Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'.

It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women's diseases.

[Gender discrepancy: time to implement gender-based clinical management]. / Position paper ANMCO: Differenze di genere nell'approccio farmacologico cardiovascolare.

It is well established that gender strongly influences cardiovascular risk factors, playing a crucial role in cardiovascular prevention, clinical pathways, diagnostic approach and treatment. Beyond the sex, which is a biological factor, gender entails a socio-cultural condition that impacts access and quality of care due to structural and institutional barriers. However, despite its great importance, this issue has not been adequately covered. Indeed sex and gender differences scarcely impact the clinical approach, creating a lot of disparities in care and outcomes of patients. Therefore, it becomes essential to increase the awareness of the importance of sex and gender influences on cardiovascular diseases. Moreover, new strategies for reducing disparities should be developed. Importantly, these differences should be taken into account in guideline recommendations. In this regard, it is crucial to include a greater number of women in clinical trials, since they are currently underrepresented. Furthermore, more women should be involved as member of international boards in order to develop recommendations and guidelines with more attention to this important topic.The aim of this ANMCO position paper is to shed light on gender differences concerning many cardiovascular drugs in order to encourage a more personalized therapeutic approach.

[ANMCO Position paper: Ionizing radiation exposure and radioprotection in the cath-lab]. / Position paper ANMCO: Radioesposizione e radioprotezione nei laboratori di cardiologia interventistica.

In the last decades, because of the improvements in the percutaneous treatment of coronary heart disease, valvular heart disease, congenital heart defects, and the increasing number of cardiac resynchronization therapy and cardioverter-defibrillator implantations, the interventional cardiologists' radio-exposure has importantly risen, causing concerns for ionizing radiation-associated diseases such as cancer and neurodegenerative disorders. Consequently, the radiation exposure issue importantly affects operators' safety. However, our knowledge of this field is poor and most operators are unaware to be at risk, especially because of the absence of effective preventive measures. The aim of this ANMCO position paper is to improve the awareness of operators and identify new ways of reducing operator ionizing radiation dose and minimizing the risk.

[ANMCO Position paper: Choosing Wisely - ANMCO proposals for 2023]. / Position paper ANMCO: Choosing Wisely ­ le proposte dell'ANMCO nel 2023.

Nowadays, a progressive and exponential increase in the use of invasive and non-invasive instrumental diagnostics and therapeutic services has been shown. Although unnecessary, instrumental examinations are often largely prescribed, replacing clinical evaluation. Their correct use, on the contrary, would address precise epidemiological and clinical contexts. Therefore identifying whether a test or procedure is appropriate or not plays a crucial role in clinical practice. Several documents from scientific societies and expert groups indicate the most appropriate cardiovascular diagnostic and therapeutic procedures. The international Choosing Wisely campaign invited the main scientific societies to identify five techniques or treatments used in their field that are often unnecessary and may potentially damage patients. The Italian Association of Hospital Cardiologists (ANMCO) joined the project identifying the five cardiological practices in our country at greater risk of inappropriateness in 2014. This list has recently been updated. Moreover, possible solutions to this problem have been proposed.

Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation.

Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.

Congenital Ventricular Diverticulum.

Herein, we describe a 54-year-old patient with a congenital ventricular diverticulum (CVD), referred to our emergency department for presyncope episodes and multiple re-entrant ventricular tachycardias (VT). Significantly, echocardiographic findings were not clear, and the diagnosis was made by cardiac magnetic resonance imaging (CMRI), which showed the presence of an apical accessory cavity connected to the ventricle and contracting synchronously. CMRI allowed the differential diagnosis with other outpouching cardiac defects. The patient underwent a subcutaneous implantable cardioverter defibrillator (S-ICD) implant and was referred for heart transplantation (HT). The diagnosis, treatment, and main findings of the CVD are discussed in this case report.

Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks.

Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.

Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management.

Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. Remarkably, accurately evaluating patients to refer to the closure strategy is extremely important. However, the selection of patients for PFO closure is still not so clear. The aim of this review is to update and clarify which patients should be considered for closure treatment.

Prevention of Spinal Cord Injury during Thoracoabdominal Aortic Aneurysms Repair: What the Anaesthesiologist Should Know.

Thoraco-abdominal aortic repair is a high-risk surgery for both mortality and morbidity. A major complication is paraplegia-paralysis due to spinal cord injury. Modern thoracic and abdominal aortic aneurysm repair techniques involve multiple strategies to reduce the risk of spinal cord ischemia during and after surgery. These include both surgical and anaesthesiologic approaches to optimize spinal cord perfusion by staging the procedure, guaranteeing perfusion of the distal aorta through various techniques (left atrium-left femoral artery by-pass) by pharmacological and monitoring interventions or by maximizing oxygen delivery and inducing spinal cord hypothermia. Lumbar CSF drainage alone or in combination with other techniques remains one of the most used and effective strategies. This narrative review overviews the current techniques to prevent or avoid spinal cord injury during thoracoabdominal aortic aneurysms repair.

Interplay between abiotic and microbial biofilm-mediated processes for travertine formation: Insights from a thermal spring (Piscine Carletti, Viterbo, Italy).

Active hydrothermal travertine systems are ideal environments to investigate how abiotic and biotic processes affect mineralization mechanisms and mineral fabric formation. In this study, a biogeochemical characterization of waters, dissolved gases, and microbial mats was performed together with a mineralogical investigation on travertine encrustations occurring at the outflow channel of a thermal spring. The comprehensive model, compiled by means of TOUGHREACT computational tool from measured parameters, revealed that mineral phases were differently influenced by either abiotic conditions or microbially driven processes. Microbial mats are shaped by light availability and temperature gradient of waters flowing along the channel. Mineralogical features were homogeneous throughout the system, with euhedral calcite crystals, related to inorganic precipitation induced by CO2 degassing, and calcite shrubs associated with organomineralization processes, thus indicating an indirect microbial participation to the mineral deposition (microbially influenced calcite). The microbial activity played a role in driving calcite redissolution processes, resulting in circular pits on calcite crystal surfaces possibly related to the metabolic activity of sulfur-oxidizing bacteria found at a high relative abundance within the biofilm community. Sulfur oxidation might also explain the occurrence of gypsum crystals embedded in microbial mats, since gypsum precipitation could be induced by a local increase in sulfate concentration mediated by S-oxidizing bacteria, regardless of the overall undersaturated environmental conditions. Moreover, the absence of gypsum dissolution suggested the capability of microbial biofilm in modulating the mobility of chemical species by providing a protective envelope on gypsum crystals.

Deep Learning Methods for Space Situational Awareness in Mega-Constellations Satellite-Based Internet of Things Networks.

Artificial Intelligence of things (AIoT) is the combination of Artificial Intelligence (AI) technologies and the Internet of Things (IoT) infrastructure. AI deals with the devices' learning process to acquire knowledge from data and experience, while IoT concerns devices interacting with each other using the Internet. AIoT has been proven to be a very effective paradigm for several existing applications as well as for new areas, especially in the field of satellite communication systems with mega-constellations. When AIoT meets space communications efficiently, we have interesting uses of AI for Satellite IoT (SIoT). In fact, the number of space debris is continuously increasing as well as the risk of space collisions, and this poses a significant threat to the sustainability and safety of space operations that must be carefully and efficiently addressed to avoid critical damage to the SIoT networks. This paper aims to provide a systematic survey of the state of the art, challenges, and perspectives on the use of deep learning methods for space situational awareness (SSA) object detection and classification. The contributions of this paper can be summarized as follows: (i) we outline using AI algorithms, and in particular, deep learning (DL) methods, the possibility of identifying the nature/type of spatial objects by processing signals from radars; (ii) we present a comprehensive taxonomy of DL-based methods applied to SSA object detection and classification, as well as their characteristics, and implementation issues.

Scalp-recorded N40 visual evoked potential: Sensory and attentional properties.

N40 is a well-known component of evoked potentials with respect to the auditory and somatosensory modality but not much recognized with regard to the visual modality. To be detected with event-related potentials (ERPs), it requires an optimal signal-to-noise ratio. To investigate the nature of visual N40, we recorded EEG/ERP signals from 20 participants. Each of them was presented with 1800 spatial frequency gratings of 0.75, 1.5, 3 and 6 c/deg. Data were collected from 128 sites while participants were engaged in both passive viewing and attention conditions. N40 (30-55 ms) was modulated by alertness and selective attention; in fact, it was larger to targets than irrelevant and passively viewed spatial frequency gratings. Its strongest intracranial sources were the bilateral thalamic nuclei of pulvinar, according to swLORETA. The active network included precuneus, insula and inferior parietal lobule. An N80 component (60-90 ms) was also identified, which was larger to targets than irrelevant/passive stimuli and more negative to high than low spatial frequencies. In contrast, N40 was not sensitive to spatial frequency per se, nor did it show a polarity inversion as a function of spatial frequency. Attention, alertness and spatial frequency effects were also found for the later components P1, N2 and P300. The attentional effects increased in magnitude over time. The data showed that ERPs can pick up the earliest synchronized activity, deriving in part from thalamic nuclei, before the visual information has actually reached the occipital cortex.

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department.

BACKGROUND: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. METHODS: Data from 718 patients presenting to the emergency department of the "Città della Salute e della Scienza" Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. RESULTS: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. CONCLUSION: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.

Spectroscopic study of volcanic ashes.

Volcanic ashes particles are subjected to substantial modification during explosive eruptions. The mineralogical and compositional changes have important consequences on the environment and human health. Nevertheless, the relationship between the speciation of iron (Fe) and the mineralogical composition and particle granulometry of the ashes, along with their interaction with water, are largely unknown. In particular, the Fe oxidation state and the possible formation of new Fe-bearing phases in presence of S, Cl, and F in the plume are key points to assess the impact of the ashes. Fragmental material ejected during volcanic activity (tephra) in 2013, was collected on the Mt. Etna (Italy) and investigated using a multi-technique approach that included conventional Electron Paramagnetic Resonance (EPR), high field EPR (HFEPR), EchoEPR, and Fe K-edge X-ray Absorption Spectroscopy (XAS). These element-selective techniques allowed obtaining a detailed information on the oxidation state and coordination environment of Fe, and of its speciation in the ash samples as a function of the granulometry. A complex mineralogical assemblage, consisting of variable amounts of nanometric crystalline Fe inclusions in a glass matrix, and of Fe-oxides and Fe-sulfur phases was revealed. A risk assessment of the ashes is attempted.

No other race effect (ORE) for infant face recognition: A memory task.

The aim of this study was to investigate how the other-race and baby schema effects interacted during face perception and recognition processes. 384 pictures representing Caucasian and non-Caucasian faces of infants and adults were shown to 24 Caucasian adult participants in an old/new recognition task. EEG/ERPs were recorded during face encoding and a successive memory session. ERP data showed a baby schema effect on N170, anterior N2 and P300 responses, which were larger to infant than adult faces, regardless of ethnicity. Conversely, an ORE was found, but only for adults faces, with N170 and N400 being larger to Caucasian than non-Caucasian adult faces. Consistently, reaction times were faster to unfamiliar faces of Caucasian than non-Caucasian adults, while no ORE was found for infants. SwLORETA, applied to the difference-waves (Caucasian - non Caucasian) elicited by adults faces (ORE), showed the strong activation of areas representing person-related information (i.e., inferior temporal gyrus), prejudice representation (i.e., the superior and middle frontal gyri), and theory of mind (i.e., the supramarginal gyrus and superior parietal lobe). The lack of ethnicity effect for infants faces is discussed in the light of their innate collative and attention capturing properties.

[ANMCO/SICI-GISE/SIC/SIECVI/SIRM Consensus document: Appropriateness of multimodality imaging in cardiovascular disease]. / Documento di consenso ANMCO/SICI-GISE/SIC/SIECVI/SIRM: Appropriatezza dell'imaging multimodale nelle patologie cardiovascolari.

The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenarios, taking into consideration not only the international guidelines and scientific documents already published, but also the reality of Italian laws as well as the various professional profiles involved in patient management and availability of technological diagnostic instruments.

Distinct neural mechanisms for reading Arabic vs. verbal numbers: An ERP study.

In this electroencephalogram/event-related potential (EEG/ERP) study, 16 volunteers were asked to compare the numerical equality of 360 pairs of multidigit numbers presented in Arabic or verbal format. Behavioural data showed faster and more accurate responses for digit targets, with a right hand/left hemisphere advantage only for verbal numerals. Occipito-temporal N1, peaking at approximately 180 ms, was strongly left-lateralized during verbal number processing and bilateral during digit processing. A LORETA (low-resolution electromagnetic tomography) source reconstruction performed at the N1 latency stage (155-185 ms) revealed greater brain activation during coding of Arabic than of verbal stimuli. Digit perceptual coding was associated with the activation of the right angular gyrus (rAG), the left fusiform gyrus (FG,BA37), and left and right superior and medial frontal areas. N1 sources for verbal numerals included the left FG (BA37), the precuneus (BA31), the parahippocampal area and a small right prefrontal activation. In addition, verbal numerals elicited a late frontocentral negativity, possibly reflecting stimulus unfamiliarity or complexity. Overall, the data suggest distinct mechanisms for number reading through ciphers (digits) or words. Information about quantity was accessed earlier and more accurately if numbers were in a nonlinguistic code. Indeed, it can be speculated that numerosity processing would involve circuits originally involved in processing space (i.e., rAG/rIPS).

Shared neural mechanisms for processing emotions in music and vocalizations.

The neural mechanisms involved in the processing of vocalizations and music were compared, in order to observe possible similarities in the encoding of their emotional content. Positive and negative emotional vocalizations (e.g. laughing, crying) and violin musical stimuli digitally extracted from them were used as stimuli. They shared the melodic profile and main pitch/frequency characteristics. Participants listened to vocalizations or music while detecting rare auditory targets (bird tweeting, or piano's arpeggios). EEG was recorded from 128 sites. P2, N400 and Late positivity responses of ERPs were analysed. P2 peak was earlier in response to vocalizations, while P2 amplitude was larger to positive than negative stimuli. N400 was greater to negative than positive stimuli. LP was greater to vocalizations than music and to positive than negative stimuli. Source modelling using swLORETA suggested that, among N400 generators, the left middle temporal gyrus and the right uncus responded to both music and vocalizations, and more to negative than positive stimuli. The right parahippocampal region of the limbic lobe and the right cingulate cortex were active during music listening, while the left superior temporal cortex only responded to human vocalizations. Negative stimuli always activated the right middle temporal gyrus, whereas positively valenced stimuli always activated the inferior frontal cortex. The processing of emotional vocalizations and music seemed to involve common neural mechanisms. Notation obtained from acoustic signals showed how emotionally negative stimuli tended to be in Minor key, and positive stimuli in Major key, thus shedding some lights on the brain ability to understand music.

Green and scalable synthesis of nanocrystalline kuramite.

The new generation of solar cells aims to overcome many of the issues created by silicon-based devices (e.g., decommissioning, flexibility and high-energy production costs). Due to the scarcity of the resources involved in the process and the need for the reduction of potential pollution, a greener approach to solar cell material production is required. Among others, the solvothermal approach for the synthesis of nanocrystalline Cu-Sn-S (CTS) materials fulfils all of these requirements. The material constraints must be considered, not only for the final product, but for the whole production process. Most works reporting the successful synthesis of CTS have employed surfactants, high pressure or noxious solvents. In this paper, we demonstrate the synthesis of nanocrystalline kuramite by means of a simpler, greener and scalable solvothermal synthesis. We exploited a multianalytical characterization approach (X-ray diffraction, extended X-ray absorption fine structure, field emission scanning electron microscopy, Raman spectroscopy and electronic microprobe analysis (EMPA)) to discriminate kuramite from other closely related polymorphs. Moreover, we confirmed the presence of structural defects due to a relevant antisite population.

Chemical variability of artificial stone powders in relation to their health effects.

The occurrence of highly severe silica-related diseases among the resin- and silica-based artificial stone workers was claimed, associated to an extremely short latency. High levels of exposure and intrinsic properties of AS are thought to modulate the development of silicosis and auto-immune diseases. This study compares parent materials and processed dusts, to shed light on changes of AS occurring in the manufacturing process, through an XRF, EPR and XAS investigation. We point out the extremely wide variability of the materials, the occurrence of chemical signatures impressed by the processing techniques, and the unprecedented generation of stable radicals associated to the lysis of the Si-O chemical bond inside the resin coated respirable crystalline silica. These results suggest that the AS processing in industrial stone workshops can create respirable dusts with peculiar physical and chemical properties, to be correlated to the observed clinical evidences.