrid treatment

Ruptured aortic arch aneurysm is a life threatening disease. Surgical repair has an high perioperative mortality rate and totally endovascular treatment is a challenge. Hybrid repair has been proposed as a valuable approach. We report the case of a patient with a contained rupture of aortic arch aneurysm. We treated him with a debranching of supraortic vessels with carotid-carotid and carotid-subclavian bypass and deployment of two enodgrafts in two different times. We consider hybrid treatment for arch and hemiarch a feasible option for aortic arch aneurysms in non emergent and in an emergency setting with an improvement in perioperative morbidity and mortality

Weapons in the jungle of femoro-popliteal lesions

Best treatment for Superficial Femoral Artery (SFA) lesions is still the subject of some controversies in the literature. The paper offers a brief overview of all the techniques currently available for the treatment of SFA lesions

Endovascular repair of thoracic and thoraco-abdominal aortic lesions

BACKGROUND: We report our "real-world" experience of endovascular repair of thoracic/thoraco-abdominal aortic lesions in patients treated from May 2002 to May 2017. METHODS: Data of all consecutive treated patients were retrospectively collected in a database and analyzed. Patients were divided into 4 groups: atherosclerotic thoracic/thoraco-abdominal aneurysms (TAA/TAAA) and floating thrombus (group A); acute complicated type B dissection (TBD), penetrating aortic ulcers (PAU) and intra-mural hematomas (IMH) in group B; chronic TBD evolving in TAA (group C); traumatic injuries (group D). Mortality, reinterventions and occurrence of neurological complications, both at 30 days and in the long term, were analyzed as primary outcomes for each group. RESULTS: Ninety-four patients were treated complessively, most for a TAA (55.3%). Thirty-days deaths and neurological complications were observed in group A only (5 cases each, 5.3%). A reintervention was necessary in 6 patients (64%) of group A. At 5 years, in group A survival was 62.8%+/- 63% and freedom from neurological complication was 88.3%+/- 4.2%. Neither deaths nor neurological complications were recorded in the other groups. No late aortic ruptures were recorded. Freedom from reintervention in group A was 54.7%+/- 7.6% at 5 years and a reintervention was needed in all patients of group D. Overall, the main cause for reintervention was a type I endoleak. CONCLUSIONS: The endovascular repair of thoracic/thoraco-abdominal aortic lesions had acceptable mortality and neurological complication rates, both at 30 days and in the long term. Reinterventions in the long term occurred more frequently after TAA/TAAA and traumatic injuries, and were mainly required for a type I endoleak

Hybrid endovascular and surgical approach for mycotic pseudoaneurysms of the extracranial internal carotid artery

Objectives: Mycotic pseudoaneurysms of the extracranial internal carotid artery are rare, and their management often represents a challenge, but treatment is necessary due to the high risk of rupture and distal brain embolization. Systemic antibiotics associated with open surgical excision of the infected tissues and carotid reconstruction using autologous grafts are the treatment of choice. The use of endovascular techniques still remains controversial in infective fields; however, it can be an attractive alternative in high-risk patients or more often as a \u201ctemporary\u201d solution to achieve immediate bleeding control for a safe surgical reconstruction. Methods: We discuss the unusual case of an extracranial right internal carotid artery mycotic pseudoaneurysm following methicillin-resistant Staphylococcus aureus infection, in a patient with poor general conditions. Results and Conclusion: The lesion was successfully treated using a hybrid endovascular and surgical procedure