Three-dimensional muon imaging of cavities inside the Temperino mine (Italy).

Muon radiography (muography) is an imaging technique based on atmospheric muon absorption in matter that allows to obtain two and three-dimensional images of internal details of hidden objects or structures. The technique relies on atmospheric muon flux measurements performed around and underneath the object under examination. It is a non-invasive and passive technique and thus can be thought of as a valid alternative to common prospecting techniques used in archaeological, geological and civil security fields. This paper describes muon radiography measurements, in the context of archaeological and geological studies carried out at the Temperino mine (LI, Tuscany, Italy), for the search and three-dimensional visualisation of cavities. This mine has been exploited since Etruscan times until recently (1973), and is now an active tourist attraction with public access to the tunnels. Apart from the archaeological interest, the importance of mapping the cavities within this mine lies in identifying the areas where the extraction ores were found and also in the safety issues arising from the tourist presence inside the mine. The three-dimensional imaging is achieved with two different algorithms: one involving a triangulation of two or more measurements at different locations; the other, an innovative technique used here for the first time, is based on the back-projections of reconstructed muon tracks. The latter requires only a single muographic data tacking and is to be preferred in applications where more than one site location can be difficult to access. Finally the quality of the three-dimensional muographic imaging was evaluated by comparing the results with the laser scan profiles obtained for some known cavities within the Temperino mine.

Primary angioplasty for acute myocardial infarction in a patient with a solitary coronary ostium and a "superdominant" right coronary artery.

Coronary artery anomalies (CAAs) are a rare angiographic finding, sometimes associated with acute coronary events. We report on a case of primary angioplasty for inferior acute myocardial infarction (AMI) in a 66-year-old woman with a solitary coronary ostium in the right sinus of Valsalva and a "superdominant" right coronary artery. We also discuss two potential pitfalls of primary angioplasty: correct interpretation of coronary anatomy and approach to challenging lesions.

Survival and hospitalization in a nurse-led domiciliary intervention for elderly heart failure patients.

AIM: Heart failure in the elderly population represents a complex clinical situation associated with frequent hospitalizations and numerous comorbidities. The present study aimed to evaluate the impact of a domiciliary-based nurse-led strategy in a group of very elderly patients affected by heart failure who were regularly seen at an outpatient heart failure clinic (HFC). METHODS: Patients were periodically assessed in their homes by two trained nurses under supervision of the cardiologists of the HFC. During each visit, the nurses examined clinical status and adherence to medication. When necessary, they also gathered venous blood samples for laboratory analysis and recorded an electrocardiogram. In addition, they provided key information regarding disease management to patients as well as to their care givers. During the baseline visit and, subsequently, every 6 months, an echocardiogram was performed at the HFC. RESULTS: Forty-four patients (52.4% male, median age 82 years) were followed up for a mean of 25 +/- 12 months. Compared to an equally long time period before randomization, during follow-up, a significant reduction in cardiac hospitalizations (from 1.83 +/- 1.54 to 1.07 +/- 1.39, P = 0.004), total hospitalizations (from 2.09 +/- 1.71 to 1.52 +/- 1.68, P = 0.003), HFC visits (from 3.31 +/- 2.33 to 2.24 +/- 1.38, P = 0.03) and New York Heart Association (NYHA) class (from 2.74 +/- 0.70 to 2.49 +/- 0.61, P = 0.04) was observed. Total 1-year mortality was 25% and was predicted by several clinical (weight loss, NYHA class), laboratory (hyperuricaemia, anaemia, renal failure, hyposodiemia) and echocardiographic (end-systolic diameter, ejection fraction, systolic pulmonary artery pressure) parameters. Multivariate analysis revealed that hyperuricaemia was as an independent predictor of mortality (odds ratio = 1.53, P = 0.038). CONCLUSIONS: The present study demonstrates that a domiciliary-based strategy in elderly patients affected by heart failure guarantees clinical stability and reduces hospitalizations as well as outpatient visits.