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AimsLeft ventricular remodelling occurs during the chronic course of aortic regurgitation (AR) and aortic stenosis (AS), leading to myocardial hypertrophy and fibrosis. Several studies have shown that extracellular volume fraction (ECV) and indexed extracellular volume (iECV) are important surrogate markers of diffuse myocardial fibrosis (MF). Postoperative data on these cardiovascular magnetic resonance (CMR) extracellular expansion parameters for either AS or AR are scarce. This study aimed to demonstrate the postoperative changes that occur in diffuse MF, and the influence of preoperative MF on the reversal of LV remodelling, in patients with AR or AS.Methods and resultsPatients with severe AR or AS and indications for surgery were prospectively enrolled. Patients underwent pre- and postoperative CMR, and ECV and iECV were quantified. Data from 99 patients were analysed (32 with AR and 67 with AS). After surgery, the left ventricle mass index decreased in both groups (AR: 110 vs. 91 g/m2; AS: 86 vs. 68 g/m2, both P < 0.001). The late gadolinium enhancement fraction (AR: preoperative 1.9% vs. postoperative 1.7%, P = 0.575; AS: preoperative 2.4% vs. postoperative 2.4%, P = 0.615) and late gadolinium enhancement mass (AR: preoperative 3.8 g vs. postoperative 2.5 g, P = 0.635; AS: preoperative 3.4 g vs. postoperative 3.5 g, P = 0.575) remained stable in both groups. Preoperative iECV and ECV were greater in the AR group (iECV: 30 mL/m2 vs. 22 mL/m2, P = 0.001; ECV: 28.4% vs. 27.2%, P = 0.048). Indexed extracellular volume decreased after surgery in both groups (AR: 30–26.5 mL/m2, AS: 22–18.2 mL/m2, both P < 0.001); it was still greater in the AR group (AR: 26.5 mL/m2 vs. AS: 18.2 mL/m2, P < 0.001). Postoperative ECV remained stable in the AR group (preoperative 28.4% vs. postoperative 29.9%; P = 0.617) and increased in the AS group (preoperative 27.2% vs. postoperative 28.6%; P = 0.033).ConclusionPatients with both AR or AS presented reduction in iECV after surgery, unfolding the reversible nature of diffuse MF. In contrast to patients with AS, those with AR developed postoperative iECV regression with stable ECV, suggesting a balanced reduction in both intracellular and extracellular myocardial components.

Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional “endocarditis team” is essential to achieve favorable clinical outcomes in such defiant scenarios.

1. Introducao Atualmente, ha grande variedade de estrategias intervencionistas – tanto transcateter, quanto cirurgicas – que podem ser indicadas para pacientes portadores de valvopatia cardiaca, com objetivo de reducao da morbimortalidade associada a esta doenca. O correto momento de indicacao e o tipo de tratamento intervencionista estao atrelados ao preciso diagnostico anatomico e funcional da valvopatia cardiaca e a uma minuciosa avaliacao global do paciente. Estas Diretrizes Brasileira de Valvopatias de 2020, alem da compilacao de evidencias cientificas e opiniao [...]

Resumo Fundamento A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. Objetivo Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. Métodos Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. Resultados RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). Conclusões A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

Background: Heart failure occurs in ~10% of patients with acute rheumatic fever (RF), and several studies have shown that cardiac decompensation in RF results primarily from valvular disease and is not due to primary myocarditis. However, the literature on this topic is scarce, and a recent case series has shown that recurrent RF can cause ventricular dysfunction even in the absence of valvular heart disease.Methods: The present study evaluated the clinical, laboratory and imaging characteristics of 25 consecutive patients with a clinical diagnosis of myocarditis confirmed by 18F-FDG PET/CT or gallium-67 cardiac scintigraphy and RF reactivation according to the revised Jones Criteria. Patients underwent three sequential echocardiograms at (1) baseline, (2) during myocarditis and (3) post corticosteroid treatment. Patients were divided according to the presence (Group 1) or absence (Group 2) of reduced left ventricular ejection fraction (LVEF) during myocarditis episodes.Results: The median age was 42 (17–51) years, 64% of patients were older than 40 years, and 64% were women. Between Group 1 (n = 16) and in Group 2 (n = 9), there were no demographic, echocardiographic or laboratory differences except for NYHA III/IV heart failure (Group 1: 100.0% vs. Group 2: 50.0%; p = 0.012) and LVEF (30 [25–37] vs. 56 [49–62]%, respectively; p < 0.001), as expected. Group 1 patients showed a significant reduction in LVEF during carditis with further improvement after treatment. There was no correlation between LVEF and valvular dysfunction during myocarditis. Among all patients, 19 (76%) underwent 18F-FDG PET/CT, with a positive scan in 68.4%, and 21 (84%) underwent gallium-67 cardiac scintigraphy, with positive uptake in 95.2%, there was no difference between these groups.Conclusion: Myocarditis due to rheumatic fever reactivation can cause left ventricular dysfunction despite valvular disease, and it is reversible after corticosteroid treatment.

Introduction: Aortic stenosis (AS) and aortic regurgitation (AR) patients develop myocardial remodeling characterized by hypertrophia and fibrosis. Cardiac magnetic resonance (CMR) imaging can detect the presence of replacement myocardial fibrosis, by using late gadolinium enhancement (LGE), and diffuse myocardial fibrosis, by using extracellular volume (ECV) based measures (relative - ECV fraction - and absolute - indexed ECV) calculated from T1 mapping. There are only few studies with AS patients and scarce data with AR patients showing an association between fibrosis and post-operative clinical outcomes. Hypothesis: There is an association between preoperative myocardial fibrosis measures and post-operative clinical outcomes in severe aortic valvular heart disease (VHD) patients submitted to surgical intervention. Methods: Patients with isolated severe AS or AR were prospectively recruited to be submitted to CMR before indicated surgery, including LGE and ECV measures quantifications. All patients were submitted to conventional surgery and were followed during post-operative period. Results: The study population included 99 patients, 67 with AS and 32 with AR. After a median post-operative follow up of 12.3 (3.2-24.4) months, the presence of LGE areas, found in 32 patients (32.3%), independently predicted post-operative combined events (global mortality or STS morbidity events or persistent NYHA functional class III-IV) during follow up in univariate and multivariate Cox regression analyses (HR 3.96, 95%CI 1.76-8.91, p Conclusions: Presence of replacement myocardial fibrosis, but not diffuse myocardial fibrosis, in preoperative CMR predicts post-operative combined clinical events in severe VHD patients submitted to surgery.

Introduction: Aortic stenosis (AS) and aortic regurgitation (AR) patients develop both myocardial hypertrophia and fibrosis. B-type natriuretic peptide (BNP) and troponin are biomarkers whose value in aortic valvular heart disease (VHD) remains controversial. Cardiac magnetic resonance (CMR) imaging can detect replacement myocardial fibrosis (MF) by using late gadolinium enhancement (LGE), and diffuse MF by using extracellular volume (ECV) based measures (relative - ECV fraction - and absolute - indexed ECV) calculated from T1 mapping. Data evaluating the relationship of these biomarkers with both types of MF are scarce in AS, and are missing in AR patients. Hypothesis: There is an association between preoperative BNP and troponin and preoperative MF measures in severe aortic VHD patients. Methods: Patients with isolated severe AS or AR were prospectively recruited to be submitted to CMR before surgery, including LGE and ECV measures quantifications. They also collected blood samples for quantification of BNP and high sensitivity T troponin. The relationship between biomarkers and MF parameters was evaluated using linear regression and nonparametric conventional tests. Results: The study population included 99 patients, 67 with AS and 32 with AR. BNP median was 63 (39-103) pg/mL and troponin median was 17 (5-34) ng/L, no difference between AS and AR (p=0.31 and p=0.88, respectively). BNP and troponin were associated with presence of LGE. BNP median was 47 (32-87) pg/mL without LGE vs. 87 (47-190) pg/mL with LGE (p=0.002). Troponin median was 13 (5-25) ng/L without LGE vs. 30 (10-71) ng/L with LGE (p=0.001). Regarding ECV measures, patients with ECV fraction higher than 28.25% had higher BNP levels (p2 had higher troponin levels (p=0.015) (Figure 1). Conclusions: BNP and troponin are associated with quantity of MF in patients with severe aortic VHD with indication of intervention.

The bicuspid aortic valve (BAV) affects 0.5 to 2% of the population and is associated with valve and aortic alterations. There is a lack of studies on the profile of these patients in the Brazilian population.To describe the profile of patients with BAV undergoing valve and/or aortic surgery in a tertiary cardiology center, in addition to the outcomes related to the intervention.Retrospective cohort including 195 patients (mean age 54±14 years, 73.8% male) diagnosed with BAV who underwent surgical approach (valvular and/or aorta) from 2014 to 2019. Clinical data, echocardiographic and tomographic studies were evaluated, as well as characteristics of the intervention and events in 30 days. A value of p0.05 was considered statistically significant.We found a high prevalence of aortic aneurysm (56.5%), with a mean diameter of 46.9±10.2 mm. Major aortic regurgitation was found in 25.1% and major aortic stenosis in 54.9%. Isolated aortic valve surgery was performed in 48.2%, isolated aortic surgery in 6.7% and combined surgery in 45.1%. The 30-day mortality was 8.2%. In the multivariate analysis, the predictors of the combined outcome at 30 days (death, atrial fibrillation and reoperation) were age (OR 1.044, 95% CI 1.009-1.081, p=0.014) and left ventricular mass index (OR 1.009, 95% CI 1.000-1.018, p=0.044).Patients with BAV approached in our service have a higher incidence of aortopathy, with the additional need to evaluate the aorta with computed tomography or magnetic resonance imaging.A válvula aórtica bicúspide (VAB) atinge de 0,5 a 2% da população e está associada a alterações valvares e de aorta. Há carência de estudos sobre o perfil desses pacientes na população brasileira.Descrever o perfil de pacientes com VAB submetidos à cirurgia valvar e/ou de aorta em um centro cardiológico terciário, assim como os desfechos relacionados à intervenção.Coorte retrospectiva incluindo 195 pacientes (idade média 54±14 anos, 73,8% do sexo masculino) com diagnóstico de VAB submetidos à abordagem cirúrgica (valvar e/ou de aorta) no período de 2014 a 2019. Foram avaliados dados clínicos, ecocardiográficos e tomográficos, além das características da intervenção e eventos em 30 dias. O valor de p0,05 foi considerado estatisticamente significante.Encontramos alta prevalência de aneurisma de aorta (56,5%), com diâmetro médio de 46,9±10,2 mm. Insuficiência aórtica importante foi encontrada em 25,1% e estenose aórtica importante em 54,9%. Cirurgia isolada em valva aórtica foi realizada em 48,2%, cirurgia isolada de aorta em 6,7% e cirurgia combinada em 45,1%. A mortalidade em 30 dias foi de 8,2%. Na análise multivariada, os fatores preditores de desfecho combinado em 30 dias (morte, fibrilação atrial e reoperação) foram idade (OR 1,044, IC 95% 1,009-1,081, p=0,014) e o índice de massa do ventrículo esquerdo (OR 1,009, IC 95% 1,000-1,018, p=0,044).Pacientes com VAB abordados no nosso serviço apresentam uma maior incidência de aortopatia, com a necessidade adicional de avaliação da aorta com tomografia computadorizada ou ressonância magnética.

Background Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. Case presentation We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. Conclusions Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.

The emergence of the novel coronavirus has led to a global pandemic which has led to the airline industry facing severe losses. For air travel to recover, airlines need to ensure safe air travel. In this paper, the authors have modelled droplet dispersion after a single breath from an index patient. Computational Fluid Dynamics (CFD) simulations are conducted using the k-w SST turbulence model in ANSYS Fluent. The authors have taken into consideration several parameters such as the size of the mouth opening, the velocity of the cabin air as well as the number of droplets being exhaled by the index patient to ensure a realistic simulation. Preliminary results indicate that after a duration of 20s, droplets from the index patient disperse within a 10 m2 cabin area. About 75% of the droplets are found the disperse for up to 2m axially behind the index patient. This could possess an enhanced risk to passengers sitting behind the index patient. Ultimately, this paper provides an insight into the potential of CFD to visualise droplet dispersal and give impetus to ensuring necessary mitigating measures can be taken to reduce the risk of infection through droplet dispersal.

DAΦNE is a lepton collider working at the energy of the φ-meson resonance, it became operational in 2000. It provided data in consecutive data-taking periods for the KLOE, DEAR and FINUDA experiments until 2006. Since 2007 it implements a new interaction scheme, the so-called “Crab-Waist” collision scheme. It is the only machine that had successfully operated this collision scheme with and without large experiment with solenoids in 2009 with the SIDDHARTA experiment and between 2014 and 2018 with the KLOE-2 experiment, respectively. It will continue operating for PADME (just using the upgraded Linac) and for Siddharta-2 in 2019-2020. Currently only few accelerator test facilities exists: the ATF2 (KEK), a top-class facility designed for the development of the International Linear Collider, CLASSE(Cornell Laboratory for Accelerator-Based Science and Education), a centre of excellence in the development of accelerator technologies located in an university campus, and ANKA (Karlsruhe), devoted to R&D of machines and applied research. The proposal of DAΦNE as a test facility (DAΦNE-TF) for accelerator physics and technology development has been presented as an open call for ideas culminated in the organization of a topical workshop in December 2018. Several lines of technological research have been identified so far for DAΦNE-TF: i) Study of low SEY (Secondary Electron Yield) elements and impedances, graphitization of chambers and other surface treatment technologies; ii) New components for accelerators (vacuum chambers, collimators, masks, kickers) and innovative beam diagnostic techniques; iii) Accelerator components realized with 3D printers; iv) High power solid state RF amplifiers; v) Wide-excursion adjustable permanent magnets; vi) High-power positron sources; vii) Components for future SLED and pulse flatness compensation; viii) Emittance manipulators; ix) Beams interacting with amorphous materials, crystals, lasers, plasma; x) Testing new methods to generate terahertz coherent radiation. In this contribution, a selection of the different activities proposed during a dedicated workshop held in Frascati Laboratories in December 2018 will be summarized.

Introduction:Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings.Hypothesis:This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample.Methods:This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data.Results:The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout.Conclusions:These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered.

Maintenance of high-quality cardiopulmonary resuscitation (CPR) in refractory ventricular fibrillation (VF) and attempted treatment of the underline cause is associated with increased survival in prolonged cardiac arrest (CA). Thrombolysis targeting treatment of presumable acute myocardial infarction during CA, although plausible, is not routinely recommended. However, with the increase in technology to aid diagnosis during cardiac arrest, it is possible to more accurately infer patients who can benefit. This paper is a case report of a patient who presented an out-hospital subtle CA attended promptly by an alone rescuer. Due to geographical and communication conditions, the rescue system was not activated and the patient was transferred to the closer emergency department after 30 minutes of collapse by the rescuer's own means. The patient was resuscitated by a complete team in a satellite emergency unit and monitored with hand-free paddles. The rhythm was recurrent VF and there was rigorous CPR. The electrocardiogram filter showed ST-segment elevation in a short moment of sustained sinus rhythm. Intra-arrest thrombolytic therapy was performed after 25 minutes of in-hospital CA and immediate return to spontaneous circulation (ROSC) observed. Patient underwent cardiac catheterization with angioplasty of the anterior descending coronary and complete neurological recovery. This case report aims to demonstrate the possible effectiveness of thrombolysis during prolonged CA when ST-segment elevation myocardial infarction diagnosis is made by electrocardiogram filter. High-quality CPR and individualization with underlining cause treatment can promote ROSC, neurological recovery and discharge with good quality of life.

Background Few data exist on the degree of interstitial myocardial fibrosis in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS) and its association with left ventricular flow reserve (FR) on dobutamine stress echocardiography. This study sought to evaluate the diffuse interstitial fibrosis measured by T1 mapping cardiac magnetic resonance technique in LFLG-AS patients with and without FR. Methods Prospective study including 65 consecutive patients (41 LFLG-AS [mean age, 67.1±8.4 years; 83% men] and 24 high-gradient aortic stenosis used as controls) undergoing dobutamine stress echocardiography to assess FR and cardiac magnetic resonance to determine the extracellular volume (ECV) fraction of the myocardium, indexed ECV (iECV) to body surface area and late gadolinium enhancement. Results Interstitial myocardial fibrosis measured by iECV was higher in patients with LFLG-AS with and without FR as compared with high-gradient aortic stenosis (35.25±9.75 versus 32.93±11.00 versus 21.19±6.47 mL/m 2 , respectively; P P =0.950 and P =0.701, respectively). Also, FR did not correlate significantly with ECV (r=−0.16, P =0.31) or iECV (r=0.11, P =0.51). Late gadolinium enhancement mass was also similar in patients with versus without FR but lower in high-gradient aortic stenosis (13.3±10.2 versus 10.5±7.5 versus 4.8±5.9 g, respectively; P =0.018). Conclusions Patients with LFLG-AS have higher ECV, iECV, and late gadolinium enhancement mass compared with high-gradient aortic stenosis. Moreover, among patients with LFLG-AS, the degree of myocardial fibrosis was similar in patients with versus those without FR. These findings suggest that diffuse myocardial fibrosis may not be the main factor responsible for the absence of FR in LFLG-AS patients.

After the successful completion of the SIDDHARTA experiment run with crab waist collisions, the electron- positron collider DA{\Phi}NE has started routine operations for the KLOE-2 detector. The new interaction region also exploits the crab waist collision scheme, but features certain complications including the experimental detector solenoid, compensating anti-solenoids, and tilted quadrupole magnets. We have performed simulations of the beam-beam collisions in the collider taking into account the real DA{\Phi}NE nonlinear lattice. In particular, we have evaluated the effect of crab waist sextupoles and beam-beam interactions on the DA{\Phi}NE dynamical aperture and energy acceptance, and estimated the luminosity that can be potentially achieved with and without crab waist sextupoles in the present working conditions. A numerical analysis has been performed in order to propose possible steps for further luminosity increase in DA{\Phi}NE such as a better working point choice, crab sextupole strength optimization, correction of the phase advance between the sextupoles and the interaction region. The proposed change of the e- ring working point was implemented and resulted in a significant performance increase., Comment: 5 pp

The Geomorphological Field Camp 2014 in the Castel di Sangro-Scontrone area is the result of geological and geomorphological teaching field work activities carried out in Central Italy by a group of 23 students attending the Structural Geomorphology and Applied Geomorphology courses (Master's Degree in Geological Science and Technology of the Università degli Studi ‘G. d'Annunzio’ Chieti-Pescara, Italy, Department of Engineering and Geology). The Field Camp 2014 was organized in May 2014, following regular classes held during the fall term. General activities for the field camp were developed over four main stages: (1) preliminary analysis of the regional geological and geomorphological setting of the area; (2) preliminary activities for the analysis of the local area (orography, hydrography and photogeology investigations, and geographical information system processing); (3) field work, focused on the analysis of a specific issue concerning structural geomorphology or applied geomorphology (e.g. landscape evolution, river channel change, landslide distribution, and flood hazard); and (4) post-field work production of the map. Finally, the fundamental role of field work in the analysis of landscape and in land management was outlined: indeed, the overall field camp enhanced the crucial role of field-based learning for young geomorphologists in order to acquire a strong sensitivity to geomorphological processes and landscape evolution.

The Quaternary Fucino basin in the central Apennines of Italy was struck by one of the strongest Italian earthquakes of the last millennium (1915, Mw 7.0). The Avezzano town, ~ 9.0 km away from the epicentre, was completely destroyed. In the surrounding area sizable coseismic surface deformation were catalogued, attesting the severity of earthquake, the proximity to the causative fault and the geological and geomorphological complexity of a basin filled by thick lacustrine sediments. The Avezzano area provides a case study to understand how shallow subsurface geology influences site effects in a deep Quaternary continental basin environment, thus being of potential interest for similar geologic contexts worldwide. Within the investigated area, different possible earthquake-induced effects can occur, such as a) stratigraphic amplifications in a wide range of resonance frequencies (from 0.4 to 15–20 Hz); b) liquefaction; c) coseismic surface faulting; d) basin-edge effects; and e) slope instability. We present and discuss results of basic seismic microzonation study (SM) of the Avezzano area, focusing on geologic constraints aimed at the reconstruction of the shallow subsurface geology, and associated potential for local seismic hazard. We adopted an interdisciplinary approach based on detailed geological-structural, geophysical and seismic analyses to investigate the seismic response of high-seismic risk area, such as the Avezzano town, given the urban and industrial expansion since the last century. We discuss methodological approaches and their uncertainties.

Motor imagery (M.I.) training has been widely used to enhance motor behavior. To characterize the neural foundations of its rehabilitative effects in a pathological population we studied twenty-two patients with rhizarthrosis, a chronic degenerative articular disease in which thumb-to-fingers opposition becomes difficult due to increasing pain while the brain is typically intact. Before and after surgery, patients underwent behavioral tests to measure pain and motor performance and fMRI measurements of brain motor activity.After surgery, the affected hand was immobilized, and patients were enrolled in a M.I. training. The sample was split in those who had a high compliance with the program of scheduled exercises (T+, average compliance: 84%) and those with low compliance (T−, average compliance: 20%; cut-off point: 55%). We found that more intense M.I. training counteracts the adverse effects of immobilization reducing pain and expediting motor recovery. fMRI data from the post-surgery session showed that T+ patients had decreased brain activation in the premotor cortex and the supplementary motor area (SMA); meanwhile, for the same movements, the T− patients exhibited a reversed pattern. Furthermore, in the post-surgery fMRI session, pain intensity was correlated with activity in the ipsilateral precentral gyrus and, notably, in the insular cortex, a node of the pain matrix.These findings indicate that the motor simulations of M.I. have a facilitative effect on recovery by cortical plasticity mechanisms and optimization of motor control, thereby establishing the rationale for incorporating the systematic use of M.I. into standard rehabilitation for the management of post-immobilization syndromes characteristic of hand surgery. Keywords: Mental imagery training, Trapeziometacarpal joint osteoarthritis, Rhizarthrosis, Brain plasticity

The KLOE-2 experiment at the INFN Laboratori Nazionali di Frascati (LNF) is currently taking data at the $e^+e^-$ DA$\Phi$NE collider which is implementing an innovative collision scheme based on a crab-waist configuration. An integrated luminosity of $\sim4$~fb$^{-1}$ has been already collected by KLOE-2, and $\geq 5$~fb$^{-1}$ is in total expected by Spring 2018. KLOE-2 represents the continuation of KLOE with an upgraded detector and an extended physics program which includes neutral kaon interferometry and test of discrete symmetries among the main topics. Entangled neutral kaon pairs produced at DA$\Phi$NE are a unique tool to test discrete symmetries and quantum coherence at the utmost sensitivity, in particular strongly motivating the experimental searches of possible CPT violating effects, which would constitute an unambiguous signal of a New Physics framework. The status of the latest ongoing analyses of KLOE/KLOE-2 data is reviewed. In particular a new preliminary measurement of the $K_S$ semileptonic charge asymmetry and related CPT tests are presented.

The human trapeziometacarpal (TMC) joint has a crucial evolutionary importance as it permits rotation and opposition of the thumb to the other fingers. In chronic TMC joint osteoarthritis (i.e., rhizarthrosis), this motor ability, essential for pinching, grasping, and manipulating objects, may become difficult or impossible due to intolerable pain. Here, we assess whether patients with rhizarthrosis show signs of abnormal brain representation of hand movements. To this end, we studied 35 patients with rhizarthrosis, affecting predominantly one of the two hands, and 35 healthy subjects who underwent both behavioural and fMRI measures of brain activity during overtly executed or imagined thumb-to-finger-opposition movements. The patients with rhizarthrosis were slower than controls both in motor execution and imagination. In the patients, correlation between the motor execution and imagination times was preserved, even though such correlation was less strong than in normal controls. The fMRI measures showed reduced activation in the hand primary motor and dorsal premotor cortex for the patients only during explicit movements. This was true for both hands, yet more so for the most affected hand. No significant differences were seen for the motor imagery task. These results show that an orthopaedic disorder that reduces patients’ motoric repertoire in the absence of any neurological impairment is sufficient to induce neurofunctional changes in the cortical representation of hand movements. The substantial preservation of motor imagery with its neural counterparts distinguishes the neurological patterns of rhizarthrosis from those of complete immobilization or amputation suggesting that motor imagery may be used to boost motor recovery in rhizarthrosis after surgical treatment.

Study Design:A retrospective, clinical, and radiographic study.Objective:To evaluate the clinical and radiologic outcome of patients treated for cervical spondylosis by anterior cervical discectomy and fusion with the plate-cage system (PCB).Summary of Background Data:Cervical spondylosis and its cl

The KLOE experiment at the phi-factory DA$\Phi$NE has measured the pion form factor in the range between 0.1 < M_{pipi}^2 < 0.85 GeV^2 using events taken at sqrt{s}= 1 GeV with a photon emitted at large polar angles in the initial state. This measurement extends the M_{pipi}^2 region covered by KLOE ISR measurements of the pion form factor down to the two pion production threshold. The value obtained in this measurement of the dipion contribution to the muon anomalous magnetic moment of \Delta a_mu^{pipi} = (478.5+-2.0_{stat}+-4.8_{syst}+-2.9_{theo}) 10^{-10} further confirms the discrepancy between the Standard Model evaluation for a_mu and the experimental value measured by the (g-2) collaboration at BNL.

Object Surgical decompression is the recommended treatment in patients with moderate to severe degenerative lumbar spinal stenosis (DLSS) in whom symptoms do not respond to conservative therapy. Multilevel disease, poor patient health, and advanced age are generally considered predictors of a poor outcome after surgery, essentially because of a surgical technique that has always been considered invasive and prone to causing postoperative instability. The authors present a minimally invasive surgical technique performed using a unilateral approach for lumbar decompression. Methods A retrospective study was conducted of data obtained in a consecutive series of 473 patients treated with unilateral microdecompression for DLSS over a 5-year period (2000–2004). Clinical outcome was measured using the Prolo Economic and Functional Scale and the visual analog scale (VAS). Radiological follow-up included dynamic x-ray films of the lumbar spine and, in some cases, computed tomography scans. Results Follow-up was completed in 374 (79.1%) of 473 patients—183 men and 191 women. A total of 520 levels were decompressed: 285 patients (76.2%) presented with single-level stenosis, 86 (22.9%) with two-level stenosis, and three (0.9%) with three-level stenosis. Three hundred twenty-nine patients (87.9%) experienced a clinical benefit, which was defined as neurological improvement in VAS and Prolo Scale scores. Only three patients (0.8%) reported suffering segmental instability at a treated level, but none required surgical stabilization, and all were successfully treated conservatively. Conclusions Evaluation of the results indicates that unilateral microdecompression of the lumbar spine offers a significant improvement for patients with DLSS, with a lower rate of complications.