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BACKGROUND: The benefits of exercise training in patients with chronic heart failure (CHF) are due to a combination of cardiac and peripheral adaptations. Separating these 2 components is normally impossible, except for patients implanted with total artificial heart (TAH), where cardiac adaptation cannot occur. METHODS AND RESULTS: We report the case of a patient implanted with a CardioWest-TAH who underwent a comprehensive strength and endurance training program and was evaluated by repeated peak cardiopulmonary exercise tests. The patient experienced a 24% increase of peak oxygen consumption and an improvement in recovery kinetics during the training period of 29 months. CONCLUSION: This unique situation of a patient with a TAH, and therefore a fixed peak cardiac output, allows us to isolate training-induced changes in the periphery, that suggest greater oxygen extraction and more efficient metabolic gas kinetics during the exercise and recovery phases. [ABSTRACT FROM AUTHOR]

Abstract: Rain–wind induced stay cable vibrations may occur at different cable eigenfrequencies. Therefore, external transverse dampers have to be designed for several target cable modes. The resulting modal damping ratios have to fulfil Irwin’s criterion for minimum Scruton number such that rain–wind induced vibrations can be excluded. For this situation, this paper presents a systematic and easy applicable design procedure for linear viscous dampers that respects Irwin’s criterion, minimizes the damper position and leads to almost minimum variance of the target modal damping ratios. Minimum damper position is preferable from the aesthetic point of view, and it minimizes the installation costs, reduces the damper support flexibility and thereby increases the damper efficiency. Minimum variance of the target modal damping ratios maximizes the safety against large amplitude vibrations due to the unpredictability of the predominant mode. [Copyright &y& Elsevier]

The introduction of radiological contrast media and intravenous (i.v.) urography in clinical diagnostics in the 1930s enabled the discovery of several diseases, including the medullary sponge kidney (MSK). MSK is a renal malformation characterized by cystic anomalies of precalyceal ducts, which is frequently associated with nephrocalcinosis and renal stones. Although it was first recognized by G Lenarduzzi in 1939, its thorough description was the result of the ante litteram multidisciplinary cooperation between a radiologist (Lenarduzzi), a urologist (Cacchi), and a pathologist (Ricci), all at the Padua University Hospital. These authors ‘established’ the paradigm for its diagnosis that is still used today. I.v. urography is the gold standard for the diagnosis of MSK, but as the technique is used less and less, there is a concrete possibility of this renal condition being forgotten in the future. Although the pathogenesis of MSK has yet to be elucidated, its association with different malformative conditions supports the idea that it is a developmental disorder. Recent findings suggest that MSK may be the consequence of a disruption of the ureteral-bud/metanephric-blastema interface.Kidney International (2006) 69, 663–670. doi:10.1038/sj.ki.5000035; published online 4 January 2006 [ABSTRACT FROM AUTHOR]

DCD heart procurement is an emerging strategy to expand cardiac donor pool, but the effect of prolonged warm ischemia times on heart transplant (HT) late outcomes is not clearly known. Uncontrolled cardiac arrest of the cardiac graft before DBD might be a useful model to assess post-transplant outcomes after prolonged warm ischemia. Aim of this study is to evaluate the impact of cardiac arrest before DBD on late clinical outcomes in HT recipients. We retrospectively analyzed and compared early and late outcomes of all subjects ≥18 years of age who underwent HT at our Center between November 1985-September 2022 and with cardiac arrest before DBD (Group 1) or without (Group 2). Of 990 enrolled HT within the study period, 104 (10.5%) (male 65, X age 36±2 years) were included in Group 1 (mean time of cardiac arrest 15.0±14.0 minutes, range 0.5-90.0 minutes, cardiac arrest >20 minutes in 19 cases). Group 1 was associated to donor age <50 years (p=0.023), h/o tobacco (p=0.006), alcohol (p=0.007) or substance abuse (p<0.001), suicide or multiple trauma-related death (p<0.001). It was not associated to EF <55% (p=0.367), coronary disease (p=0.922), valve disease (p=0.327) or a specific recipient gender or age. Cardiac arrest <20 and >20 minutes were not associated to increased 30-day mortality compared to Group 2 (8.7% vs 8.5%, p=0.613, and 5.3% vs 8.5%, p=0.816, respectively). At 37-year follow-up, we did not find any significant difference in terms of overall survival (p=0.259) or severe CAV (p=0.54) between the two groups (Figure 1). Cardiac arrest of the donor heart does not affect early and late mortality neither the risk of severe CAV. According to these data, cardiocirculatory arrest of the donor graft might not be a contraindication to its use for HT also at longer warm ischemia times before donation, confirming DCD HT as a potential source of donor hearts, with similar results to DBD also in the long-term. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: The effectiveness of any treatment depends not only on the choice of therapy, but also, to a large extent, on the patient''s active cooperation. Adherence to medical prescriptions and particularly to immunosuppressive therapy is crucial to prevent medical complications that negatively influence graft function and patient survival after organ transplantation. The aim of this study was to assess, among patients who underwent solid organ transplantation, nonadherent behaviors (NAB) to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions. Materials and methods: We evaluated patients who underwent solid organ transplantation from March 2008 to June 2009. All participants completed an anonymous 15-item questionnaire to assess NAB. Results: We enrolled 218 organ transplant patients: 103 liver, 50 kidney, 52 heart, and 13 lung. There were 152 men and the overall age was 52.2 ± 0.8 years (mean ± standard deviation [SD]) time from transplantation, 83.6 ± 4.5 months (mean ± SD). Overall 37.9%, 38.8%, and 12.8% of patients reported nonadherence to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions, respectively. Considering nonadherence to immunosuppressive therapy and to general prescriptions, the percentage of kidney transplant patients who referred NAB was significantly lower compared with other organ transplant patients (P = .008 and P = .04, respectively). Nonadherent patients to immunosuppressive therapy and to general medical prescriptions displayed a longer interval from transplantation compared with adherent patients (P = .02 and P = .03, respectively). Among patients nonadherent to the correct lifestyle, the rates of men and of patients with disability pension were significantly higher compared to adherent patients (P = .001 and P = .002, respectively). Conclusions: Poor adherence to medical prescriptions and to adequate lifestyle is common among organ transplant patients, especially those who have undergone liver transplantation. Psychoeducational interventions for transplanted patients and their families are needed to improve adherence. [Copyright &y& Elsevier]