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Introduction: Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy., Materials and Methods: This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023., Inclusion Criteria: patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse., Results: The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO 2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant., Conclusion: Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi., (© 2024 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.)

Squamous cell carcinoma of the head and neck (SCCHN) is among the ten most common cancers worldwide, with advanced SCCHN presenting with a 5-year survival of 34% in the case of nodal involvement and 8% in the case of metastatic disease. Disease-free survival at 2 years is 67% for stage II and 33% for stage III tumors, whereas 12-30% of patients undergo distant failures after curative treatment. Previous treatments often hinder the success of salvage surgery and/or reirradiation, while the standard of care for the majority of metastatic SCCHN remains palliative chemo- and immuno-therapy, with few patients eligible for locoregional treatments. The aim of this paper is to review the characteristics of recurrent SCCHN, based on different recurrence sites, and metastatic disease; we will also explore the possibilities not only of salvage surgery and reirradiation but also systemic therapy choices and locoregional treatment for metastatic SCCHN.

Background: Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce., Objective: The purpose of this study was to evaluate the impact of gaps within such a lesion set., Methods: We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg)., Results: Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05)., Conclusion: Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance., (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

The aim of this work was to collect occurrence data on chemical contaminants in rye-wheat bread marketed in Poland and subsequently estimate the risk due to dietary exposure to those chemicals for different population age groups in Poland. The choice of the food matrix has been driven by the fact that bread is an important component of the diet of Poles. Therefore, the collection of data on this staple food might be of interest form a public health perspective. The analytes under investigation belong to different categories: process contaminants (acrylamide), mycotoxins (deoxynivalenol, deoxynivalenol-3-glucoside, nivalenol and nivalenol-3-glucoside) and environmental contaminants (aluminium, arsenic, cadmium, chromium, lead and nickel). The activities presented in this technical report have been carried out in the frame of the European Food Risk Assessment (EU-FORA) Fellowship Programme. The objective of the fellowship is to provide middle-early career scientists with new skills and knowledge on food risk assessment. This goal is pursued through a hands-on experience in a competent organisation active in fields within EFSA's mission. In this case, the work programme has been implemented at the Department of Food Safety and Chemical Analysis of the State Research Institute of Agriculture and Food Biotechnology Prof. Wacław Dąbrowski (IBPRS-PIB), located in Warsaw, Poland. A significant part of the research work consisted in the implementation of different analytical techniques to collect occurrence data that were subsequently combined with consumption data retrieved from the EFSA Comprehensive European Food Consumption Database to assess the exposure and characterise the risk. Finally, an attempt has been made to identify uncertainties and evaluate their impact on results., (© 2022 Wiley‐VCH Verlag GmbH & Co. KgaA on behalf of the European Food Safety Authority.)

Introduction: Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion., Methods and Results: The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients., Conclusion: VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins., (© 2022 Wiley Periodicals LLC.)

Background: An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics., Objective: The purpose of this study was to describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage., Methods: Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage >0.5 mV during high-density 3-dimensional mapping were studied., Results: Sinus node exits varied among patients along a lateral oblique arc extending from the anterior aspect of the superior vena cava (SVC) to the mid-posterior wall of the right atrium (RA). Conduction slowing or block at one of the smooth components that faces the crista terminalis was observed in 54% of cases, including complete block at the SVC musculature and systemic venous sinus in 6% of cases. Depending on these 2 key features of RA activation, interatrial conduction was mediated by the Bachmann bundle (64%) and posterior bundles (54%), with an overlap of the resulting left atrial breakthrough location. Wavefront collision was consistently observed at 3 sites: the septal aspect of the cavotricuspid isthmus, and the lower aspects of the dome and of the mitral isthmus., Conclusion: During sinus rhythm, atrial activation occurs via distinct sequences mediated by a complex interaction of anatomic factors., (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the prevalence of esophageal and periesophageal thermal injury in patients undergoing radiofrequency (RF) atrial fibrillation (AF) ablation using 8 mm tip catheters during three different esophageal protection strategies., Methods: Forty-five consecutive patients with paroxysmal or persistent AF underwent first ablation procedure, besides esophagogastroduodenoscopy (EGD) combined with radial endosonography (EUS) performed before and after the pulmonary vein (PV) isolation. Before the procedure, patients were randomly assigned to one of three esophageal lesion protection strategies: group I-without any protective or monitoring dispositive and limiting RF applications to 30 W for 20 seconds, in left atrium posterior wall (LAPW); group II-power and time of RF delivery, up to 50 W for 20 seconds at LAPW, limited by esophageal temperature monitoring; group III-applications of RF in LAPW with fixed power application of 50 W for 20 seconds during continuous esophageal cooling., Results: Baseline characteristics of patients were similar in all groups. The four PVs were isolated in 14 (93.3%), 13 (86.7%), and 15 (100%) patients, respectively in groups I, II, and III. The mean RF power was significantly higher (P < .001) in the posterior side of PVs in group III. Post-AF ablation EGD and EUS revealed two esophageal wall ulcerations and two periesophageal mediastinal edemas only in the esophageal cooling group (P = .008)., Conclusion: Esophageal cooling balloon strategy resulted in a higher RF power energy delivery when ablating at the LA posterior wall, using 8 mm nonirrigated tip catheters under temperature mode control. Despite that, patients presented a relatively low incidence of esophageal and periesophaeal injuries., (© 2020 Wiley Periodicals, Inc.)

Background: Aging is associated with extensive and pervasive changes in cardiovascular structure and function, which may result in electrocardiographic alterations. The typical modifications seen in an electrocardiogram (ECG) in elders are: prolonged PR and QT intervals, QRS left-axis deviation and microvolt T wave. Several studies have included elderly people, but not long-living elderly and centenarians in particular who represent an increasing part of the population., Objective: The aim of this study was to investigate the electrocardiographic findings in a population of centenarians and to compare the results with the few studies present in the literature., Methods: We analyzed 42 healthy centenarians (12 males, 30 females; average age 101.43 ± 1.80 years) living in Messina, a municipality of Eastern Sicily, in Italy. They were clinically and functionally evaluated. All ECGs were analyzed by a single observer blind to clinical data. We assessed survival by phone recall., Results: PR interval mean duration was 190 ± 3.3 ms, QRS 90 ± 1.4 ms, QTc interval mean duration was 370 ± 3.5 ms. Entirely normal ECG recordings were found in 7 centenarians (16.6%). The most frequently observed abnormalities included left-axis deviation and left anterior hemiblock in 16 centenarians (38.09%), left ventricular hypertrophy and aspecific ST-T wave abnormalities in 13 subjects (30.95%). We found no statistically significant differences between men and women. The mean age at death was 102.44 ± 2.45, and we did not find significant differences in age at death in long-living elderly in relation to different electrocardiographic findings. Comparing our results with two previous studies in the literature, the first conducted in Switzerland [Cornu: Rev Med Suisse Rom 1979;99:107-113] and the second in Nebraska [Lakkireddy et al.: Am J Cardiol 2003;92:1249-1251], we found a higher frequency of left ventricular hypertrophy that was compatible with the prevalence of hypertension in our centenarians (33.3%). Moreover, we did not find left bundle branch block, and the frequency of premature beats was remarkably less than that observed in the Swiss and US studies., Conclusions: Considering the increasing rate of centenarians, we believe that the results of the present study on electrocardiographic changes in centenarians may also be useful in clinical practice., (Copyright © 2011 S. Karger AG, Basel.)

Background and Aims: Centenarians display a lower incidence of vascular ischemic events. A high platelet count and increased QT dispersion (QTd) represents a risk factor for cardiovascular events. The aim of this study was to evaluate platelet count and QTd in healthy centenarians and to establish correlations between these two indices., Methods: 16 healthy centenarians (4 males, 12 females, range 100-105 years) living in a municipality of Eastern Sicily, and 40 healthy control subjects, divided into two groups: group A (N=20), age range 45-65 years, 7 males, 13 females; and group B (N=20), range 65-85 years, 6 males, 14 females, were examined. Platelets were counted using a blood analyzer and QTd was measured in standard 12-lead electrocardiograms. Differences in platelet count were assessed by one-way analysis of variance (ANOVA) and the Bonferroni test. Correlation coefficients between platelet count and QTd were calculated with the Spearman rank test., Results: Centenarians showed a lower platelet count compared with controls, which was significant with respect to older controls, group B (p<0.05). QTd values did not significantly differ between centenarians and controls. A significant correlation between QTd and platelet count was evident in centenarians but not in controls. This correlation became evident in control subjects with a platelet count < or = 240,000/mm3., Conclusions: We hypothesize that a reduced number of platelets and the maintenance of normal QTd may contribute to extreme longevity and protect centenarians from cardiovascular events.

Recent evidence indicates that longevity may be achieved when efficient defence mechanisms against oxidative stress, infections, neoplasia, and cardiovascular events are preserved. Centenarians represent an example of "successful aging," and the aim of this study was to evaluate serum levels of vitamins A and E, which represent two important nonenzymatic antioxidant defence systems, and their correlation in 16 healthy centenarians and two groups of control subjects. Centenarians showed normal values of retinol (450.9 +/- 240.3 ng/mL) and alpha-tocopherol (9220.2 +/- 3410.9 ng/mL). Moreover, a significant direct correlation between the two vitamins was observed in centenarians (Rho = 0.715, p = 0.0056), such as in younger control subjects (Rho = 0.618, p = 0.0168), but not in older control subjects. We assume that the preservation of normal values and the correlation between vitamin A and E concentrations protects centenarians against oxidative stress and contributes to their extreme longevity.

Interleukin (IL)-18 is highly expressed in macrophages from human atherosclerotic plaques, suggesting its involvement in ischemic syndromes. We evaluated IL-18 and IL-18 binding protein (BP) in healthy centenarians, as longevity is characterized by a reduced incidence of ischemic events. For comparison, patients with chronic ischemic syndromes (CIS) were evaluated. Serum IL-18 and IL-18BP levels were measured by non-cross-reacting ELISA in 16 healthy centenarians and in two age-control populations, each of 18 healthy individuals aged 55.9+/-1.43 and 74.3+/-1.35, respectively, as well as in 23 CIS patients, and another cohort of 23 healthy subjects that were age- and sex-matched with CIS patients. Centenarians displayed significantly higher total IL-18 serum levels compared to each control group. Elevated IL-18 levels were also present in CIS patients. However, centenarians had a significant higher level of IL-18BP compared to the cohort of 23 controls (P=0.0014), and compared to CIS patients (P=0.043); as a result centenarians exhibited a lower level of free IL-18 than CIS patients. The present results indicate that quenching of IL-18 by IL-18BP may explain the apparent paradox of elevated serum IL-18 with no vascular signs in centenarians.

The authors present the results of 19 flexion osteotomies performed in cases of avascular necrosis of the femoral head and followed up after an average of 8 1/2 years. Significant clinical improvement was achieved in 85% of the patients. The radiographic picture is not quite as positive, but only 26% of the patients developed severe degenerative arthritis. The authors therefore consider this technique to be a valid alternative to immediate prosthetic replacement in selected patients.

Histologic findings of the bone-cement junction are presented for 10 implants in rabbits and 12 human specimens. Nondecalcified sections were made, employing embedding techniques that conserve the cement. Different time periods from operation were considered. The histological approach considers mainly the distribution of the osseous elements, with a description of the sites of new and old bone, of resorptive lacunae and of fibrous tissue. Fluorescent sequential labelling of bone tissue allowed a dynamic evaluation of the viability of bone after insertion of the cement. Histologic features may be summarized as follows: In the initial phase after PMMA implantation a zone of necrosis is present around the cement. In a second phase there is very active bone formation and remodelling in the tissue adjacent to the cement, with fibrous tissue formation. Long-term adaptive bone remodelling leads to extensive resorption of cortical bone and new bone formation producing a shell around the cement with new trabeculae radiating towards the cortex.