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Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient’s management, as early treatment improves the prognosis. Cardiovascular infections are difficult to diagnose on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices, while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. This chapter describes the main epidemiological, clinical, and diagnostic challenges in infective endocarditis and infections associated with cardiovascular implantable electronic devices, with particular regard to the role of WBC SPECT/CT and [18F]FDG PET/CT in each diagnostic algorithm. In addition, the needs of proper hybrid equipment, dedicated imaging acquisition protocols, specific expertise for imaging reading and imaging interpretations in this field are discussed, emphasizing the need of a specific reference framework within a cardiovascular multidisciplinary team approach.

The use of implantable medical devices has increased in “modern” medical and surgical practice, and the rate of their infections is variable, depending on the type of device and the population risk profile. The overall risk of device-related infection across the population is around 1%, but it might be significantly increased in specific populations as vulnerability to microbial pathogens increases in elderly, immuno-compromised, and hospitalized patients. Device-related infection results from the multifaceted interaction of bacterial, device, and host factor. Multiresistant nosocomial pathogens are the most common organisms colonizing the surface of devices, and a full understanding of how a biofilm formation is crucial to understand the pathogenesis of their infection and define the most suitable treatment. This chapter describes the most relevant implantable medical devices of interest to nuclear medicine and the corresponding diagnostic strategy for each of them with particular regard to the role of nuclear medicine procedure in the diagnostic algorithm.

This chapter reviews the methodological aspects of peripheral lymphoscintigraphy. Advantages and disadvantages of intradermal versus subcutaneous radiopharmaceutical administration and subfascial injections are discussed. The protocol currently used at our site for bicompartmental peripheral lymphoscintigraphy, enabling investigation of the deep lymphatic circulation first followed by evaluation of the superficial lymphatic circulation, is described. Imaging protocols for peripheral lymphoscintigraphy as well as for intracavitary lymph effusions with the most widely employed stress tests to enhance lymphatic flow are also reviewed. Interpretation and reporting by visual qualitative analysis and by semiquantitative evaluation are carefully reported and discussed. The basic concepts of imaging lymphatic circulation with PET/CT, PET/MR, CT, and indocyanine green are also presented and discussed.

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe.

The engine combustion network (ECN) Spray A is modelled using the Reynolds-averaged Navier-Stokes-transported probability density function (RANS-TPDF) approach to validate the application of a new multiple mapping conditioning (MMC) mixing model to multiphase reactive flows. The composition TPDF equations are solved using a Lagrangian stochastic approach and the spray is modelled with a discrete particle approach. The model is first validated under non-reacting conditions (at 900 K) using experimental mixture-fraction data. Reactive simulations are then performed for three different ambient temperatures (800, 900, 1100 K) and oxygen concentrations (13, 15, 21%) at an ambient density of 22.8 kg/m3. The MMC mixing model is compared with the interaction by exchange with the mean (IEM) mixing model. The ignition delay predictions are not sensitive to the mixing model and are predicted well by both the mixing models under all the tested ambient conditions. The IEM model overpredicts the flame lift-off length (FLOL) at high temperature and high oxygen conditions with a mixing constant Cφ=2. The MMC model with Cφ=2 and a target correlation coefficient rt=0.935 between the mixture fraction and a reference variable used to condition mixing predicts good FLOL under all the conditions except 800 K. It is demonstrated that the lift-off length is controllable by changing the target correlation coefficient, while Cφ and therefore the mixing fields are held fixed. In comparison to the MMC model, the IEM model predicts a higher variance of temperature conditioned on mixture fraction near the flame base owing to its lacking the property of localness. The mixing distance between the notional TPDF particles in the composition space is also higher with the IEM model and it is demonstrated that by changing rt, different levels of mixing locality can be achieved.

The restoring effect of selective agronomic strategies on optimal soil functionality of degraded areas within organic vineyard was evaluated using the nematode community as an indicator of soil quality. Three different restoring strategies were implemented in two organic farms located in Tuscany (Italy). The relative abundance of nematode trophic groups and the maturity index showed that the use of compost improved soil biological quality and increased the abundance of predators. Instead, dry mulching and green manure applications were useful to control the most dangerous nematodes of grapevines, namely the virus-vector Xiphinema index (Longidoridae).

The objective of this study is to evaluate conditional moment closure (CMC) approaches to model chemical reaction rates in compositionally stratified, autoigniting mixtures, in thermochemical conditions relevant to stratified charge compression ignition (SCCI) engines. First-order closure, second-order closure and double conditioning are evaluated and contrasted as options in comparison to a series of direct numerical simulations (DNSs). The two-dimensional (2D) DNS cases simulate ignitions in SCCI-like thermochemical conditions with compositionally stratified n-heptane/air mixtures in a constant volume. The cases feature two different levels of stratification with three mean temperatures in the negative-temperature coefficient (NTC) regime of ignition delay times. The first-order closure approach for reaction rates is first assessed using hybrid DNS-CMC a posteriori tests when implemented in an open source computational fluid dynamics (CFD) package known as OpenFOAMⓇ. The hybrid DNS-CMC a posteriori tests are not a full CMC but a DNS-CMC hybrid in that they compute the scalar and velocity fields at the DNS resolution, thus isolating the first-order reaction rate closure model as the main source of modelling error (as opposed to turbulence model, scalar probability density function model, and scalar dissipation rate model). The hybrid DNS-CMC a posteriori test reveals an excellent agreement between the model and DNS for the cases with low levels of stratification, whereas deviations from the DNS are observed in cases which exhibit high level of stratifications. The a priori analysis reveals that the reason for disagreement is failure of the first-order closure hypothesis in the model due to the high level of conditional fluctuations. Second-order and double conditioning approaches are then evaluated in a priori tests to determine the most promising path forwards in addressing higher levels of stratification. The a priori tests use the DNS data to compute the model t

Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country