Multiple number-naming associations: How the inversion property affects adults' two-digit number processing.

Some number-naming systems are less transparent than others. For example, in Dutch, 49 is named "negenenveertig," which translates to "nine and forty," i.e., the unit is named first, followed by the decade. This is known as the "inversion property," where the morpho-syntactic representation of the number name is incongruent with its written Arabic form. Number word inversion can hamper children's developing mathematical skills. But little is known about its effects on adults' numeracy, the underlying mechanism, and how a person's bilingual background influences its effects. In the present study, Dutch-English bilingual adults performed an audiovisual matching task, where they heard a number word and simultaneously saw two-digit Arabic symbols and had to determine whether these matched in quantity. We experimentally manipulated the morpho-syntactic structure of the number words to alter their phonological (dis)similarities and numerical congruency with the target Arabic two-digit number. Results showed that morpho-syntactic (in)congruency differentially influenced quantity match and non-match decisions. Although participants were faster when hearing traditional non-transparent Dutch number names, they made more accurate decisions when hearing artificial, but morpho-syntactically transparent number words. This pattern was partly influenced by the participants' bilingual background, i.e., their L2 proficiency in English, which involves more transparent number names. Our findings suggest that, within inversion number-naming systems, multiple associations are formed between two-digit Arabic symbols and number names, which can influence adults' numerical cognition.

Emotions and mathematics: anxiety profiles and their influence on arithmetic performance in university students.

Mathematics anxiety (MA), general and test anxieties affect mathematics performance. However, little is known about how different anxiety profiles (i.e. individual configurations of anxiety forms) influence the relationship between MA and mathematics performance in university students. To the best of our knowledge, studies that have categorized participants based on their anxiety profiles and investigated how such groups differ in mathematics performance and other individual characteristics have all been conducted only with children and adolescents. Using latent profile analysis, we identified five different anxiety profiles in UK university students (N = 328) based on their MA, test anxiety (TA) and trait general anxiety levels (GA). Beyond extreme profiles (high or low levels in all forms of anxiety), we found groups characterized by more specific anxiety forms (MA profile, TA profile and high anxiety with low MA learning profile). These profiles were differentially related to arithmetic performance (but not the performance in a non-mathematics task), and individual factors (e.g. self-concept and self-efficacy). Results can inform the design of interventions tailored to individuals' unique anxiety profiles and highlight the necessity to further study the underpinning mechanisms that drive the MA developmental trajectory from childhood to adulthood.

[Right heart catheterization in Italian catheterization laboratories: results of the SICI-GISE national survey promoted by the GISE Young Committee]. / Il cateterismo cardiaco destro nei laboratori di emodinamica italiani: risultati dell'indagine nazionale SICI-GISE promossa dal Comitato GISE Young.

BACKGROUND: Over the past decades, the improvements in the diagnostic power and availability of non-invasive cardiac imaging techniques have led to a decline of right heart catheterization (RHC) performance. However, RHC remains the gold standard for diagnosing pulmonary hypertension and an essential tool for the evaluation of patient candidacy to heart transplantation. METHODS: This survey was carried out jointly by the Young Committee of GISE, with the support of the SICI-GISE Society, and the ICOT group, with the aim of evaluating how the interventional cardiology community perform RHC. A web-based questionnaire based on 20 questions was distributed to SICI-GISE members. RESULTS: The survey was distributed to 1550 physicians with 174 (11%) responses. Most centers perform few procedures per year (<10 RHC/year) and a dedicated cardiologist is usually lacking. Patients were frequently admitted as ordinary hospitalization regimen and the most frequent indication for RHC was the hemodynamic assessment of pulmonary hypertension, followed by diagnostics of valvular diseases and advanced heart failure/heart transplantation. Indeed, the majority of participants (86%) are involved in transcatheter procedures for structural heart disease. The average time taken to perform the RHC was approximately 30-60 min. The femoral access (60%) was the most frequently used, usually by an echo-guided approach. Two-thirds of participants discontinued oral anticoagulant therapy before RHC. Only 27% of centers assess wedge position from an integrated analysis. Furthermore, the edge pressure is detected in the end-diastolic cardiac phase in half cases and in the end-expiratory phase in only 31%. The most commonly used method for cardiac output calculation was the indirect Fick method (58%). CONCLUSIONS: Guidance on the best practice for performing RHC is currently lacking. A more precise standardization of this demanding procedure is warranted.

Multidimensional components of (state) mathematics anxiety: Behavioral, cognitive, emotional, and psychophysiological consequences.

The present study aimed to analyze the different components of state mathematics anxiety that students experienced while solving calculation problems by manipulating their stress levels. A computerized mathematical task was administered to 165 fifth-graders randomly assigned to three different groups: positive, negative, and control conditions, in which positive, negative, or no feedback during the task was given, respectively. Behavioral (task performance), emotional (negative feelings), cognitive (worrisome thoughts and perceived competence), and psychophysiological responses (skin conductance and vagal withdrawal) were analyzed. Behavioral responses did not differ in the positive and negative conditions, while the latter was associated with children's reportedly negative emotional states, worries, and perceived lack of competence. The stress induced in the negative condition led to an increase in skin conductance and cardiac vagal withdrawal in children. Our data suggest the importance of considering students' interpretation of mathematics-related experiences, which might affect their emotional, cognitive, and psychophysiological responses.

Values of PCT in neonates.

BACKGROUND: Procalciton (PCT) is a precursor polypeptide of the hormone calcitonin, produced in C cells of the thyroid. It has been demonstrated that microbial toxins and proinflammatory mediators can cause the release of PCT from tissues and cells in the body. PCT thus has become an important marker in the diagnosis of infection. METHODS: In this retrospective study we analyzed blood samples performed for clinical purposes from the newborns present in our hospital in the year 2019. We developed a database of 1356 PCT values obtained from 224 infants at risk for neonatal infection; we selected those PCT values obtained within 24 hours from a blood sampling for blood culture. RESULTS: Babies with positive blood culture had PCT values more elevated than those with negative blood culture (17.061 ng/mL [C.I. 10.8-23.2] vs. 4.6 ng/mL [C.I. 2.6-6.6]). No statistically significant difference was found between babies with negative blood culture born before or after 37 weeks of gestation. CONCLUSIONS: This paper gives useful data of PCT values in non-infective babies. It is worth to show that the normality values should not be confused with those of older children or adults. Moreover, it shows the reliability of PCT as an infection index.

Coronary angiography- or fractional flow reserve-guided complete revascularization in multivessel disease STEMI: A Bayesian hierarchical network meta-analysis.

AIMS: To identify the best strategy to achieve complete revascularization (CR) in patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). METHODS AND RESULTS: We systematically reviewed the literature for randomized controlled trials (RCTs) comparing IRA-only PCI and CR guided by angiography or fractional flow reserve (FFR) in MVD-STEMI. Both frequentist (classical) and Bayesian network meta-analysis were performed, including a comparative hierarchy estimation of the probability to reduce the primary composite endpoint of all-cause death and new myocardial infarction (MI). We identified 11 RCTs, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the primary endpoint (OR: 0.73; 95%CI0.55-0.97). We observed non-significant difference between angiography and FFR guidance in reducing the primary endpoint (OR: 0.73, 95% CI 0.35-1.57). The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of all-cause death or new MI (SUCRA92%). CONCLUSIONS: In patients with MVD-STEMI, CR is associated with a reduction in all-cause mortality and new MI compared with IRA-only PCI. Angio-guided CR is associated with the lowest risk of all-cause death or new MI, therefore the role of FFR-guidance in this setting is questionable. CONDENSED ABSTRACT: Both frequentist and Bayesian network meta-analysis were performed to compare infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) and complete revascularization (CR) guided by angiography or fractional flow reserve (FFR) in multivessel disease (MVD) and acute ST-elevation myocardial infarction (STEMI). Eleven randomized controlled trials were identified, including 8193 STEMI patients. Compared with IRA-only strategy, CR significantly reduced the incidence of the composite endpoint of all-cause death and new myocardial infarction without significant difference in angio-guided and FFR-guided CR. The Bayesian probability analysis ranked angio-guided CR as the best intervention yielding lowest risk of the composite endpoint and, therefore the role of FFR-guidance in this setting is questionable.

Effects of a short and intensive transcranial direct current stimulation treatment in children and adolescents with developmental dyslexia: A crossover clinical trial.

Developmental Dyslexia (DD) significantly interferes with children's academic, personal, social, and emotional functioning. Nevertheless, therapeutic options need to be further validated and tested in randomized controlled clinical trials. The use of transcranial direct current stimulation (tDCS) has been gaining ground in recent years as a new intervention option for DD. However, there are still open questions regarding the most suitable tDCS protocol for young people with DD. The current crossover study tested the effectiveness of a short and intensive tDCS protocol, including the long-term effects, as well as the influence of age and neuropsychological processes at baseline on reading improvements. Twenty-four children and adolescents with DD were randomly assigned to receive active tDCS during the first slot and sham tDCS during the second slot or vice versa. Five consecutive daily sessions of left anodal/right cathodal tDCS set at 1 mA for 20 min were administered over the parieto-occipital regions. Reading measures (text, high frequency word, low frequency word, and non-word lists) and neuropsychological measures (visual-spatial and verbal working memory, phoneme blending, and rapid automatized naming tasks) were collected before, immediately after, 1 week and 1 month later the treatment. Our results showed that only the active tDCS condition improved non-word reading speed immediately after and 1 month later the end of the treatment compared with baseline. In addition, the improvement in non-word reading speed was significantly correlated with age and with neuropsychological measures (verbal working memory and phoneme blending) at baseline but only in the active tDCS condition. The current crossover study contributed to enforce previous effects of tDCS, including long-term effects, on non-word reading speed and to understand the effect of age and neuropsychological processes on reading outcomes. Our findings showed that tDCS could be a low-cost and easy-to-implement treatment option with long-term effects for children and adolescents with DD.

Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging.

Background: Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race. Materials and methods: Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist. Results: Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05). Conclusion: Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.

Mathematics-gender stereotype endorsement influences mathematics anxiety, self-concept, and performance differently in men and women.

Mathematics anxiety (MA) is negatively associated with mathematics performance. Although some aspects, such as mathematics self-concept (M self-concept), seem to modulate this association, the underlying mechanism is still unclear. In addition, the false gender stereotype that women are worse than men in mathematics can have a detrimental effect on women. The role that the endorsement of this stereotype (mathematics-gender stereotype (MGS) endorsement) can play may differ between men and women. In this study, we investigated how MA and mathematics self-concept relate to arithmetic performance when considering one's MGS endorsement and gender in a large sample (n = 923) of university students. Using a structural equation modeling approach, we found that MA and mathematics self-concept mediated the effect of MGS endorsement in both men and women. For women, MGS endorsement increased their MA level, while in men, it had the opposite effect (albeit weak). Specifically, in men, MGS endorsement influenced the level of the numerical components of MA, but, unlike women, it also positively influenced their mathematics self-concept. Moreover, men and women perceived the questions included in the considered instruments differently, implying that the scores obtained in these questionnaires may not be directly comparable between genders, which has even broader theoretical and methodological implications for MA research.

Anal Fistula Human Amniotic Membrane Endosealing (F-HAME): A Proof of Concept Study.

The treatment of cryptoglandular anal fistula (AF) is often a challenge for surgeons. Several sphincter-saving procedures have been described as an alternative to fistulotomy, with the common goal of promoting healing and preserve anal continence. The aim of this proof of concept study was to assess the outcomes of human amniotic membrane (HAM) implantation in cryptoglandular transphincteric AF. Two consecutive female were recruited. The primary outcome was clinical healing at 6 months. Secondary outcomes were ultrasonographic healing, complications and reinterventions, AF symptoms, fecal incontinence, psychological impact of treatment, recurrence, development of additional AF, patient satisfaction, and quality of life, as measured using validated questionnaires. Both patients (40 and 54-year-old) previously underwent incision and drainage of anal abscess with concomitant seton placement. HAM implantation was performed as a day case under local anesthesia. No intra- or post-procedural complications occurred. Clinical and radiological healing were not achieved at 6 months. However, the external outlet discharge diminished through time, with sustained improvements in quality of life. Clinical healing occurred at 7 months in both patients. Psychological impact of treatment and patient satisfaction were overall good, with improvements in the PHQ-9, GAD-7, and Short Assessment of Patients Satisfaction. HAM implantation is safe and improves patients' quality of life, progressively leading to clinical healing. Future studies are needed to assess its safety in other etiology of AF.

Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma.

This study aimed to analyze the outcomes of HCC patients treated with a novel technique-pulsed microwave ablation (MWA)-in terms of safety, local tumor progression (LTP), intrahepatic recurrence (IHR), and overall survival (OS). A total of 126 pulsed microwave procedures have been performed in our center. We included patients with mono- or multifocal HCC (BCLC 0 to D). The LTP at 12 months was 9.9%, with an IHR rate of 27.8% at one year. Survival was 92.0% at 12 months with 29.4% experiencing post-operative complications (28.6% Clavien-Dindo 1-2, 0.8% Clavien-Dindo 3-4). Stratifying patients by BCLC, we achieved BCLC 0, A, B, C, and D survival rates of 100%, 93.2%, 93.3%, 50%, and 100%, respectively, at one year, which was generally superior to or in line with the expected survival rates among patients who are started on standard treatment. The pulsed MWA technique is safe and effective. The technique can be proposed not only in patients with BCLC A staging but also in the highly selected cases of BCLC B, C, and D, confirming the importance of the concept of stage migration. This procedure, especially if performed with a minimally invasive technique (laparoscopic or percutaneous), is repeatable with a short postoperative hospital stay.

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy.

Objective of the study was to compare number of X-rays performed for neonatal central line tip positioning when real-time US is used compared to X-ray only, and to assess consequences on position accuracy, irradiation and cost. Retrospective monocentric cohort study conducted at Evelina London Children's Hospital Neonatal Unit over 6 months. Study was conducted during implementation of US for line tip localisation with formulation of US protocol. Tip position on X-ray was reviewed by one neonatologist and one radiologist and inter-rater agreement calculated. Criteria for good, satisfactory or inadequate position of the tip were defined. Estimated effective radiation dose and cost for each X-ray was determined. Two hundred seventy-four lines were inserted (nPICC, UVC, UAC). Eighty-three lines were scanned with US (US group); 191 lines were not (no-US group). Number of X-rays performed was significantly lower in the US group: 1.19 vs. 1.5 (p 0.001), related to a significantly lower percentage of lines requiring multiple X-rays (38.7% no-US group vs. 19.9% US group; p 0.004). Accuracy was higher in US group with more lines at cavoatrial junction (p 0.05) and was significantly increased with US use for lines inserted from lower limbs (22.9% and 76.2%, p 0.001). Inter-rater agreement was strong (k > 0.8). US group received lower mean radiation dose (p < 0.001) and cost related to X-ray was significantly reduced (p 0.001). CONCLUSION: Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. WHAT IS KNOWN: • The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidence suggest significant inaccuracy of X-ray compared to ultrasound. WHAT IS NEW: • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.

Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta-analysis.

OBJECTIVES: We aim to define whether the timing of microaxial left ventricular assist device (IMLVAD) implantation might impact on mortality in acute myocardial infarction (AMI) cardiogenic shock (CS) patients who underwent primary percutaneous coronary intervention (PPCI). BACKGROUND: Despite the widespread use of PPCI, mortality in patients with AMI and CS remains high. Mechanical circulatory support is a promising bridge to recovery strategy, but evidence on its benefit is still inconclusive and the optimal timing of its utilization remains poorly explored. METHODS: We compared clinical outcomes of upstream IMLVAD use before PPCI versus bailout use after PPCI in patients with AMI CS. A systematic review and meta-analysis of studies comparing the two strategies were performed. Effect size was reported as odds ratio (OR) using bailout as reference group and a random effect model was used. Study-level risk estimates were pooled through the generic inverse variance method (random effect model). RESULTS: A total of 11 observational studies were identified, including a pooled population of 6759 AMI-CS patients. Compared with a bailout approach, upstream IMLVAD was associated with significant reduction of 30-day (OR = 0.65; 95% confidence interval [CI] = 0.51-0.82; I2 = 43%, adjusted OR = 0.54; 95% CI = 0.37-0.59; I2 = 3%, test for subgroup difference p = 0.30), 6-month (OR = 0.51; 95% CI = 0.27-0.96; I2 = 66%), and 1-year (OR = 0.56; 95% CI = 0.39-0.79; I2 = 0%) all-cause mortality. Incidence of access-related bleeding, acute limb ischemia and transfusion outcomes were similar between the two strategies. CONCLUSION: In patients with AMI-CS undergoing PPCI, upstream IMLVAD was associated with reduced early and midterm all-cause mortality when compared with a bailout strategy.

Adverse Drug Reactions of Acetaminophen and Ibuprofen in the Paediatric Population: Analysis of the Italian Spontaneous Reporting Database.

BACKGROUND: Acetaminophen and ibuprofen are the only antipyretics drugs approved in children, and are considered safe and well tolerated. However, data regarding the adverse drug reaction (ADR) profile of these drugs in children are scattered. AIM: The aim of our study is to evaluate the ADRs of acetaminophen and ibuprofen through an observational study over a period of 15 years (January 2005-April 2020). Reports of suspected ADRs to the active substances 'acetaminophen' and 'ibuprofen' are listed and accessible through the Italian spontaneous reporting database (RAM system) by AIFA (Pharmacovigilance of the Italian Drug Agency). METHODS: Acetaminophen ADRs in paediatric populations were 15% of cases, with more frequent involvement of skin and soft tissue (54.36%) and gastrointestinal apparatus (44.09%); liver dysfunction accounts for 5.67%. RESULTS: Ibuprofen paediatric ADRs were 26%: skin and soft tissues in 63.16% of cases, gastrointestinal tract in 47.75%, hematemesis and melena in 6.38%; kidney injury in 2.25% of cases. CONCLUSION: Children aged 2 to 11 are more frequently affected by ADRs than infants and adolescents. The risk of gastrointestinal and renal side effects is significantly higher with ibuprofen. Hepatobiliary side effects are more frequently linked to acetaminophen. Potentially fatal ADRs have been reported sporadically for both drugs.

Factors for heterogeneous outcomes of angina and myocardial ischemia without obstructive coronary atherosclerosis.

BACKGROUND AND OBJECTIVES: The absence of obstructive coronary artery disease (CAD) in patients with angina is common, but its prognosis is debated. We investigated outcomes of such patients to identify predictors of cardiovascular events. METHODS: We selected 1014 patients with angina, evidence of myocardial ischemia at the electrocardiogram (ECG) exercise test or imaging stress tests, and nonobstructive CAD (absence of lumen diameter reduction ≥50%) at coronary angiography between 1999 and 2015. Note that, 1905 age- and risk factors-matched asymptomatic subjects served as "real-world" comparators. The primary endpoint was the occurrence of all-cause death or myocardial infarction. RESULTS: At 6-years median follow-up (interquartile range, 3-9 years), the primary endpoint occurred in 53 patients (5.5%, 0.92/100 person-years). Besides similar event rates compared with asymptomatic subjects (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.62-1.15, p = 0.28), the index population showed a very heterogeneous prognosis. Patients with nonobstructive CAD (HR 1.85, 95% CI 1.02-3.37, p = 0.04, compared with "normal" coronary arteries) and ischemia at imaging tests (HR 2.11, 95% CI 1.07-4.14, p = 0.03, compared with ischemia detected only at the ECG exercise test) were at higher risk and those with both these components showing even >10-fold event rates as compared with the absence of both. Three-hundred and twenty-five patients (34%) continued to experience angina, 69 (7.2%) underwent repeat coronary angiography, and 14 (1.5%) had consequent coronary revascularization for atherosclerosis progression. CONCLUSION: Apart from the impaired quality of life, angina without obstructive CAD has an overall benign but very heterogeneous prognosis. Nonobstructive CAD and myocardial ischemia at imaging tests both confer a higher risk.

Effects of a short, intensive, multi-session tDCS treatment in developmental dyslexia: Preliminary results of a sham-controlled randomized clinical trial.

Developmental Dyslexia (DD) significantly interferes with academic, personal, social and emotional functioning. Nevertheless, established therapeutic options are still scarce. Research has begun to emerge studying the potential action of transcranial direct current stimulation (tDCS) for ameliorating reading. However, there are still open questions regarding the most suitable tDCS protocol in young with DD. The current study tested the effectiveness of a short, intensive and multi-session tDCS protocol and presented preliminary data from a randomized sham-controlled crossover trial. Twenty-seven children and adolescents with DD were randomly assigned to active tDCS or sham tDCS. Active tDCS group received five daily-consecutive sessions of left anodal/right cathodal set at 1mA for 20min over parieto-occipital regions. Reading measures, including text, high frequency word, low frequency word and non-word lists, were recorded before, immediately after the treatment and 1-week later. We found that only the active tDCS group ameliorated non-word reading speed immediately after and 1-week later the end of the treatment compared to the baseline. Some suggestions for the development of future tDCS protocols in children and adolescents with DD are given.

A Prospective, observational, Italian multi-center registry of self-aPposing® cOronary Stents in patients presenting with ST-segment Elevation Myocardial InfarcTION: The iPOSITION registry.

BACKGROUND: Primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) can be challenging for high thrombus burden and catecholamine-induced vasoconstriction. The Xposition-S stent was designed to prevent stent undersizing and minimize strut malapposition. We evaluated 1-year clinical outcomes of a nitinol, self-apposing®, sirolimus-eluting stent, pre-mounted on a novel balloon delivery system, in de novo lesions of patients presenting with STEMI undergoing pPCI. METHODS: The iPOSITION is a prospective, multicenter, post-market, observational study. The primary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death, recurrent target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). RESULTS: The study enrolled 247 STEMI patients from 7 Italian centers. Both device and procedural success occurred in 99.2% of patients, without any death, TV-MI, TLR, or stent thrombosis during the hospital stay and at 30-day follow-up. At 1 year, TLF occurred in 2.6%, cardiac death occurred in 1.7%, TV-MI occurred in 0.4%, and TLR in 0.4% of patients. The 1-year stent thrombosis rate was 0.4%. CONCLUSIONS: The use of an X-position S self-apposing® stent is feasible in STEMI pPCI, with excellent post-procedural results and 1-year outcomes.

The 'dreaded PFO': anatomical and functional features of high risk for stroke.

Patent foramen ovale (PFO) has a high prevalence in general population and can be implicated in cryptogenic stroke among young people. Recent trials have shown that transcatheter PFO closure is superior to medical treatment in the secondary prevention of ischaemic stroke. The benefit in the reduction of stroke recurrence is particularly evident in patients who have documentation of a PFO with high-risk characteristics. Therefore, after the assessment of a clear causal relationship with the event, a thoughtful documentation of anatomic (height, length, presence of an aneurysmatic or a floppy atrial septum, a prominent Eustachian valve or Chiari's network, an acute angle with the inferior vena cava) and functional high-risk characteristics is mandatory.

Management of pain in newborn circumcision: a systematic review.

Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known: • Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods. • A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New: • The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches. • We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.

Upfront triple oral combination therapy including selexipag in a high-risk patient with idiopathic pulmonary arterial hypertension: a case report.

BACKGROUND: Selexipag is an oral selective prostacyclin IP receptor agonist approved in patients with low- and intermediate-risk pulmonary hypertension (PH); evidence in patients at high risk is lacking. CASE SUMMARY: A 42-year-old woman with worsening dyspnoea (World Health Organization functional class III-IV) and suspected PH at echocardiographic examination was evaluated in our Pulmonary Hypertension Centre. Right heart catheterization showed pre-capillary PH with reduced cardiac index and increased pulmonary vascular resistance. High-resolution computed tomography excluded parenchymal lung disease and ventilation/perfusion (V/Q) lung scan was negative for mismatched perfusion defects so the conclusive diagnosis was high-risk idiopathic pulmonary arterial hypertension (PAH). The patient refused an initial combination therapy including a parenteral prostacyclin analogue (PCA) in accordance with the ESC/ERS guidelines, so an off-label triple oral combination therapy including a phosphodiesterase-5 inhibitor, an endothelin receptor antagonist, and selexipag was started. At 3- and 6-month follow-up we found a clinical and haemodynamic improvement, so the patient was reclassified as low risk. Her clinical condition is currently stable. DISCUSSION: Despite the benefit of parenteral PCAs in high-risk PAH, low adherence to treatment may be explained by adverse side effects related to the intravenous route of administration. Given the potential effect seen in our patient, upfront triple oral combination therapy in PAH high-risk patients should be further evaluated in a controlled clinical trial.