Management of macro-reentrant right atrial tachycardia around multiple leads aided by high-density mapping.

BACKGROUND: A 61-year-old male with Steinert Dystrophy and prior history of cardiac implantable device complained of highly symptomatic right atrial tachycardia. Unresponsive to pharmacological therapy. METHODS: The patient underwent catheter ablation procedure aided by high-density mapping. RESULTS: Ablation procedure was succesful. CONCLUSIONS: This unique case report highlights the role of high-density mapping in the identification of critical isthmus and management of macro-reentrant tachycardia in complex situations such as the presence of multiple leads in the chamber.

Occupational exposure to carbon fibers impregnated with epoxy resins and evaluation of their respirability.

Objectives: The study aims to investigate occupational exposure to carbon fibers impregnated with epoxy resins (carbon fiber reinforced [CFR]) in workers at an airplane fuselage section construction plant, by environmental and biological monitoring.Materials and methods: Determination of airborne CFR was done by environmental sampling with active samplers, 11 of which were stationary and 19 personal samplings. The subsequent analyses were performed in the scanning electron microscope fitted with an X-ray microanalysis system (SEM-EDXA). Biological monitoring was carried out by determining CFR in exhaled breath condensate (EBC) collected from 19 male workers who wore personal environmental samplers (exposed workers) and from 10 male workers at the same factory who had no occupational exposure to CFR (internal controls). CFR analysis was done by SEM, applying the method used for determining asbestos fibers in aqueous samples.Results: The airborne CFR concentrations were found to be significantly higher (p = 0.03) at personal samplings (median value 7.01 ff/L, range 1.24-11.16 ff/L) than stationary samplings (median value 1.93 ff/L, range 0.55-10.09 ff/L). The aerodynamic diameters calculated starting from the length and geometric diameter of the sampled CFRs were always higher than 20 µm. CFR was not found in any of the EBC samples collected from the exposed workers and controls.Conclusions: Despite the evidence of occupational exposure to low concentrations of CFR, the absence of such fibers in the EBC in the exposed workers confirms their non-respirability, as expected based on their aerodynamic diameter.

Endometrial LGR7 expression and implantation failure.

Implantation failure is considered as a major cause of infertility in women with recurrent pregnancy loss (RPL) and in otherwise healthy women with unexplained infertility. Preliminary data in primates suggested that relaxin (RLX) is involved in endometrial preparation for implantation. In a prospective observational study, the endometrial RLX receptor (LGR7) expression was assessed in three groups of patients with regular ovulatory cycle and normal uterine cavity: 23 with RPL (Group A), 23 with unexplained infertility undergone at least three cycles of failed in vitro fertilization (IVF) reporting good oocyte and embryo quality (Group B), 23 with proven fertility (Group C). Assessment of LGR7 expression was performed with both polymerase chain reaction (PCR) analysis and immunohistochemistry on endometrial samples obtained with hysteroscopic biopsy performed in the secretory phase of the menstrual cycle. Endometrial LGR7 was less expressed in group A and B versus C, both by PCR analysis (p = 0.024) and immunohistochemistry. The decreased expression of the endometrial RLX receptor in women with implantation failures, both in vitro fertilization failure and recurrent pregnancy loss, suggests that RLX may play a crucial role in the structural and functional changes of the endometrium during the window of implantation.

Sequential protocol with urinary-FSH/recombinant-FSH versus standard protocol with recombinant-FSH in women of advanced age undergoing IVF.

A stimulation protocol mimicking the physiological pattern of FSH release may improve IVF outcome in women of advanced age. Urinary-FSH delivers a wider range of isoforms including the most acidic produced during the early follicular phase when oestradiol level is low, a common condition in women of advanced reproductive age. We hypothesized that a stimulation protocol using urinary-FSH during the early follicular phase and then shifting toward recombinant-FSH may improve oocyte quality and pregnancy rate in 35-40 years old patients in IVF program. A retrospective study was performed: after a standard down-regulation with GnRH-analogue, 115 women underwent stimulation with urinary-FSH for 6 days according to a step-down approach and then shifting to recombinant-FSH (group A), 115 women underwent a stimulation protocol with only recombinant-FSH (group B). Days of stimulation were lower in group A than in group B, a higher proportion of MII oocytes and of grade 1 embryos, higher implantation rate and pregnancy rate were observed in group A versus group B. We conclude that a sequential protocol using urinary-FSH in the early days of stimulation and subsequently recombinant-FSH may improve the IVF outcome in patients of advanced reproductive age.

Self-Calibrated Laser-Induced Breakdown Spectroscopy for the Quantitative Elemental Analysis of Suspended Volcanic Ash.

Real-time analysis of fine ash in volcanic plumes, which represent magma fragments expelled from the crater during explosive eruptions, is a valuable tool for volcano monitoring and hazard assessment. To obtain the chemical characterization of the juvenile pyroclastic material emitted in volcanic plumes, many analytical techniques can be used. Among them, laser-induced breakdown spectroscopy (LIBS) is the one that can most easily be adapted to advanced applications in extreme environments. In this paper, LIBS experiments based on self-calibrated approaches are used to determine the elemental composition of suspended volcanic ash. To simulate the conditions of dispersed volcanic ash in the atmosphere, different sizes of volcanic ash samples are suspended in the air by laser-induced shockwaves in a dedicated chamber, and a parametric study is carried out to establish the optimal experimental conditions for recording usable plasma emission spectra for each ash size. The quantitative analysis is performed using a self-calibrated analytical method, including calibration-free LIBS, which is based on the calculation of the spectral radiance of a uniform plasma in local thermodynamic equilibrium. The method accounts intrinsically for self-absorption since it modifies the intensity of spectral lines and thus leads to an underestimation of the elemental fraction. An intensity calibration of the spectra based on the measurements of Fe lines intensities was also used in this work to deduce the apparatus response from the spectrum itself and avoid the use of standard calibration lamps. Results demonstrate the potential of real-time measurements of elemental fractions in volcanic ash with good agreement with the literature composition.

Percutaneous edge-to-edge repair as a bailout option to treat Iatrogenic leaflet perforation.

An 80-year-old man was referred to our center for heart failure and severe degenerative mitral regurgitation (MR). Transesophageal echocardiography revealed severe MR due to anterior leaflet prolapse, mainly in its central portion (A2) in the context of fibroelastic deficiency.

Microplastics in inland and offshore sediments in the Apulo-Lucanian region (Southern Italy).

Inland and offshore sediments from Southern Italy were studied in order to evaluate the occurrence and nature of microplastics (MPs). Inland sediments were collected in the Bradano and Basento rivers (Apulo-Lucanian region, Southern Italy), while offshore sediments were collected on the continental shelf near Bari (Adriatic Sea) and Metaponto (Ionian Sea). MPs were detected and characterized using optical microscopy, micro-Fourier-Transform Infrared spectroscopy (µ-FTIR) and micro-Raman analyses. The number of MPs present varied between 144 and 1246 kg-1 of dry sediment (468.8 ± 410,7 MPs kg-1) with a predominance of black fibers; no correlation emerged between MPs and sediment grain size. In river sediments, the occurrence of MPs is associated with local pollution, whereas the offshore occurrence of MPs depends on seasonal river flow and submarine canyons. Compositional analyses suggest that the main source of MPs in the studied sediments is sewage discharge from residential areas.

Probabilistic hydro-geomorphological hazard assessment based on UAV-derived high-resolution topographic data: The case of Basento river (Southern Italy).

The combined use of Unmanned Aerial Vehicles (UAVs) and Structure from Motion (SfM) photogrammetry allows the collection and processing of high-resolution data on demand, which is key for the constant and detailed monitoring of the fluvial environment. In addition, through the ever-increasing development of new techniques of mapping and data processing (i.e., UAVs swarm, BVLOS flight missions, high-performance photogrammetry workflow), it is now possible to detect large areas at high-resolution, providing support for spatiotemporal insights into hydro-geomorphological processes and hazard assessment, in order to ensure an effective management and to prevent catastrophic phenomena (i.e., floods). The main goal of this paper is to use UAV-based high-resolution topographic data to constrain the probabilistic hazard assessment of extended reaches of Basento river (Basilicata, Italy). To demonstrate the influence of geomorphology and riverbed sediment on hazard assessment, a sensitivity analysis was carried out on the resolution of the UAV-derived DEMs; on the riverbed roughness coefficient resulting from photo-sieving analysis and on the morphological change detection over short-time ranges (2019-2021). We found that lower resolution DEMs lead to an increase of flooding probability (in several river cross-sections an increase even higher than 99 % resulted), and that a greater roughness coefficient involves an increase in the probability of flooding (with a maximum increase of about 9 %). Moreover, the multitemporal high-resolution outputs resulting from SfM allowed the identification of morphological changes, in short-times, caused by an anthropic modification of the river bank, which significantly affected the flooding hazard.

Coronary Computed Tomography Angiography for the Assessment of Sirolimus-Eluting Resorbable Magnesium Scaffold.

BACKGROUND: Little evidence to date has described the feasibility and diagnostic accuracy of coronary computed tomography angiography (CCTA) with noninvasive fractional flow reserve (CT-FFR) in coronary vessels with resorbable magnesium scaffold (RMS). METHODS: The SHERPA-MAGIC is a prospective study enrolling patients receiving RMS. The present analysis considered patients undergoing CCTA 18 months after the index procedure. CCTA images were employed to investigate reabsorption status, luminal measurements, and noninvasive FFR. Three-year follow-up was available for all patients. RESULTS: Overall, 26 patients with a total of 29 coronary arteries treated with 35 RMS were considered. The most frequently involved vessel was left anterior descendent (LAD). Median stent length was 25 (20-25) mm, with a median diameter of 3 (3-3.5) mm. At 18-month CCTA, all scaffolded segments were patent. Complete RMS reabsorption was observed in 27 (93%, 95% CI 77-99%) cases. Median minimal lumen diameter (MLD) and area (MLA) of the scaffolded segments were 2.5 [2.1-2.8] mm and 6.4 [4.4-8.4] mm2, respectively. Median CT-FFR was 0.88 [0.81-0.91]. Only one (3.5%) vessel showed a flow-limiting CT-FFR value ≤0.80. During the 3-year follow-up, only one (4%) adverse event was observed. Conclusions: In patients undergoing RMS implantation, CCTA including noninvasive CT-FFR evaluation is feasible and allows investigation of long-term RMS performance.

Inverting sediment bedforms for evaluating the hazard of dilute pyroclastic density currents in the field.

Pyroclastic density currents are ground hugging gas-particle flows associated to explosive volcanic eruptions and moving down a volcano's slope, causing devastation and deaths. Because of the hostile nature they cannot be analyzed directly and most of their fluid dynamic behavior is reconstructed by the deposits left in the geological record, which frequently show peculiar structures such as ripples and dune bedforms. Here, a set of equations is simplified to link flow behavior to particle motion and deposition. This allows to construct a phase diagram by which impact parameters of dilute pyroclastic density currents, representing important factors of hazard, can be calculated by inverting bedforms wavelength and grain size, without the need of more complex models that require extensive work in the laboratory.

[Transcatheter approach of concomitant mitral and tricuspid regurgitation]. / Approccio transcatetere nei pazienti affetti da insufficienza mitralica severa e concomitante insufficienza tricuspidale severa.

Severe mitral regurgitation represents the second most common indication for valve surgery in Europe. In the last decade, transcatheter mitral valve repair has become an established effective and safe treatment option for patients at high or prohibitive operative risk. A relevant proportion of these patients develop significant tricuspid regurgitation. Once considered a benign and reversible finding, nowadays increasing attention is being paid to the coexistence of this valvular disease, as a growing body of evidence points towards its negative prognostic role. Over the last few years, transcatheter repair has been performed successfully also for the treatment of significant tricuspid regurgitation in patients at high surgical risk. Therefore, combined transcatheter repair is emerging as a treatment strategy for high surgical risk patients with both severe mitral and tricuspid regurgitation. In this review, we provide a comprehensive summary of the epidemiology, pathophysiology, and prognostic role of the coexistence of severe mitral and tricuspid regurgitation. We then discuss the evidence in favor of combined surgical treatment and the emerging data supporting combined transcatheter treatment, with attention to available treatment technologies. The paper is further enriched with three practical case reports and with the suggestion of a decision-making algorithm for the management of this complex subset of patients.

The impact of pyroclastic density currents duration on humans: the case of the AD 79 eruption of Vesuvius.

Pyroclastic density currents are ground hugging gas-particle flows that originate from the collapse of an eruption column or lava dome. They move away from the volcano at high speed, causing devastation. The impact is generally associated with flow dynamic pressure and temperature. Little emphasis has yet been given to flow duration, although it is emerging that the survival of people engulfed in a current strongly depends on the exposure time. The AD 79 event of Somma-Vesuvius is used here to demonstrate the impact of pyroclastic density currents on humans during an historical eruption. At Herculaneum, at the foot of the volcano, the temperature and strength of the flow were so high that survival was impossible. At Pompeii, in the distal area, we use a new model indicating that the current had low strength and low temperature, which is confirmed by the absence of signs of trauma on corpses. Under such conditions, survival should have been possible if the current lasted a few minutes or less. Instead, our calculations demonstrate a flow duration of 17 min, long enough to make lethal the breathing of ash suspended in the current. We conclude that in distal areas where the mechanical and thermal effects of a pyroclastic density currents are diminished, flow duration is the key for survival.

A computational platform for the virtual unfolding of Herculaneum Papyri.

Ancient Herculaneum papyrus scrolls, hopelessly charred in the 79 A.D. Vesuvius eruption, contain valuable writings of the Greek philosophers of the day, including works of the Epicurean Philodemus. X-ray phase contrast tomography has recently begun unlocking their secrets. However, only small portions of the text hidden inside the scroll have been recover. One of the challenging tasks in Herculaneum papyri investigation is their virtual unfolding because of their highly complicated structure and three-dimensional arrangement. Although this procedure is feasible, problems in segmentation and flattening hinder the unrolling of a large portion of papyrus. We propose a computational platform for the virtual unfolding procedure, and we show the results of its application on two Herculaneum papyrus fragments. This work paves the way to a comprehensive survey and to further interpretation of larger portions of text hidden inside the carbonized Herculaneum papyri.

Ablation of Atrioventricular Nodal Re-Entrant Tachycardia Combining Irrigated Flexible-Tip Catheters and Three-Dimensional Electroanatomic Mapping: Long-Term Outcomes.

BACKGROUND: Transcatheter ablation is the standasrd treatment for atrioventricular nodal re-entrant tachycardia (AVNRT). However, different techniques are available. Data about the use of irrigated flexible-tip catheters and three-dimensional electroanatomical mapping (3D EAM) for AVNRT ablation are scant. The aim of this study was to evaluate in long-term follow-up efficacy and safety of a novel approach for AVNRT treatment. METHODS: This is a cohort single arm study with long-term follow-up. Patients with AVNRT were treated with catheter ablation by means of irrigated flexible-tip catheters combined with 3D EAM. RESULTS: One-hundred-and-fifty patients were enrolled and followed-up for a median of 38 months (minimum 12, maximum 74). Acute procedural success rate was 96.7% (145/150 patients). During follow-up, 11 patients had arrhythmia recurrences (7.3%). No patient developed atrioventricular conduction block with need for pacemaker implantation (0%). Fourteen patients died during follow-up (9.3%). CONCLUSIONS: Acute procedural success and long-term follow-up show that AVNRT could be safely and effectively treated with irrigated flexible-tip catheters and 3D EAM.

Identification and chromosome mapping of loci predisposing to colorectal cancer that control Wnt/beta-catenin pathway and progression of early lesions in the rat.

Sporadic colorectal cancer (CRC) is a major health concern worldwide. Epidemiologic evidence suggests a polygenic predisposition to CRC, but the genes responsible remain unknown. Here, we performed genome-wide scanning of male (ACI/SegHsd x Wistar-Furth)F2 (AWF2) rats to map susceptibility genes influencing the evolution of early colorectal lesions to adenocarcinoma following 1,2-dimethylhydrazine administration. Phenotypic analysis revealed higher incidence/multiplicity and lower size of adenomas in ACI/SegHsd (ACI) and (ACI/SegHsd x Wistar-Furth)F1 (AWF1) than Wistar-Furth (WF) rats and higher incidence/multiplicity of poorly differentiated adenocarcinomas in WF than ACI rats, with intermediate values in AWF1 rats. Linkage analysis of 138 AWF2 rats identified three loci on chromosomes 4, 15 and 18 in significant linkage with lesion multiplicity that were identified as rat Colon cancer resistance (rCcr) 1, rCcr2 and rCcr3, respectively. Seven other loci on chromosomes 5, 6, 15, 17, 18 and 20 were in suggestive linkage with adenoma/adenocarcinoma multiplicity/surface area. Six of them were identified as rCcr4-9 and a locus on chromosome 5 was identified as a susceptibility locus, rCcs1. Significant interactions between rCcr3 and rCcr6, rCcr6 and rCcr8 and rCcr5 and rCcr9, and four novel epistatic loci controlling multiplicity/size of colorectal lesions were discovered. Apc, located at rCcr3, did not show functional promoter polymorphisms. However, influence of susceptibility/resistance genes on Wnt/beta-catenin pathway was shown by defective beta-catenin inactivation in WF but not in ACI and AWF1 rat adenocarcinomas. These data indicate that inheritance of predisposition to CRC depends on interplays of several genetic factors, and suggest a possible mechanism of polygenic control of CRC progression.

Myo-inositol therapy for poor-responders during IVF: a prospective controlled observational trial.

BACKGROUND: The overall incidence of poor ovarian response in IVF cycles has been reported to be between 9 and 24%. The management of these patients remains a significant challenge in assisted reproduction. The aim of the present study was to evaluate the effect of myo-inositol (MI) on ovarian function in poor responders undergoing ICSI. METHODS: The study is a prospective controlled observational trial, that involved 72 poor responders included in an ICSI program and divided into two groups; group A: 38 patients who have been assuming MI (4 g) + folic acid (FA) (400 µg) for the previous 3 months before the enrollment day; group B: 38 patients assuming FA (400 µg) alone for the same period. COH was carried out in the same manner in the two groups. The main goal was the assessment of oocytes retrieved number and quality; secondary endpoints were the Ovarian Sensitivity Index (OSI: n° oocytes retrieved/total Gonadotropins units × 1000), oestradiol levels on the day of hGC, fertilization rate, implantation rate, ongoing pregnancy rate. RESULTS: There was no significant difference between the two groups regarding oestradiol level, but total rec-FSH units were significantly lower (p = 0.004) and M2 oocytes rate significantly higer (p = 0.01) in group A. The ovarian sensitivity index was higher, reaching a statistical significance (p < 0.05), in the group of patients pre-treated with MI, showing an improvement in ovarian sensibility to gonadotropin. CONCLUSIONS: Our results suggest that MI therapy in poor responders results in an increased of the number of oocytes recovered in MII and of the gonadotropin Ovarian Sensitivity Index (OSI), suggesting a MI role in improving ovarian response to gonadotropins. Therefore MI seems to be helpful in "poor responders" undergoing IVF cycles.

Recombinant human FSH reduces sperm DNA fragmentation in men with idiopathic oligoasthenoteratozoospermia.

A prospective randomized controlled study was designed to evaluate the effects of recombinant human follicle-stimulating hormone (rFSH) treatment on sperm DNA fragmentation in men with idiopathic oligoasthenoteratozoospermia (iOAT). One hundred twenty-nine men with sperm count less than 10 × 10(6) spermatozoa/mL and forward motility <25% were included; normal serum levels of FSH, luteinizing hormone (LH), and testosterone, and no other causes of infertility were enrolled. The patients were randomized into 2 groups: 65 men were treated on alternate days for 90 days with injections of 150 IU rFSH, and 64 subjects received nonantioxidant vitamin supplements. Main outcome measures were serum levels of FSH, LH, testosterone, and inhibin B and DNA fragmentation index (DFI) at baseline and after 90 days. No significant differences were observed between the 2 groups with regard to sperm parameters and hormone values. The DFI was similar between the 2 groups at the time of the enrollment but reduced significantly (P < .05) after rFSH therapy in study group, whereas no significant variation occurred in the control group. In the subgroup of patients with high basal DFI values (>15%), rFSH treatment significantly increased DFI (P < .01), whereas no significant variation occurred after 90 days of vitamin supplements. We conclude that rFSH administration improves sperm DNA integrity in iOAT men with increased DFI values. The degree of sperm DFI might be useful to identify those iOAT patients in which rFSH treatment can be advantageous.