In the summer of 2016, extensive decline, and mortality of multiple species of Mediterranean shrubs and trees were recorded in a park in Athens (Greece). The progressive crown decline of shrubs and ...trees was occasionally associated with collar and stem bleeding cankers, and root necrosis.
Phytophthora nicotianae
was found to the responsible for such decline in the park. The possible drivers of this extensive decline were investigated and discussed with a specific focus on pathogen invasiveness and site invasibility. The pathogen was probably unintentionally introduced from commercial nurseries. Its spread was likely favored by intrinsic traits such as polyphagy, adaptation to warm climate, potential of recombination, and reproduction, long persistence of inoculum in the soil, which determine the high invasiveness in the Mediterranean climate. A multiple linear regression model was elaborated that evidenced a significant association of the level of inoculum in the plant beds with specific site traits such as total host richness and the quote of susceptible hosts. Furthermore, a multivariate model evidenced that specific host taxa were the drivers of inoculum build-up. Based on the results of the present study, the strategies to reduce the site invasibility by the polyphagous
P. nicotianae
without sensibly affecting the park’s ornamental value must consider the choice of plant taxa and their combination in the plant beds.
Background
A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA.
Methods
...A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with
p
-value, was used.
Results
In model A, gender (OR 2.04,
p
= 0.001), BMI (OR 1.07,
p
= 0.002), previous surgery (OR 1.29,
p
= 0.048), site (OR 21.8,
p
< 0.001) and size of the lesion (OR 1.16,
p
= 0.002), cumulative sum of procedures (OR 0.99,
p
< 0.001), extended (OR 26.72,
p
< 0.001) or associated procedures (OR 4.32,
p
= 0.015) increased the pOT. In model B, ASA (OR 2.86,
p
= 0.001), lesion size (OR 1.20,
p
= 0.005), and extended resection (OR 8.85,
p
= 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99,
p
< 0.001; OR 1.37,
p
= 0.007; OR 1.70,
p
< 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively.
Conclusion
A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course.
The efficacy of standard operating procedures (SOPs) for the decontamination of ambulances against SARS-CoV-2 has been debated. In Italy, the differential use of ambulances was implemented by ...regional health authorities, with selected vehicles being used exclusively for transporting COVID-19 patients. We investigated the presence of SARS-CoV-2 on high-touch surfaces in ambulances to assess contamination dynamics and the effectiveness of decontamination SOPs. Four high-touch surfaces were sampled before and after decontamination (T0; T1). The gloves of the EMS crew chief were also sampled. RNA extraction was performed with a commercial kit, followed by RT-qPCR molecular detection of SARS-CoV-2. A total of 11 transports were considered. Seven transports had at least one positive sample; all were related to a COVID-19 patient. Three of the negative transports had dealt with COVID-19 case, and one had dealt with a COVID-19-negative patient. One door handle and one oxygen knob were positive at T0, with negative T1 swabs. The monitors were positive in 5 transports at T0, yet they were never positive at T1. Three stretcher handles tested positive at T0, and two of them also at T1, possibly having bypassed decontamination during personnel dismounting. Gloves were contaminated in five transports, in which 1 to 3 additional samples (monitor, knob, stretcher) resulted as positive. Overall, the efficacy of decontamination SOPs was confirmed under the unprecedented conditions of the COVID-19 emergency. However, the importance of correct hand-hygiene and glove-disposal should be further emphasized through the dedicated training of EMS personnel.
The eastern coastline of the Gulf of Trieste (north-eastern Adriatic Sea, Italy) is characterized by the occurrence of coastal and submarine freshwater springs of karstic origin. In one of these ...areas, we performed a survey with a drone with a thermal camera installed, in tandem with in situ oceanographic sampling with a CTD. Drone images revealed a small time-space scale (i.e., up to a few meters) phenomenon of freshwater plumes floating over seawater. Comparing sea surface temperature data with those acquired in situ revealed that the phenomenon was not clearly detectable by the classical oceanographic monitoring, this surface spring freshwater layer being too thin. Instead, the drone’s thermal camera detected these dynamics with great accuracy, indicating that aerial drones can be efficiently used for studying fine-scale events involving surface waters (e.g., spills/pollution). The experience gained allowed us to discuss some of the advantages and disadvantages of using drone thermal imaging for monitoring alongshore areas.
Introduction
Despite numerous ECG algorithms being developed to localize the site of manifest accessory pathways (AP), they often require stepwise multiple‐lead analysis with variable accuracy, ...limitations, and reproducibility. The study aimed to develop a single‐lead ECG algorithm incorporating the P‐Delta interval (PDI) as an adjunct criterion to discriminate between right and left manifest AP.
Methods
Consecutive WPW patients undergoing electrophysiological study (EPS) were retrospectively recruited and split into a derivation and validation group (1:1 ratio). Sinus rhythm ECG analysis in lead V1 was performed by three independent investigators blinded to the EPS results. Conventional ECG parameters and PDI were assessed through the global cohort.
Results
A total of 140 WPW patients were included (70 for each group). A score‐based, single‐lead ECG algorithm was developed through derivation analysis incorporating the PDI, R/S ratio, and QRS onset polarity in lead V1. The validation group analysis confirmed the proposed algorithm's high accuracy (95%), which was superior to the previous ones in predicting the AP side (p < 0.05). A score of ≤+1 was 96.5% accurate in predicting right AP while a score of ≥+2 was 92.5% accurate in predicting left AP. The new algorithm maintained optimal performance in specific subgroups of the global cohort showing an accuracy rate of 90%, 92%, and 96% in minimal pre‐excitation, posteroseptal AP, and pediatric patients, respectively.
Conclusions
A novel single‐lead ECG algorithm incorporating the PDI interval with previous conventional criteria showed high accuracy in differentiating right from left manifest AP comprising pediatric and minimal pre‐excitation subgroups in the current study.
The study ECG algorithm and main findings. The study ECG algorithm is shown incorporating the PDI with other conventional ECG criteria in lead V1 during sinus rhythm. The main study findings are presented on a LAO fluoroscopic projection with AP sites and the corresponding PDI (color scale) and new algorithm scores (numbers within white circles). AP, accessory pathway; CS, Coronary sinus; FVP, fasciculoventricular pathway; HB, His bundle; L, left; LA, left anterior; LAL, left anterolateral; LAO, left anterior oblique; LL, left lateral; LP, left posterior; LPL, left posterolateral; LPS, left posteroseptal; MCV, middle cardiac vein; ms, milliseconds; PDI, P‐Delta interval; R, right; RA, right anterior; RAL, right antero‐ateral; RAS, right anteroseptal; RL, right lateral; RMS, right midseptal; RP, right posterior; RPL, right posterolateral; RPS, right posteroseptal; SN, sinus node; SR, sinus rhythm; WPW, Wolff‐Parkinson‐White.
This study aimed to collect and analyze the literature data regarding Chiari network (CN) and other right atrium (RA) remnants comprising the Eustachian and Thebesian valves (EV, ThV) as a potential ...entrapment site during different percutaneous cardiac procedures (PCP).
A systematic search was conducted using Pubmed and Embase databases following the PRISMA guidelines to obtain available data concerning PCP associated with entrapment of inserted materials within CN-EV-ThV. The final analysis included 41 patients who underwent PCP with reported material entrapment within these RA remnants. The PCP was atrial septal defect (ASD)/patent foramen ovale (PFO) closure, catheter ablation, and pacemaker/defibrillator implantation in 44%, 22%, and 17% of patients, respectively. The entrapped materials were ASD/PFO devices, multipolar electrophysiology catheters, passive-fixation pacing leads, and J-guidewires in about 30%, 20%, 15%, and 10% of patients, respectively. Intraprocedural transthoracic, transoesophageal and intracardiac echocardiography showed sensitivity to reveal these structures of 20%, ∼95%, and 100%, respectively. A percutaneous approach successfully managed 70% of patients, while cardiovascular surgery was required in 20% and three patients died (7.3%).
CN and other RA remnants may cause entrapment of various devices or catheters during PCP requiring right heart access. The percutaneous approach, guided by intraprocedural imaging, appears safe and effective in managing most patients. Prevention includes recognizing these anatomical structures at baseline cardiac imaging and intraprocedural precautions. Further studies are needed to analyze the actual incidence of this condition, its clinical impact and appropriate management.
•Chiari network and Eustachian valve may cause catheter/device entrapment complicating percutaneous cardiac procedures.•Atrial septum devices, complex EP catheters, and tined pacing leads appear vulnerable.•Percutaneous approach is usually effective management but surgery may be required.•Prevention includes preprocedural recognition of these structures and intraprocedural precautions.
Following the spread of the infection from the new SARS-CoV2 coronavirus in March 2020, several surgical societies have released their recommendations to manage the implications of the COVID-19 ...pandemic for the daily clinical practice. The recommendations on emergency surgery have fueled a debate among surgeons on an international level.We maintain that laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis, even in the COVID-19 era. Moreover, since laparoscopic cholecystectomy is not more likely to spread the COVID-19 infection than open cholecystectomy, it must be organized in such a way as to be carried out safely even in the present situation, to guarantee the patient with the best outcomes that minimally invasive surgery has shown to have.
Abstract
The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by “bumping” during right‐heart catheterization. In the era of cardiac ...electrophysiology, catheter‐induced RBB block (CI‐RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre‐existing RBBB, the transient nature of CI‐RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI‐RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self‐limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI‐RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His‐Purkinje‐System, such as fasciculo‐ventricular pathways, bundle branch reentry, and right‐Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI‐RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates.
Objectives:
Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in ...the European Union.
Methods:
We compared the average values of estimated
R
t
before and after school reopening, identifying any significant increase with a one-sample
t
-test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in
R
t
for countries in the EU and to search for relationships between
R
t
before schools reopened and the average increase in
R
t
afterward.
Results:
The mean reproduction number increased in 16 out of 26 countries. The maximum increase in
R
t
was reached after a mean 28 days. We found a negative relationship between the
R
t
before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in
R
t
for the European Union was 23%.
Conclusion:
We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19.
Multiple myeloma, the second most common hematologic malignancy, frequently relapses because of chemotherapeutic resistance. Fibroblast growth factors (FGF) act as proangiogenic and mitogenic ...cytokines in multiple myeloma. Here, we demonstrate that the autocrine FGF/FGFR axis is essential for multiple myeloma cell survival and progression by protecting multiple myeloma cells from oxidative stress-induced apoptosis. In keeping with the hypothesis that the intracellular redox status can be a target for cancer therapy, FGF/FGFR blockade by FGF trapping or tyrosine kinase inhibitor impaired the growth and dissemination of multiple myeloma cells by inducing mitochondrial oxidative stress, DNA damage, and apoptotic cell death that were prevented by the antioxidant vitamin E or mitochondrial catalase overexpression. In addition, mitochondrial oxidative stress occurred as a consequence of proteasomal degradation of the c-Myc oncoprotein that led to glutathione depletion. Accordingly, expression of a proteasome-nondegradable c-Myc protein mutant was sufficient to avoid glutathione depletion and rescue the proapoptotic effects due to FGF blockade. These findings were confirmed on bortezomib-resistant multiple myeloma cells as well as on bone marrow-derived primary multiple myeloma cells from newly diagnosed and relapsed/refractory patients, including plasma cells bearing the t(4;14) translocation obtained from patients with high-risk multiple myeloma. Altogether, these findings dissect the mechanism by which the FGF/FGFR system plays a nonredundant role in multiple myeloma cell survival and disease progression, and indicate that FGF targeting may represent a therapeutic approach for patients with multiple myeloma with poor prognosis and advanced disease stage.
This study provides new insights into the mechanisms by which FGF antagonists promote multiple myeloma cell death. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/00/0/000/F1.large.jpg.
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