Retrograde balloon hemostasis.

Despite improvements in current devices and techniques for complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI), procedural complications, including coronary perforation, still occur and could be life-threatening. A patient with a history of multivessel coronary artery disease and a CTO of the right coronary artery (RCA) underwent successful retrograde crossing of an RCA CTO. After wiring the CTO body and lesion dilatation, a drug-eluting stent was implanted in the distal RCA toward the posterior descending artery. A large Ellis type III perforation occurred at the distal edge of the stent. Septal crossing with a balloon and tamponade of the perforation site through the retrograde collaterals followed, as the RCA was not suitable to accommodate easily both the covered stent and the balloon simultaneously. This case report presents a novel approach the "septal retrograde ping-pong" technique, which demonstrates successful treatment of coronary perforations by utilizing a retrograde approach through a septal collateral. This technique proves to be effective in situations where the conventional antegrade balloon or covered stent delivery methods are not feasible or unsuccessful. This innovative approach offers a promising alternative for managing challenging cases of coronary perforations, providing new insights and potential solutions for interventional cardiologists.

Safety and efficacy of an ultra low dose fluoroscopic protocol for chronic total occlusion recanalization.

BACKGROUND: Chronic total occlusion (CTO) revascularization is a major source of radiation for both patients and physicians. Therefore, efforts to minimize radiation during CTO percutaneous coronary intervention (PCI) are highly encouraged. AIMS: To evaluate the impact of an Ultra Low fluoroscopic Dose Protocol (ULDP), based on 3.75 frames per second for the fluoroscopy and 7.5 frames per second for the cine acquisition, during CTO PCI. METHODS: One hundred fifty consecutive patients who underwent CTO PCI were retrospectively enrolled. Eighty-five underwent standard dose protocol (SDP) and 65 ULDP. Radiation exposure and acute clinical outcomes were compared between groups. Results were stratified according to lesion complexity. RESULTS: Patients undergoing ULDP, as compared to those undergoing SDP, showed a significant reduction of kerma area product, both for simple lesions (6861.0 vs. 13236.0 mGy × cm2 ; p = 0.014) and complex lesions (CL) (8865.0 vs. 16618.0 mGy × cm2 ; p < 0.001). Similarly, Air Kerma (AK) was lower when ULDP was used (1222.5 vs. 2015.0 cGy in SL, p = 0.134; 1499.0 vs. 2794.0 cGy in CL, p < 0.001). No significant differences were reported regarding procedural success and in-hospital major adverse cardiovascular events between groups. Notably, there was not any crossover from ULDO to SDP due to poor quality images. Interestingly, fluoroscopy time, procedural time and contrast volume was significantly lower in patients undergoing ULDP only for CLs. CONCLUSIONS: ULDP significantly reduces radiation exposure in the setting of high complexity procedures such as CTO PCI. This reduction seemed to be greater with increased procedural complexity and did not impact acute success or adverse clinical events.

Cutting balloon to optimize predilation for stent implantation: The COPS randomized trial.

OBJECTIVES: The objective of this study is to investigate the use of cutting balloon (CB) inflated at high pressure compared with noncompliant balloon (NCB) for the treatment of calcified coronary lesions. BACKGROUND: No data are available regarding the safety and efficacy of CB inflated at high pressure in coronary artery calcifications. METHODS: Patients with calcified lesions (more than 100° of calcium demonstrated at baseline intravascular ultrasound) were randomized. Primary endpoint of the study was the final minimal stent area (MSA) and stent symmetry in the calcific segment. Secondary endpoints included rate of device failure and the 1-year rate of target lesion revascularization, target vessel revascularization, and major adverse cardiovascular events. RESULTS: From September 2019 to June 2021, a total of 100 patients were included and randomized; 13 patients were excluded for major protocol deviations. Lesions were complex (type B2/C n = 61 [71.2%]) with a mean arch of calcium of 266 ± 84°, a calcium length of 12 ± 6.6 mm. CB was inflated at comparable atmospheres when compared with NCB (18.3 ± 5 vs. 19 ± 4.5, p = 0.46). In the per-protocol population, the final MSA at the level of the calcium site was significantly higher in the CB group (8.1 ± 2 vs. 7.3 ± 2.1, p = 0.035) with a higher eccentricity index achieved in the CB group (0.84 ± 0.07 vs. 0.8 ± 0.08, p = 0.013). Three device failure occurred in the CB group. One-year follow-up outcomes were comparable. CONCLUSIONS: Treatment of calcified lesions with high-pressure CB has a good safety profile and is associated with a larger MSA and higher eccentricity of the stent at the level of the calcium site compared with NCB.

SUOH 03 Guidewire for the Management of Coronary Artery Dissection: Insights from a Multicenter Registry.

Background: In the setting of coronary artery dissection, both spontaneous and iatrogenic, fixing the intimal tear, usually with stent implantation, can be extremely challenging if the distal wire position has been lost. Common complications are mainly related to the inadvertent subintimal tracking of the guidewire while attempting to gain the distal true lumen. Aims: To report the registry results of using the SUOH 0.3 guidewire for managing coronary artery dissection in a real-world multicenter setting. Methods: The study population in this retrospective, multicenter, international registry included 75 consecutive patients who underwent PCI and required an antegrade wiring of a dissected coronary artery. Results: Successful use of SUOH 0.3 was achieved in 69 (92%) patients. The use of a microcatheter was associated with a significantly higher rate of TIMI 3 flow at the end of the procedure (no microcatheter: n = 17, 81%; microcatheter: n = 52, 96.3%; p = 0.017). The first recanalization attempt was made with the SUOH 03 guidewire in 48 (64%) cases, and it was successful in 42 (87%). The overall PCI success rate was reported in 72 (96%) patients, with no significant differences among patients with different origins, mechanisms, and locations of dissection. Conclusions: In this setting, the SUOH 0.3 guidewire provides high procedural success without additional complex techniques.

Device entrapment during percutaneous coronary intervention.

INTRODUCTION: Device entrapment is a life-threatening complication during percutaneous coronary intervention (PCI). However, the success for its management is predominantly based on operator experience with limited available guidance in the published literature. METHODS: A systematic review was performed on December 2021; we searched PubMed for articles on device entrapment during PCI. In addition, backward snowballing (i.e., review of references from identified articles and pertinent reviews) was employed. RESULTS: A total of 4209 articles were retrieved, of which 150 studies were included in the synthesis of the data. A methodical algorithmic approach to prevention and management of device entrapment can help to optimize outcomes. The recommended sequence of steps are as follows: (a) pulling, (b) trapping, (c) snaring, (d) plaque modification, (e) telescoping, and (f) surgery. CONCLUSIONS: In-depth knowledge of the techniques and necessary tools can help optimize the likelihood of successful equipment retrieval and minimization of complications.

Management and outcomes of coronary artery perforations treated with the block and deliver technique.

OBJECTIVES AND BACKGROUND: Coronary artery perforation (CAP) is a potentially life-threatening complication during percutaneous coronary interventions (PCI) and the best strategy for its management is yet to be proved. We aimed to analyze the safety, efficacy, and long-term clinical outcomes of the block and deliver (BAD) technique, as only anecdotal cases are reported in literature. METHODS: From January 2016 to January 2020, all consecutive patients treated with the BAD technique at five high-volume centers in Italy were retrospectively identified. RESULTS: 25 CAPs treated with the BAD technique were included. The most frequently perforated artery was the left anterior descending artery (32%) and spring-coil wires with a hydrophilic coating were the most common culprit wires (68%). Mean sealing time was 46.9 ± 60.1 min, with no significant differences between CTO-PCIs and non-CTO PCIs (p = .921). Acute successful sealing of the CAP was achieved in 96% of the cases. Immediate cardiac tamponade occurred in 28% of patients, four during CTO PCI and three during non-CTO PCI (p = .55). Two patients required pericardiocentesis during hospitalization, one patient developed acute kidney injury, and one patient underwent cardiac surgery due to severe mitral regurgitation. At 1-year follow-up no significant differences were observed between groups in terms of POCE (25 vs 25%, p = .628) and its individual components. CONCLUSION: The BAD technique proved to be effective for the management of CAP, showing high successful sealing rates. Rates of in-hospital events and at 1-year follow-up did not significantly differ between patients suffering CAP during CTO revascularization or during non-CTO PCI.

An algorithmic approach to balloon-uncrossable coronary lesions.

Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.

Effectiveness of the "new rope coil" composite core Suoh 0.3 guidewire in the management of coronary artery dissections.

Coronary artery dissection is a well-known complication of percutaneous coronary interventions. In this setting, coronary artery dissection is caused by mechanical injury of the arterial wall. However, dissection may also occur spontaneously. In both situations, an intimal tear or dissection allows blood entering and separating the layers of the coronary arterial wall. Despite percutaneous approach is still the preferred and the quickest way to restore coronary flow, it remains challenging. One of the main reasons for procedural failure is due to the difficult advancement of a guidewire into the true lumen. In such situation, the ideal wire should have a soft tip, high torque control, and excellent flexibility. Assuming that, the "new rope coil" composite core Suoh 0.3 guidewire, with its unique combination of characteristics, could allow better orientation insight into a dissected coronary artery increasing the chance of procedural success. We collected a case series of nine consecutive patients in which the Suoh 0.3 guidewire was able to gain the true lumen distally to a dissected segment.

Correction to: Human behavior and Homo-mammal interactions at the first European peopling: new evidence from the Pirro Nord site (Apricena, Southern Italy).

In the original publication of this article, one of the author names was incorrectly captured. The first name should be Razika, then family name should be Chelli-Cheheb.

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification.

The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1,395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; and 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared with information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known nonpathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification.

Human behavior and Homo-mammal interactions at the first European peopling: new evidence from the Pirro Nord site (Apricena, Southern Italy).

Recent functional and zooarchaeological studies conducted on the archeological finds of Pirro Nord (PN13) produced new, reliable data on early European hominid subsistence activities. The age of the site is estimated to be ~ 1.3-1.6 Ma, based on bio-chronological data, and the archeological excavation of the Pirro Nord 13 fissure led to the discovery of more than 300 lithic artifacts associated with thousands of vertebrate fossil remains of the final Villafranchian (Pirro Nord Faunal Unit). The analysis of the fossil faunal remains allowed for the identification of anthropogenic traces linked to the exploitation of different animal carcass (cut marks and intentional bone breakages). Use-wear traces were also observed on some flint artifacts and have been interpreted as the result of the exploitation of animal resources by early hominids and carnivores. It has not been possible to identify the type of access that hominins developed on the carcasses, although it has been established that the hominins competed with carnivores for animal resources. The stone tools and faunal remains with anthropogenic traces recovered in the PN13 fissure represent among the earliest evidence of hominin faunal exploitation in Europe.

The trap and occlude technique for retrograde wire externalization during chronic total occlusion revascularization.

Different strategies of retrograde approach were introduced in recent years to improve the success rate of percutaneous coronary intervention for coronary chronic total occlusions. The aim of this report is to describe a new technique, called "Trap and Occlude Technique," for retrograde wire externalization during CTO percutaneous revascularization. This technique may save time and reduce radiation exposure and procedure-related bleeding.

Self-apposing stent-assisted coil embolization for the treatment of coronary artery aneurysm.

Coronary artery aneurysms (CAA) represent an uncommon disease with yet unclear standards of treatment. Clinical and anatomic characteristics determine choice of treatment. Stent-assisted coil embolization has been described as a valuable option for management of patients with wide-neck coronary aneurysms. Choice of appropriate stent sizing can be challenging particularly when there is a large difference between proximal and distal diameters. We report a case of stent-assisted coil embolization of a coronary aneurysm using a self-expandable stent. This type of stent can be helpful to treat CAA involving coronary sites where marked tapering of vessel diameter is often present.

Cornus mas (L.) Fruit as a Potential Source of Natural Health-Promoting Compounds: Physico-Chemical Characterisation of Bioactive Components.

Interest in new sources of anti-inflammatory and antioxidant compounds has recently become a major research issue, with the cornelian cherry (Cornus mas L.) receiving particular attention for its significant amounts of phenolic compounds and vitamins, which exhibit a wide range of biological and pharmacological properties. This study was aimed at increasing knowledge regarding the cornelian cherry in Italy through the analysis of biologically active substances in the locally available genotype "Chieri". Spectrophotometric methods were applied to evaluate antioxidant activity, total anthocyanin content and total polyphenolic content. Identification and quantification of the main phytochemical compounds (polyphenols, monoterpenes, organic acids and vitamin C) was performed via high performance liquid chromatography coupled to a diode array detector. C. mas extracts showed high levels of total soluble solids and low acidity. High amounts of phenolic secondary metabolites were observed, with particular reference to anthocyanins (134.71 mgC3G/100 gFW), which confer remarkable nutraceutical properties to the analysed samples. These results highlight the potential of C. mas fruits as a good source of natural antioxidants, suggesting their use as a functional food. Future studies should focus on identifying other specific phytochemical compounds and the genetic traits of local varieties in order to improve cornelian cherry cultivars for food and medicine production.

The Balloon-Microcatheter technique for treatment of coronary artery perforations.

Coronary perforation (CP) is a rare but potentially lethal complication of percutaneous coronary intervention (PCI). Management of CP is mainly conditioned by the extension of coronary rupture and location of the perforation. Successful treatment is highly affected by the operator's familiarity with tools and dedicated techniques to achieve prompt sealing of the disruption. We describe a "Balloon-Microcatheter" technique that may allow fast, safe, and effective management of CP with a single ≥ 6 Fr guiding catheter. © 2016 Wiley Periodicals, Inc.

Feasibility of UV-VIS-Fluorescence spectroscopy combined with pattern recognition techniques to authenticate a new category of plant food supplements.

Bud extracts, named also "gemmoderivatives", are a new category of natural products, obtained macerating meristematic fresh tissues of trees and plants. In the European Community these botanical remedies are classified as plant food supplements. Nowadays these products are still poorly studied, even if they are widely used and commercialized. Several analytical tools for the quality control of these very expensive supplements are urgently needed in order to avoid mislabelling and frauds. In fact, besides the usual quality controls common to the other botanical dietary supplements, these extracts should be checked in order to quickly detect if the cheaper adult parts of the plants are deceptively used in place of the corresponding buds whose harvest-period and production are extremely limited. This study aims to provide a screening analytical method based on UV-VIS-Fluorescence spectroscopy coupled to multivariate analysis for a rapid, inexpensive and non-destructive quality control of these products.

Analytical fingerprint and chemometrics as phytochemical composition control tools in food supplement analysis: characterization of raspberry bud preparations of different cultivars.

BACKGROUND: The raspberry, Rubus idaeus L., provides several plant parts (as buds) used for food supplements. The aim of this research was to establish a technique for chemical composition control of R. idaeus herbal preparations, using chromatographic methods. These methods allowed us to identify and quantify the main phytochemicals, obtaining a specific phytochemical fingerprint (phytocomplex). Combined with two different chemometric methods - clustering analysis and principal component analysis - the raspberry bud extracts of the different cultivars were efficiently characterized. RESULTS: Rubus idaeus buds were identified as a rich source of anti-inflammatory and antioxidant compounds: organic acids, vitamins and catechins were found to be the most discriminating variables by chemometric techniques to differentiate raspberry cultivars. In particular, catechins (13.25%) and flavonols (8.71%) were the most important polyphenolic classes, followed by cinnamic and benzoic acids. CONCLUSION: This study developed a useful tool for R. idaeus extract phytochemical characterization that could be applied also for differentiation and composition control of other herbal preparations. © 2015 Society of Chemical Industry.

Clinical validation of the NANDA-I diagnosis of impaired memory in elderly patients.

PURPOSE: The aim of this study was to perform a clinical validation of the defining characteristics of impaired memory (IM) in elderly patients at a long-term care institution. METHODS: A sample of 123 elderly patients was evaluated with a questionnaire designed to identify IM according to the NANDA-I taxonomy. Accuracy measures were calculated for the total sample and for males and females separately. RESULTS: Sensitivity and specificity values indicated that: (1) inability to learn new skills is useful in screening IM, and (2) forgets to perform a behavior at a scheduled time, forgetfulness, inability to learn new information, inability to recall events, and inability to recall factual information are confirmatory indicators. CONCLUSION: Specific factors can affect the manifestation of IM by elderly patients. The results may be useful in improving diagnostic accuracy and efficiency of the IM nursing diagnosis.

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers.

INTRODUCTION: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. METHODS: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. RESULTS: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. CONCLUSIONS: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.