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• The "Strain applied method" is proposed. • The method applies to finite-element plane-strain analyses. • The method allows the prediction of surface settlements induced by mechanised tunnelling. • The method includes "Predictive lines" particularly useful for Class A predictions. • The "Predictive lines" are calibrated for mechanized tunnelling in coarse-grained soils. The paper focuses on the prediction of tunnelling-induced settlements in greenfield conditions. The main components of ground deformation are investigated with approaches based on both empirical and numerical solutions. In particular, the study analyses five well documented case histories of shield-driven tunnels bored in coarse-grained soil deposits and compares the predicted and measured settlements. A specific approach for FEM-2D modelling of soil-shield interaction (called " Strain Applied Method ") has been implemented and its potential for the prediction of the settlement trough has been discussed. The analyses were performed for the green field conditions with the Finite Element software Plaxis. The mechanical behaviour of the soil has been modelled by both the usual linear elasto-plastic model (Mohr-Coulomb, MC) and the advanced Hardening Soil model with small strain stiffness (HSs). The comparison of results shows that the settlements calculated by the HSs model are generally in better agreement with the field measurements. Then, the analysis has been focused on the volume loss obtained for the five case histories, finding some significant correlations between volume loss and the specific parameters required by the proposed FEM-2D model. The predictive capabilities of the 2D model, with parameters estimated by specific correlations, were demonstrated by applying the proposed method for two new case histories, not included in the initial set utilized to find the correlations. [ABSTRACT FROM AUTHOR]

Mitral valve repair (MVr) combined with papillary muscle approximation (PMA) may improve repair durability in severe ischemic mitral regurgitation (MR), when compared with MVr alone. We sought to identify preoperative transthoracic echocardiographic markers associated with MR recurrence after MVr with PMA. A post-hoc analysis was performed on patients with severe ischemic MR who underwent coronary artery bypass graft surgery with MVr with PMA in the papillary muscle approximation randomized trial. The PMA was performed utilizing a 4-mm polytetrafluoroethylene graft placed around the papillary muscles. Linear regression analyses and receiver-operating characteristic curves were used to identify echocardiographic variables and diagnostic models associated with recurrent MR. There were 48 patients with a mean age of 63 ± 7 years, a left ventricular ejection fraction of 35% ± 5%, and a left ventricular end-diastolic diameter of 63 ± 3 mm. Of these, 37 patients had baseline and 5-year follow-up echocardiograms, with moderate-to-severe MR recurring in 27%. Linear regression analyses revealed associations between preoperative pulmonary artery systolic pressure (standardized beta coefficient, β = 0.49/mm Hg, p = 0.002), MV tenting area (β = 0.47/cm2, p = 0.004), a symmetric MV tethering pattern (β = 0.44, p = 0.007), and left ventricular end-diastolic diameter (β = 0.37/mm, p = 0.02) with follow-up MR grade. The presence of both MV tenting area 3.1 cm2 or greater (area under the curve 0.822) and left ventricular end-diastolic diameter of 64 mm or greater (area under the curve 0.801) was the most robust discriminative model for moderate-to-severe MR recurrence (specificity 92%, sensitivity 69%, area under the curve 0.804, p = 0.003). In patients undergoing coronary artery bypass graft surgery with MVr plus PMA, the extent of baseline MV apparatus and left ventricle geometric remodeling identifies patients at increased risk for MR recurrence. [ABSTRACT FROM AUTHOR]

In the Mediterranean ecosystem, wildfires are very frequent and the predicted future with a probable increase of fires could drastically modify the vegetation scenarios. Vegetation fires are an important source of gases and primary emissions of fine carbonaceous particles in the atmosphere. In this paper, we present gaseous and particulate emissions data from the combustion of different plant tissues (needles/leaves, branches and needle/leaf litter), obtained from one conifer ( Pinus halepensis ) and one deciduous broadleaf tree ( Quercus pubescens ). Both species are commonly found throughout the Mediterranean area, often subject to wildfires. Experiments were carried out in a combustion chamber continuously sampling emissions throughout the different phases of a fire (pre-ignition, flaming and smoldering). We identified and quantified 83 volatile organic compounds including important carcinogens that can affect human health. CO and CO 2 were the main gaseous species emitted, benzene and toluene were the dominant aromatic hydrocarbons, methyl-vinyl-ketone and methyl-ethyl-ketone were the most abundant measured oxygenated volatile organic compounds. CO 2 and methane emissions peaked during the flaming phase, while the peak of CO emissions occurred during the smoldering phase. Overall, needle/leaf combustion released a greater amount of volatile organic compounds into the atmosphere than the combustion of branches and litter. There were few differences between emissions from the combustion of the two tree species, except for some compounds. The combustion of P. halepensis released a great amount of monoterpenes as α-pinene, β-pinene, p-cymene, sabinene, 3-carene, terpinolene and camphene that are not emitted from the combustion of Q. pubescens . The combustion of branches showed the longest duration of flaming and peak of temperature. Data presented appear crucial for modeling with the intent of understanding the loss of C during different phases of fire and how different typologies of biomass can affect wildfires and their speciation emissions profile. [ABSTRACT FROM AUTHOR]

The paper discusses a method to assess the seismic performance of rock wedges in contact with arch-dam abutments based on the Newmark displacement approach, conveniently modified to include all possible three-dimensional failure mechanisms and forces transmitted by the structure. Under rigid-block and no-rotations assumptions, the method allows to consider the three components of the seismic input, the progressive detachment of the block from the supporting discontinuity planes, the possible recover of the contact, and the temporary complete detachment of the block from the rock mass. In addition to gravitational and seismic inertial actions, static and dynamic forces exerted at the dam-wedge contact, including those related to the inertial interaction with the reservoir, are included in the analyses. A case study is presented, referred to the seismic verification of the Ridracoli arch-gravity dam (Italy), founded on a marly-arenaceous formation. In particular, the right abutment is thoroughly investigated against wedge sliding involving bedding planes of particularly poor resistance. The results in terms of maximum wedge displacements are compared with the corresponding factor of safety obtained with a limit equilibrium approach, indicating that even a wedge resulting unstable with limit equilibrium analyses shows relatively small displacements at the end of the seismic excitement. [ABSTRACT FROM AUTHOR]

Norway spruce ( Picea abies ) is a strong emitter of biogenic volatile organic compounds (BVOCs). In the present study we investigated how shoot canopy position and high levels of stressors such as high temperature and ozone concentration, affect BVOC emission rates by means of in-situ and ex-situ experimental measurements. Therefore, BVOC emission from current-year spruce shoots was investigated under field and manipulated (temperature, ozone) laboratory conditions. Emitted BVOCs were sampled on desorption tubes, coupled with gas-exchange measurements of CO 2 assimilation rate and stomatal conductance, and detected by gas chromatography coupled with mass spectrometry. Total BVOC emission rates from sun shoots under standard conditions were higher than those from shade shoots, although this was significant only in July, on the contrary, only α-pinene and γ-terpinene emission rates showed significant differences between sun and shade acclimated shoots in August. Limonene , α-pinene , β-pinene , and myrcene were identified as the most abundant BVOCs in both campaigns with emission rates above 0.2 nmol m −2 s −1 . Ex-situ measurements revealed a significantly higher total BVOC emissions under high temperature level (40 °C) by ca. 175% as compared with standard temperature (30 °C), while a short-term fumigation of acute O 3 concentration (200 ppb) had no effect on BVOC emissions and its spectrum. These findings might have a relevance considering the role of these compounds in protecting against oxidative stress and their possible stimulation in particular stressful conditions. Implication of such results into emission models may contribute to a more accurate estimation of BVOC emissions for Central European mountain regions dominated by Norway spruce forests and their rate under predicted climate change. [ABSTRACT FROM AUTHOR]

Background: Guidelines recommend surgery for patients with severe ischemic mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular repair is associated with longer survival, but randomized studies are lacking.Objectives: This study sought to investigate the benefit of papillary muscle surgery on long-term clinical outcomes of patients with ischemic MR.Methods: Ninety-six patients with severe ischemic MR were randomized to either undersizing restrictive mitral annuloplasty (RA) or papillary muscle approximation with undersizing restrictive mitral annuloplasty (PMA) associated with complete surgical myocardial revascularization. The primary endpoint was change in left ventricular end-diastolic diameter (LVEDD) after 5 years, measured as the absolute difference from baseline, which was evaluated by paired Student t tests. Secondary endpoints included changes in echocardiographic parameters, overall mortality, the composite cardiac endpoint (major adverse cardiac and cerebrovascular events [MACCE]), and quality of life (QOL) during the 5-year follow-up.Results: At 5 years, mean LVEDD was 56.5 ± 5.7 mm with PMA versus 60.6 ± 4.6 mm with RA (mean change from baseline -5.8 ± 4.1 mm and -0.2 ± 2.3 mm, respectively; p < 0.001). Ejection fraction was 44.1 ± 6% in the PMA group versus 39.9 ± 3.9% in the RA group (mean change from baseline 8.8 ± 5.9% and 2.5 ± 4.3%, respectively; p < 0.001). There was no statistically significant difference in mortality at 5 years, but freedom from MACCE favored PMA in the last year of follow-up. PMA significantly reduced tenting height, tenting area, and interpapillary distance soon after surgery and for the long-term, and significantly lowered moderate-to-severe MR recurrence. No differences were found in QOL measures.Conclusions: Compared with RA only, PMA exerted a long-term beneficial effect on left ventricular remodeling and more effectively restored the mitral valve geometric configuration in ischemic MR, which improved long-term cardiac outcomes, but did not produce differences in overall mortality and QOL. [ABSTRACT FROM AUTHOR]

Biomass burning is an important ecological factor in the Mediterranean ecosystem and a significant source of several atmospheric gases and particles. This paper demonstrates the performance of a recently developed combustion chamber, showing its capability in estimating the emission from wildland fire through a case study with dried leaf litter of Quercus robur. The combustion chamber was equipped with a thermocouple, a high resolution balance, an epiradiometer, two different sampling lines to collect volatile organic compounds (VOCs) and particles, and a portable analyzer to measure carbon monoxide (CO) and carbon dioxide (CO2) emission. VOCs were determined by gas chromatography-mass spectrometry (GC-MS) after enrichment on adsorption traps, but also monitored on-line with a proton-transfer-reaction mass spectrometer (PTR-MS). Preliminary qualitative analyses of emissions from burning dried leaf litter of Q. robur found CO and CO2 as the main gaseous species emitted during the flaming and smoldering stages. Aromatic VOCs, such as benzene and toluene, were detected together with several oxygenated VOCs, like acetaldehyde and methanol. Moreover, a clear picture of the carbon balance during the biomass combustion was obtained with the chamber used. The combustion chamber will allow to distinguish the contribution of different plant tissues to the emissions occurring during different combustion phases. [ABSTRACT FROM AUTHOR]

Background context Recently, positive results in bracing patients with idiopathic scoliosis (IS) above 45° who refused surgery have been presented in a retrospective study. Obviously, this can give only an efficacy (EA) analysis, as there is neither a control group, nor it is possible to know failures because of dropouts. Purpose To present the prospective results of bracing patients affected by IS above 45° and still growing. Study design Prospective study including all IS patients with 45° or more, Risser stage 0 to 4, who had their first evaluation in our institute, an outpatient clinic specialized in scoliosis evaluation and conservative treatment, from March 1, 2003 to December 21, 2010 and utterly denied any surgical intervention. Patient sample Of 59 patients, we excluded 2 patients still in treatment and 57 (11 males) patients were included. At the beginning of the study, they were 15 years 3±22 months of age, had 52.5° Cobb (range, 45°-93°), and Risser 2 (0-4). Thirty-nine accepted a full-time brace treatment (BG) to try avoiding surgery, 18 refused any treatment and served as controls (CG). Outcome measures Physiological measures: radiographic and clinical data. Methods Treatment: A year of full-time Sforzesco brace (23 hours/day) or Risser cast (8-12 months) and gradual weaning after Risser 3; all patients performed exercises; and International Society on Scoliosis Orthopaedic and Rehabilitation Treatment management criteria were respected. Analyses: EA in patients who completed treatment/observation (34 in BG and 10 in CG) and intent-to-treat (ITT) with worst case analysis in the whole population. Relative risk (RR) and 95% confidence interval (CI) have been computed. Results Efficacy: failures were 23.5% in BG and 100% in CG. Intent-to-treat: failures were 20.5% in BG and 55.6% in CG. Relative risks of failure in CG were 4.3 (95% CI, 3.6-4.9) in EA and 2.7 (95% CI, 2.0-3.5) in ITT (p<.05). Percentage of patients (53.8%) improved: RRs of improvement in BG were 1.6 (95% CI, 1.46-1.9) in EA and 1.9 (95% CI, 1.6-2.2) in ITT (p<.05). Patients who joined the treatment achieved a 10.4°±10.7° Cobb improvement, an ATR reduction of 4.2°±4.3°, and an esthetic improvement of 2.8±1.9 of 12 points (TRACE). At the end, in BG, 24 patients were below 45° and 6 patients below 35°. Conclusions Through this study we can conclude that the conservative brace plus exercises treatment (if correctly performed and managed) is a suitable alternative for those patients who reject any surgical intervention for IS above 45°. But we could also conclude that a good brace treatment should be considered as the first choice to try avoiding fusion because of the high sanitary and social costs of surgery. [ABSTRACT FROM AUTHOR]

Abstract: Purpose.: Phospholipase activity, one of Helicobacter pylori pathogenicity factors, has not been investigated enough, so far, although it may induce a remarkable damage to the gastric mucosa. In the present work, we have compared the whole phospholipase activity of H. pylori strains isolated from patients with gastric carcinoma with that of strains isolated from dyspeptic patients without gastric carcinoma. Methods.: We measured the phospholipase activity of one distinct H. pylori colony isolated from each of 10 patients with gastric carcinoma and 10 controls, dyspeptic patients without endoscopic and histological signs of gastric carcinoma. We also determined the phospholipase activity of 20 additional strains isolated from different areas of neoplastic and non-neoplastic tissue of two patients with gastric carcinoma, the cagA and vacA positive G27 and 328 wild strains and their respective vacA and cagA negative isogenic mutants. The whole phospholipase activity of strains was determined by measuring the release of 14C-labeled palmitic acid from the radioactive l-3-phosphatidylcholine, 1,2-di[1-14C]palmiloyl substrate; results were expressed in pmol of palmitic acid per mg of protein. Results.: H. pylori strains isolated from patients with gastric carcinoma had levels of phospholipase activity significantly higher than those of strains isolated from controls (99.37 [S.D. 40.45] versus 34.46 [S.D. 16.46], P <0.001). In patients with gastric carcinoma, the mean phospholipase activity of strains isolated from neoplastic tissue was similar to that of strains isolated from non-neoplastic tissues (123.02 [S.D. 44.36] and 115.77 [S.D. 81.48], respectively. Interruption of cagA gene caused a ca. 20% reduction of phospholipase activity (36.38 versus 45.22 of the wild strain); that of vacA caused no reduction of phospholipase activity (26.53 and 25.37 of the wild strain). Conclusions.: The infection by H. pylori strains that produce high levels of phospholipase may increase the risk of developing gastric carcinoma. We hypothesise that indirect products of phospholipase activity, such as prostaglandins, leukotrienes and lysophospholipids, may mediate carcinogenesis. [Copyright &y& Elsevier]

Menadione is selectively toxic to erythrocytes. Although GSH is considered a primary target of menadione, intraerythrocyte thiolic alterations consequent to menadione exposure are only partially known. In this study alterations of GSH and protein thiols (PSH) and their relationship with methemoglobin formation were investigated in human and rat red blood cells (RBC) exposed to menadione. In both erythrocyte types, menadione caused a marked increase in methemoglobin associated with GSH depletion and increased oxygen consumption. However, in human RBC, GSH formed a conjugate with menadione, whereas, in rat RBC it was converted to GSSG, concomitantly with a loss of protein thiols (corresponding to menadione arylation), and an increase in glutathione–protein mixed disulfides (GS–SP). Such differences were related to the presence of highly reactive cysteines, which characterize rat hemoglobin (cys β125). In spite of the greater thiol oxidation in rat than in human RBC, methemoglobin formation and the rate of oxygen consumption elicited by menadione in both species were rather similar. Moreover, in repeated experiments under N2 or CO-blocked heme, it was found that menadione conjugation (arylation) in both species was not dependent on the presence of oxygen or the status of heme. Therefore, we assumed that GSH (human RBC) and protein (rat RBC) arylation was equally responsible for increased oxygen consumption and Hb oxidation. Moreover, thiol oxidation of rat RBC was strictly related to methemoglobin formation. [Copyright &y& Elsevier]

Abstract Purpose Recently an increase in radiosurgery treatments for multiple metastases has been observed. Traditionally these lesions were treated using one isocenter for each target and the patient had to be shifted during a single session for repositioning.The implementation of single-isocenter volumetric modulated arc therapy (VMAT) radiosurgery technique for multiple intracranial lesions allows a significant reduction of treatment times, as well as enhancing accuracy by reducing the potential intrafraction motion [1]. Methods For 20 patients treated with VMAT for multiple brain metastases we have analyzed the treatment process. Each case had different number and distribution of metastases. We performed a CT simulation scan with 1.25 mm thickness slice for all patients. The simulation images were registered with a MR in order to define the targets. For each case we compared the VMAT single-isocenter technique plan with the sums of the plans of every single lesion. Plans were evaluated using Dose Volume Histograms, Conformity and Uniformity Indexes. All the plans were optimized with 6 MV flattened filter free arcs. Set up checks were performed using both BrainLAB ExacTrac and Varian Cone Beam CT (CBCT). For 10 patients we also evaluated the intrafraction motion. Results No significant difference was detected between the two techniques. The single-isocenter technique comes out better for the dose distributions especially for low doses. We discovered a good agreement between ExacTrac and CBCT and a minimum intrafraction movement (<1 mm) which was dosimetrically insignificant also for peripheral lesions. We underline a very significant reduction of treatment times. Conclusions Both methods achieve good dosimetric results. Single-isocenter VMAT radiosurgery treatment for multiple metastases is a faster technique and could be performed safely using image guided radiotherapy treatment thus relieving patient discomfort. [ABSTRACT FROM AUTHOR]

Abstract Objective The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. Methods From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. Results Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. Conclusions Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD. [ABSTRACT FROM AUTHOR]

Objective The symmetry of mitral valve tethering and regional left ventricle wall dysfunction are reported to play a fundamental role in the outcomes and long-term durability of surgical repair in ischemic mitral regurgitation (IMR). We recently demonstrated in a randomized clinical trial (the Papillary Muscle Approximation trial) the superiority of papillary muscle approximation (PMA) in combination with standard restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in terms of adverse left ventricular remodeling and mitral regurgitation (MR) recurrence. This approach, however, failed to produce a survival advantage and was still plagued by a high incidence of reoperation. We therefore performed a subanalysis of the PMA trial on the basis of preoperative parameters to elucidate the value of subvalvular surgery in certain subcategories of patients with the aim of creating a decisional algorithm on the best operative strategy. Methods We performed a subanalysis of PMA trial, evaluating 96 patients with severe IMR and eligible for myocardial revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48) in association with coronary artery bypass grafting. Endpoints included left ventricular remodeling, MR recurrence, overall mortality, reoperation, and a composite cardiac endpoint (cardiac death, stroke, reintervention, hospitalization for heart failure, or New York Heart Association class worsening). Stratification variables were preoperative symmetry of mitral valve tethering and regional wall motion abnormality. Results PMA improved ventricular remodeling and recurrence of MR in both preoperative symmetric and asymmetric tethering and in case of inferior wall dyskinesia but did not produce an additional benefit in anterolateral wall dysfunction. Conclusions Preoperative symmetric and asymmetric tethering and isolated inferior wall dyskinesia are an indication for subvalvular apparatus surgery in IMR. [ABSTRACT FROM AUTHOR]

A recent study suggests a correlation between idiopathic scoliosis in adolescence and eating disorders. However, this does not correspond with our clinical experience in the same population. The aim of this study was to verify the correlation between scoliosis and eating disorders in adolescence. A cross-sectional study was designed including 187 consecutive adolescent girls with a diagnosis of idiopathic scoliosis (mean Cobb angle 26°, range 11–73°, age 15.2±2.5; 24% juveniles, 76% adolescent type) and 93 schoolgirls as controls (age 14.9±1.0). All of the participants answered the Italian validated questionnaire EAT-26 about eating habits in order to identify any eating disorders. Body mass index (BMI) was calculated for all participants and compared to reference data. Statistical Analysis: chi-square test, Student''s t-test, Pearson''s correlation coefficient. Only 3 (1.6%; 95% CI −0.2–3.4%) participants in the scoliosis group showed EAT-26 scores suggestive for eating disorders versus 7 (7.5%; 95% CI 2.2–12.9%) in the school population (p <0.05). The BMI was slightly lower (p <0.05) for scoliosis patients (19±0.2) than for school girls (21±0.3). EAT-26 is recognized among the most valid questionnaires for eating disorders and has been widely applied in various countries. By applying this questionnaire, a lower incidence of eating disorders in female scoliosis patients was found than in the general population (using both our own controls and Italian reference values). This contrasts with some expert opinions and a recent study performed in Italy. The low BMI already reported in the literature as being typical of scoliosis participants is confirmed by our data. [Copyright &y& Elsevier]

Poster: RTT track: Imaging acquisition and registration, OAR and target definition PO-1847: ART in prostate cancer: how to use an offline approach with daily CBCT and deformable registration L. Capone, F. Cavallo, F. Lusini, D. Di Minico, B. Nardiello, N. Leonardo, P. Gentile. [Extracted from the article]

Management of preoperative antiplatelet therapy in coronary artery bypass grafting (CABG) is variable among surgeons: guidelines collide with prejudices because replacement of aspirin with low-molecular-weight heparin is still performed because of a presumed minor bleeding risk. This study aims to analyze postoperative bleedings and complications in patients scheduled for elective primary isolated on-pump CABG, depending on preoperative aspirin treatment or its replacement with enoxaparin. In this cohort study, we propensity score matched 200 patients in whom aspirin was stopped at least 5 days before CABG and replaced with enoxaparin and 200 patients who continued aspirin therapy until the day before surgery. Postoperative bleedings and complications were monitored during hospitalization. Among patients who continued aspirin treatment, mean overall bleeding was 701.0 ± 334.6 ml, whereas in the matched enoxaparin group, it was significantly greater (882.6 ± 64.6 ml, p value <0.001); this was associated with reduced postoperative complications, lower values of postoperative C-reactive protein in aspirin takers, and a presumed protective effect for statins. After propensity score adjustment, aspirin treatment carried a protective effect against major postoperative bleeding (odds ratio 0.312, p = 0.001). In conclusion, postoperative bleeding is reduced in patients who continued aspirin, likely due to a reduction in postoperative inflammation. The practice of empirically discontinuing aspirin and replacing it with enoxaparin before CABG should be abandoned. Patients with coronary artery disease referred to CABG should continue antiplatelet medications until the surgical procedure. Those results might be extended to patients under oral anticoagulant therapy requiring CABG. [ABSTRACT FROM AUTHOR]

Background In patients with ischemic mitral regurgitation, leaflet prolapse requires an accurate evaluation since surgical approach depends on valvular and subvalvular characteristics. This study aims to describe a cohort of patients over a long-term follow up, analyzing survival, reoperation and predictive factors of surgical outcomes. Methods and results From March 1994 to June 2011, 75 patients with ischemic mitral regurgitation and leaflet prolapse underwent surgical myocardial revascularization and mitral valve repair (90.7%) or replacement (9.3%). Our cohort was followed up until April 2015, with a mean follow up of 7 ± 3 years. Cardiac-related deaths occurred in 26 patients, with a mean survival of 114.2 months, including eight patients with in-hospital mortality. Reoperation was performed in 14 patients, due to valve repair failure. Twenty-six patients experienced moderate-to-severe mitral regurgitation. A preoperative LVEDD > 62 mm, LVESD > 52 mm, previous anteroseptal myocardial infarction, diffuse coronary artery disease, papillary anatomy type 1, partial rupture of the papillary muscle, A1-A2 scallop prolapse and postoperative mitral valve configuration (tenting area, tenting height, alfa-1 angle and alfa-2 angle) were identified as independent predictors of poor outcome. An index quantifying the stress on the annulus imparted by annuloplasty was elaborated and predicted endpoints. Conclusion Leaflet prolapse is an important entity in patients with ischemic mitral regurgitation, and its pathogenic mechanism mostly relies on papillary muscle lesion or elongation. Perioperative parameters describing geometric features of left ventricle, valvular and subvalvular components should be considered to provide a tailored approach for mitral valve repair, or to opt for immediate replacement in case of unfavorable geometry. [ABSTRACT FROM AUTHOR]

Abstract: Background: Advanced glycation endproducts (AGEs) and its receptors (RAGEs) are heterogeneous signaling proteins associated to diabetes and responsible of endothelial alterations leading to atherosclerosis progression and graft failure. The aim of this study was to investigate the role of statin in reducing AGEs related endothelial damage. Methods: Endothelial cell(EC) obtained from leftovers of saphenous vein grafts of non-diabetic patients were incubated with AGEs (2 and 20μM) and subsequently treated with Simvastatin. Neutrophils (PNM) adherence, ROS production and RAGE and peroxisome proliferator-activated receptors-gamma (PPAR-γ) expression were analyzed. As clinical validation of the in vitro findings, ECs of diabetic patients in optimized glycaemic control administered with a 3weeks Simvastatin regimen were similarly processed. Results: Simvastatin blunted the rise in PMN adhesion and ROS generation following stimulation of saphenous vein EC culture with AGEs in vitro. This effect was time dependent and was associated to an increase in PPAR-γ induction paralleled by a decrease in RAGEs expression. Parallely, data from diabetic patients administered with Simvastatin showed a similar significant reduction in PNM adhesion and ROS generation. Simvastatin treatment significantly decreased RAGEs expression in ECs from diabetic patients and determined a slight increase in PPAR-γ expression but the latter failed to reach statistical significance. Interference in the function of these two crucial pathways might be at the root of the statin antinflammatory and antithrombotic effect in the context of AGEs-associated damage. Conclusions: Despite the recently raised warning on the use of statins in the diabetic population, this study elucidates their cornerstone position in endothelial homeostasis of saphenous grafts in patients with controlled diabetes. [Copyright &y& Elsevier]

Abstract: Background: Molecular mechanisms underlying abdominal aneurysm (AAA) formation and rupture are not well understood. Early detection and repair of AAA may reduce the high mortality rates associated with rupture. Serum proteomics allows the detection of alterations in the expression of proteins, guiding further studies on these target molecules as potential markers. Analysis of proteomic profile of asymptomatic patients with AAA allows the identification of reliable predictors or markers of disease presence or progression. Methods: A proteomics approach based on two-dimensional electrophoresis and mass spectrometry was used to compare serum proteomic profiles of patients with AAA who are candidates for surgical repair compared with healthy controls. We analyzed in parallel the proteomic profile of subjects with cardiac heart failure to discriminate these two pathologies, which show similar pattern of systemic inflammation process. Results: We identified in AAA subjects four serum proteins that show altered expression profile and that could be specifically linked to AAA pathology. We discuss the role of our identified proteins with their possible implications in disease outcome. Conclusions: This approach could provide an initial screening tool that may drive the basis for further research in the field of cardiovascular diseases. These results need to be validated in larger studies to find potential markers of AAA presence or progression to use in clinical settings. Summary: A proteomics approach was used to compare serum proteomic profiles of patients with abdominal aortic aneurysm who are candidates for surgical repair compared with healthy controls. Four serum proteins showed altered expression profile that could be correlated with the pathology. This approach could provide an initial screening tool that may drive the basis for further research in the field of cardiovascular diseases. [Copyright &y& Elsevier]

Abstract: Background: Abnormal erythrocyte deformability can cause severe complications during cardiopulmonary bypass (CPB) surgery, including both hemolysis and perfusion abnormalities. Objectives: The goals of this study were to evaluate changes in erythrocyte membrane fluidity and lipid peroxidation during CPB and to examine the effect of simvastatin treatment on these parameters. Methods: Patients undergoing cardiac surgery involving CPB were selected and randomized to receive either simvastatin 40 mg/d or placebo for 3 weeks before surgery. Three blood samples were obtained at different times during surgery for analysis of erythrocyte membrane fluidity, anion permeability, and lipid peroxidation. Erythrocyte ghosts were prepared and incubated with a lipophilic fluorescent probe (diphenyl-hexatriene), and fluorescence anisotropy was evaluated by spectrophotofluorimetric assay as a measure of membrane fluidity. Anion permeability was evaluated by the specific absorption of methemoglobin (CM) at 590 and 635 nm after treatment of heparinized blood with NaNO2. The formation of thiobarbituric acid-reactive substances was evaluated as an index of lipid peroxidation. Aspartate transaminase and lactate dehydrogenase were also measured as indices of hemolysis. Results: Forty patients met the inclusion criteria (20 simvastatin, 20 placebo). Their characteristics differed significantly at baseline only in terms of the lipid profile; the statin group had higher levels of high-density lipoprotein cholesterol (P = 0.01) and lower levels of low-density lipoprotein cholesterol (P = 0.001) than the placebo group. CPB was found to significantly modify characteristics of the erythrocyte membrane. Compared with preoperative values, CPB induced decreases in both mean (SD) erythrocyte membrane fluidity and anion permeability (preoperative CM: 0.69 [0.02]; 24-hour postoperative CM: 0.18 [0.02]; P < 0.001) and an increase in mean (SD) membrane lipid peroxidation (preoperative malonyl dialdehyde [MDA]: 0.21 [0.01] nmol/mL; postoperative MDA: 0.10 [0.02] nmol/mL; P < 0.001). Treatment with simvastatin was associated with a significant reduction in mean (SD) membrane lipid peroxidation both preoperatively and at 24 hours postoperatively compared with placebo (preoperative MDA: 0.07 [0.01] vs 0.10 [0.02] nmol/mL, respectively; P < 0.05; postoperative MDA: 0.10 [0.04] vs 0.21 [0.01] nmol/mL; P < 0.05). In addition, statin treatment was associated with significant increases in anion permeability preoperatively and postoperatively compared with placebo (preoperative CM: 0.79 [0.01] vs 0.69 [0.02]; P < 0.01; 24-hour postoperative CM: 0.30 [0.01] vs 0.18 [0.02]; P < 0.01). Conclusion: The results of this study suggest that among these patients undergoing CPB surgery, use of simvastatin for 3 weeks before the surgery had significant beneficial effects on erythrocyte membrane fluidity, lipid peroxidation, and anion permeability. [Copyright &y& Elsevier]

Abstract: Background: Inhaled nitric oxide (iNO) is proposed in the management of pulmonary hypertension (PH) in patients undergoing cardiac surgery. Secondary PH related to a long-standing heart valve disease however may be refractory to iNO. Aim of this prospective study was to determine whether the combination of iNO plus dipyridamole (DP), a cyclic guanosine monophosphate-specific phosphodiesterase inhibitor (PDE5), may enhance and/or prolong the response to iNO in adult patients with secondary valve-related PH undergoing cardiac surgery, and attenuate rebound events related to its discontinuation. Methods: Responses in 27 patients, 11 male, mean age 72±11 years, with PH due to mitral and/or aortic valve disease, were studied in the Intensive Care Unit after cardiac surgery, during sedation and stable hemodynamic conditions. The effect of isolated iNO administration (40 ppm), iNO combined with DP (0.2 mg/kg i.v.), and DP alone (1 mg/kg/24 h) on pulmonary vascular resistance, mean pulmonary artery pressure, cardiac index, mixed venous O2Sat%, and mean arterial pressure were determined. Results: All patients showed at least a 10% decrease in pulmonary vascular resistance vs. baseline after administration of iNO [responders]. Inhaled NO and the combination of iNO/DP produced a reduction of pulmonary vascular resistance and mean pulmonary artery pressure (p&#60;0.05). Cardiac index improved with a significant difference between iNO and the association iNO/DP versus baseline (p&#60;0.05). This significant hemodynamic improvement versus baseline was maintained during isolated DP administration (p&#60;0.05), but not during isolated iNO discontinuation. Mixed venous oxygen saturation showed an overall improvement of 17% (p&#60;0.05). Conclusions: Inhaled NO and DP infusion might represent a valuable association in the management of PH secondary to a heart valve disease in patients undergoing cardiac surgery. Their beneficial hemodynamic effects might be particularly valuable in the management of patients with associated right ventricular dysfunction. [Copyright &y& Elsevier]

Poster: RTT track: Risk management/quality management PO-1943: Analysis of RT performance using quality indicators derived from automated treatment pathways L. Capone, D. Di Minico, B. Nardiello, F. Lusini, F. Cavallo, B. Tolu. [Extracted from the article]