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We present the first and only case, reported in literature, of a 67-years-old man with a mycotic aneurysm (MA) of the left posterior inferior cerebellar artery (PICA), caused by group B Streptococcus, that we surgically treated, performing neck aneurysm clipping, preserving patency of parent vessel. Moreover the peculiarity of this case is represented by the fact that the MA is originated from a tooth abscess, treated about two years before. To date, there have been only 10 cases of association between MA with either tooth pathologies or dental surgical procedures and our case is the only one originating from PICA. Therefore an extensive literature analysis was performed. Hence if we observe a patient with a fusiform aneurysm in posterior intracranial circulation and clinical history of fever and/or persistent neck swelling after dental pathologies, it is mandatory to consider the possibility of a MA, for a correct differential diagnosis. If the diagnosis is confirmed, it is necessary to research the origin of infection and to set the specific antibiotics therapy. [ABSTRACT FROM AUTHOR]

The importance of predictions of earthquake-induced pore water pressure has been widely recognized for reliable evaluations of strong-motion response of saturated soil. The build-up of excess pore water pressure, in fact, causes reduction in soil stiffness and strength, in some cases leading to liquefaction. Simplified predictive models in the literature are empirically based on the results of cyclic laboratory tests carried out in strain- or stress-controlled conditions. Most of such empirical models require, preliminarily, that the irregular earthquake load is reduced to an equivalent number of cycles of uniform shear stress, in order to reproduce the effect of a laboratory cyclic test. To avoid such conversion, rather complex and not always reliable, a stress-based model is here proposed that allows for the direct generalization of the cyclic test data to irregular stress histories. More realistic predictions should take into account also the dissipation and redistribution of pore pressure within a soil deposit, which can be effectively modelled using the one-dimensional theory of consolidation. The build-up and dissipation models have been incorporated in a program for 1D seismic response analyses in the time domain, in order to carry out coupled dynamic analyses in terms of effective stress. In this paper, after a brief recall of the proposed PWP model, the code performance will be verified with reference to a case history of a dyke damaged during the seismic sequence occurred in Emilia plain (Italy) in May, 2012. [ABSTRACT FROM AUTHOR]

Modelling of soil shear rupture due to an earthquake is not generally implemented in the common codes for 1D seismic response analysis. It requires the use of advanced plasticity-based constitutive models of soil, that are often neglected in practice. A good balance between simplicity and reliability can be achieved with methods based on simplified formulations of the mathematical equations and of the constitutive models. The paper presents a computer code based on this philosophy conceived, addressed and optimised to reliably model both the ‘transient’ seismic response (‘stick’ mode) and the permanent deformation mechanisms accounting for the coupled effects of deformability and strength (‘slip’ mode). The code can be adopted to evaluate the seismic performance of different geotechnical systems that can be reasonably approximated to a 1D problem. In the paper, the code is applied to model a soft-storey failure occurred in a framed structure heavily damaged during a strong-motion earthquake. [ABSTRACT FROM AUTHOR]

Objectives This study sought to investigate whether the beneficial impact of high-dose rosuvastatin against contrast-induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients varied in relation to baseline high-sensitivity C-reactive protein (hs-CRP) levels. Background High-dose rosuvastatin administered on admission has been shown to prevent CI-AKI and improve short- and mid-term clinical outcome in ACS patients. Methods All 504 statin-naïve ACS patients enrolled in the PRATO-ACS (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Acute Kidney Injury and Myocardial Damage in ACS Patients) study were stratified into baseline hs-CRP tertiles: <2.7 mg/l, ≥2.7 to <7.5 mg/l, and ≥7.5 mg/l. The primary endpoint was CI-AKI occurrence (creatinine ≥0.5 mg/dl or ≥25% above baseline within 72 h). Logistic regression models were used to evaluate the relationship between hs-CRP levels and effects of rosuvastatin. Results Patients with higher baseline hs-CRP values presented a significantly higher incidence of CI-AKI (5.4%, 8.7%, and 18.3% in the first, second, and third tertiles, respectively; p = 0.0001). The beneficial effect of rosuvastatin was markedly significant in the third hs-CRP tertile (odds ratio: 0.20; 95% confidence interval: 0.07 to 0.54; p = 0.002). Statin-treated patients in the third tertile presented a significantly lower rate of adverse events at 30 days (7.2% vs. 17.4%, p = 0.043) with a trend toward better outcome at 6 months (6.02% vs. 13.04%, p = 0.12). Conclusions High-dose rosuvastatin administered on admission appears to exert more effective kidney protection in ACS subjects with higher baseline hs-CRP levels resulting in better short- and mid-term clinical outcome. (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Nephropathy and Myocardial Damage in Patients With Acute Coronary Syndrome Undergoing Coronary Intervention [PRATO-ACS]; NCT01185938 ) [ABSTRACT FROM AUTHOR]

Background There is a strong correlation between adverse clinical events and peak values of myocardial necrosis markers in non–ST-elevation acute coronary syndrome patients. In this clinical setting, high-dose statin treatment exerts acute beneficial effects against renal and myocardial damage. The aim of this report was to evaluate if, on admission, high-dose rosuvastatin can exert cardioprotective effects when administered in addition to high-dose clopidogrel. Methods In the PRATO-ACS trial, 504 consecutive statin-naïve non–ST-elevation acute coronary syndrome patients scheduled for early invasive strategy and pretreated with high-dose clopidogrel were randomly assigned to rosuvastatin (40 mg on admission followed by 20 mg/d; statin group, n = 252) or no statin treatment (control group, n = 252). Serial myocardial biomarker samples were collected before and after angiography and/or percutaneous coronary intervention. The primary end point was the peak level of cardiac troponin I (cTnI) during the index event. Results Statin-treated patients presented median cTnI peak values similar to controls (3.9 [0.6-12.8] vs 3.5 [1.2-11.9] ng/mL, respectively; P = .60]; no differences were found between the 2 groups in cTnI and creatine kinase–MB values at any time point, in either preangiography and postangiography peak values or their cumulative release. In patients submitted to percutaneous coronary intervention, periprocedural myocardial infarction occurred in 8 (4.7%) of 171 statin-treated and 7 (4.3%) of 162 control patients ( P = .87). Conclusion In the PRATO-ACS trial, early high-dose rosuvastatin did not show cardioprotective effects when administered in addition to high-dose clopidogrel. [ABSTRACT FROM AUTHOR]

Carotid intima media thickness (CIMT) is frequently increased in hypertensive patients, correlated with blood pressure levels but clinical trials have evaluated the effect of different antihypertensive drugs on CIMT with contradictory results. Because of these conflicting results, our work aimed to address these questions by realizing a meta-analysis on all randomized controlled trials studying the effects of different antihypertensive products on the CIMT. Methods: We systematically reviewed all randomized controlled trials of antihypertensive treatment on CIMT. 29 trials were identified in three databases. We conducted a combined analysis of antihypertensive effects using the overall effect. Findings: A significant positive overall effect size on global comparison of CIMT with antihypertensive drugs compare to placebo was found using a random effect model (−0.08 [−0.13; −0.03]). Overall effect sizes were significant for ACE (−0.08 [−0.14; -0.02]) and beta blockers (−0.09 [−0.19; 0.05]) versus placebo. Data did not allow other comparison versus placebo. Significant and beneficial overall effect size was observed for Calcium antagonists compare to both ACE (0.37 [0.20; 0.54]) and Diuretics (−0.09 [−0.16; −0.02]). Significant and beneficial overall effect size was observed for AT1 compare to Beta blockers (0.61 [0.46; 0.77]). In subgroup analysis, significant and beneficial overall effect size was found both for low and high decrease in blood pressure, for baseline CIMT lower or equal than 0.82 in contrast with CIMT greater than 0.82 and for treatment duration less than 24 months in contrast with an increase in CIMT after 24 months. Interpretation: anti-hypertensive treatment is associated with a significant decrease of CIMT. Calcium channel blockers are the most effective treatment follow by ACE inhibitors. Standardization of the protocols of measurements of the CIMT is required to assess longterm effects of CIMT reduction on cardiovascular morbi-mortality. [Copyright &y& Elsevier]