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Background Identification of adequate landing zone for transcatheter pulmonary valve implantation (TPVI) is crucial to successfully treat an aneurysmatic native right ventricle outflow tract (RVOT); three-dimensional (3D) patient-tailored digital and physical printed models are available but their actual strengths and weaknesses still not well documented. The aim of the study was to tackle TPVI planning in the dysfunctional and borderline RVOT exploiting both digital and physical printed 3D patient-specific models. Methods Electrocardiographically gated computed tomography (CT) angiography was segmented and anatomical RVOT geometrical changes dynamically tracked throughout the cardiac cycle using in-house processing. A compliant 3D-printed model was manufactured from the diastolic rest phase to test in vitro the catheter-based procedure feasibility; results were compared against CT-derived in vivo measurements and the actual catheterization outcome. Results CT-gated analysis successfully quantified in vivo RVOT dynamic changes corroborating the feasibility of non-conventional pulmonary jailing percutaneous intervention. Clinicians used the 3D-printed model to test the steps of the jailing procedure; yet, the deformable 3D model printed at diastole underestimated the final implant dimensions obtained during cardiac catheterization by the same operators. Conclusions Multidisciplinary synergy between CT-gated analysis and pre-procedural tests on 3D-printed phantoms can help the interventional team to tackle complex TPVI procedures. To fully exploit 3D-printed models, adequate selection of the still frame to print and tuning of printing material properties is crucial and can be aided by 3D dynamic virtual models.

Percutaneous pulmonary valve implantation (PPVI) allows treatment of both pulmonary valve stenosis and regurgitation ([1][1]). Originally used only in stenotic conduits through Melody Transcatheter Pulmonary Valve (Medtronic, Minneapolis, Minnesota) implantation ([2][2]), with the advent of larger

The current study aims to perform a stochastic analysis on microturbine compact recuperators to evaluate the impact of uncertainties in design parameters on their cost and volume, by using two different probabilistic approaches: Monte Carlo (MC) and Response Sensitivity Analysis (RSA). These two methods have been developed in Matlab® and then coupled with CHEOPE (Compact Heat Exchanger Optimisation and Performance Evaluation) software, which allows to analyze two different types of recuperators, used in microturbine applications: the furnace-brazed plate-fin type and the welded primary surface type. This paper focuses on an analysis of plate-fin type recuperators, for which the cost function adopted was tuned and verified in a previous study. Three main parameters of the recuperator have been considered as uncertain: effectiveness, hot side and cold side pressure drops. The uncertainties associated with these three parameters are based on industrial knowledge. The aforementioned stochastic methods have been used to propagate such uncertainties on the relevant outputs, such as cost and volume, allowing us to evaluate the least expensive and the most compact recuperator among those analysed.

Background: We assessed levels of depression, anxiety, stress, anhedonia, somatization, psychological distress, sleep, and life quality in patients with mesial temporal lobe epilepsy (MTLE) after one year of containment measures started in Italy to stem the COVID-19 pandemic. Methods: We consecutively enrolled 51 patients with MTLE, administering an online survey that compared the year before and after the COVID-19 propagation. We analyzed clinical data (e.g., seizure frequency, life quality) and neuropsychological assessment through Somatic Symptom Scale-8 (SSS-8), Beck Depression Inventory (BDI-2), State-Trait Anxiety Inventory (STAI-Y), Depression, Anxiety and Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale (SHAPS), Impact of Event Scale-Revised (IES-R). The BDI-2 and STAI-Y scores were compared to those acquired in the same patients before the COVID-19 outbreak. Results: Comparing our population with MTLE before and after COVID-19 outbreak, we found a significant worsening in life quality (p = 0.03), SSS-8 (p = 0.001), BDI-2 (p = 0.032), and STAI-Y scores (p < 0.001). After one year of pandemic, 88.2% of patients obtained pathological scores at PSQI, 19.6% at SHAPS, 29.4% at IES-R. Reduction of life quality correlated with anxiety, depression, stress, and somatization. Higher levels of anhedonia correlated with stress, depression, and anxiety. Somatization correlated with depression, anxiety, and sleep quality. Distress levels correlated with anxiety, somatization, and depression. Conclusions: We demonstrated a significant worsening of depression, anxiety, life quality, and somatization in patients with MTLE after one year of COVID-19 beginning. Concomitantly, results suggest that the pandemic had a negative impact on sleep quality, psychological distress, and anhedonia, but not on epilepsy itself.

Introduction The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina. Objectives To determine the prevalence and relevant clinical characteristics of COPD in a representative sample. Material and methods We performed a cross-sectional study in a population of adults aged ≥40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV1/FVC ratio Results Of 4599 surveys and 3999 spirometries, 3469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4–15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34–43); stage 2: 52% (CI: 47–56); stage 3: 10% (CI: 7–13); and stage 4: 1% (CI: 0–2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47–56); B: 43% (CI: 39–48); C: 1% (CI: 0–2); D: 4% (CI: 2–6). The rate of underdiagnosis was 77.4% (CI: 73.7%–81.1%) and diagnostic error 60.7% (CI: 55.1%–66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50–59 years of age and 19.23 in those >80 years), male gender (OR 1.62; CI: 1.31–2), smoking (OR 1.95; CI: 1.49–2.54), low socioeconomic status (OR 1.33; CI: 1.02–1.73), and previous tuberculosis (OR 3.3; CI: 1.43–7.62). Conclusions We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error.

Resumen Introduccion La prevalencia de la enfermedad pulmonar obstructiva cronica (EPOC) en Argentina no habia sido estudiada. Objetivos Determinar la prevalencia de EPOC y rasgos clinicos relevantes en una muestra representativa. Material y metodos Estudio de corte transversal en poblacion ≥ 40 anos en 6 aglomerados urbanos seleccionada aleatoriamente mediante muestreo por conglomerados. Se aplico una encuesta estructurada y espirometrias pre y postbroncodilatador (PBD). Se definio EPOC en quienes presentaban un cociente FEV1/FVC PBD Resultados Se realizaron 4.599 encuestas y 3.999 espirometrias, de las cuales 3.469 fueron utiles (86,8%). La prevalencia de EPOC fue de 14,5% (IC: 13,4-15,7). La distribucion de los casos compatibles con EPOC segun FEV1 (GOLD-2017) fue: 1: 38% (IC: 34-43); 2: 52% (IC: 47-56); 3: 10% (IC: 7-13); y 4: 1% (IC: 0,-2) y de acuerdo al modelo combinado ABCD (GOLD 2017): A: 52% (IC: 47-56); B: 43% (IC: 39-48); C: 1% (IC: 0-2) y D: 4% (IC: 2-6). El subdiagnostico fue del 77,4% (IC 73,7-81,1%) y el error diagnostico de 60,7% (IC 55,1-66,3%). Encontramos asociacion significativa de presencia de EPOC con edad (OR 3,77 en 50-59 anos a 19,23 en > 80 anos), sexo masculino (OR: 1,62; IC: 1,31-2), tabaquismo (OR: 1,95; IC: 1,49-2,54), nivel socieconomico bajo (OR: 1,33; IC: 1,02-1,73) y antecedentes de tuberculosis (OR: 3,3; IC: 1,43-7,62). Conclusiones Se estima que mas de 2,3 millones de argentinos padecen EPOC con elevada tasa de subdiagnostico y error diagnostico.

Introduction Geographical variations may impact outcomes in chronic obstructive pulmonary disease (COPD). We evaluated differences in baseline characteristics and outcomes between patients enrolled in Latin America compared with the rest of the world (RoW) in the TIOtropium Safety and Performance In Respimat® (TIOSPIR®) trial. Methods TIOSPIR®, a 2–3-year, randomized, double-blind trial (n = 17 116; treated set), compared safety and efficacy of once-daily tiotropium Respimat® 5 and 2.5 μg with tiotropium HandiHaler® 18 μg. This post-hoc analysis pooled data from all treatment arms to assess mortality, exacerbations, cardiac events, and serious adverse events (SAEs) between both regions. Results At baseline, patients enrolled in Latin America (n = 1000) versus RoW (n = 16 116) were older, with higher pack-years of smoking history and more exacerbations, but less cardiac history. In this analysis, patients in Latin America versus RoW had an increased risk of death (hazard ratio [HR] [95% confidence interval (CI)]: 1.52 [1.24–1.86]; P Conclusions TIOSPIR® patients in Latin America had a higher risk of death or moderate-to-severe exacerbation, but a lower risk of severe exacerbation than those in RoW. Geographical differences may impact outcomes in COPD trials.

Computational approaches to detect the signals of adverse drug reactions are powerful tools to monitor the unattended effects that users experience and report, also preventing death and serious injury. They apply statistical indices to affirm the validity of adverse reactions reported by users. The methodologies that scan fixed duration intervals in the lifetime of drugs are among the most used. Here we present a method, called TEDAR, in which ranges of varying length are taken into account. TEDAR has the advantage to detect a greater number of true signals without significantly increasing the number of false positives, which are a major concern for this type of tools. Furthermore, early detection of signals is a key feature of methods to prevent the safety of the population. The results show that TEDAR detects adverse reactions many months earlier than methodologies based on a fixed interval length.

Study design Case report and review of literature. Objective To report a rare complication of anterior cervical decompression and fusion (ACDF) in a patient with severe cervical cord compression and review of relevant literature. Introduction The white cord syndrome is a very rare condition characterized by an ischemic-edematous lesion of the spinal cord following a surgical procedure, lacking intra o perioperative surgical or anesthesiological complications. Case report A 64-years old male affected by a severe cervical stenosis at multiple levels, with voluminous C3–C4 and C5–C6 disc herniations associated to T2-hyperintense myelomalacic area at C3–C4 level was admitted to our Unit of Neurosurgery in July 2015. A double-level anterior cervical decompression and fusion (ACDF) procedure was performed without intraoperative complications and, in the immediate post-operative period, the patient developed a severe motor weakness to four limbs. The post-operative cervical spine MRI revealed an extension of the hyperintensity on the C5–C6 level. In the immediate post-operative course high doses of dexamethasone were administered, in order to treat the secondary spinal damage. The patient was, after few days, transferred to a Rehabilitation Unit where a partial improvement of the motor weakness was gradually observed. We report the second case of this complication in Literature to support the theory of a possible reperfusion injury after a double ACDF. We speculate an ethiologic mechanism similar to a long-term no-reflow phenomenon, likely during the post-ischemic period in myocardial or cerebral infarction. Conclusions Despite the pathophysiology of non-reflow phenomenon is not widely known, we suspect that an improper blood flow after the double-level discectomy could have led to the changes in medullar hemodynamics.