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The genomic era has resulted in the generation of a massive amount of genetic data concerning the genomic diversity of bacterial taxa. As a result, the microbiological community is increasingly looking for ways to define reference bacterial strains to perform experiments that are representative of the entire bacterial species. Despite this, there is currently no established approach allowing a reliable identification of reference strains based on a comprehensive genomic, ecological, and functional context. In the current study, we developed a comprehensive multi-omics approach that will allow the identification of the optimal reference strains using the Bifidobacterium genus as test case. Strain tracking analysis based on 1664 shotgun metagenomics datasets of healthy infant faecal samples were employed to identify bifidobacterial strains suitable for in silico and in vitro analyses. Subsequently, an ad hoc bioinformatic tool was developed to screen local strain collections for the most suitable species-representative strain alternative. The here presented approach was validated using in vitro trials followed by metagenomics and metatranscriptomics analyses. Altogether, these results demonstrated the validity of the proposed model for reference strain selection, thus allowing improved in silico and in vitro investigations both in terms of cross-laboratory reproducibility and relevance of research findings.

Plants are usually considered static organisms, but they can perform a wide range of movements that can be a source of inspiration for robots. The roots’ growing motion is the most noteworthy since they are excellent diggers that can move in unstructured environments and navigate past barriers. Furthermore, root growth has a high energy efficiency since it penetrates the soil at its tip, adding new material without displacing the already grown portion, minimizing the energy dissipation due to friction and lowering the inertia. A robot inspired by the growth of roots could be used in search and rescue or environmental monitoring. The design of a soft robot inspired by root growth is presented in this article. The robot body consists of a cylindrical plastic membrane folded inside itself. The robot body is inflated, and its tip is everted, expanding its length as air is blown from the base. Velcro straps are placed on the membrane’s exterior surface to keep it folded. The head is positioned inside the tip, which houses the mechanism that controls the growth direction. It consists of housing for two balloons that are selectively inflated, and their expansion applies pressure on the exterior surface, opening the Velcro straps and determining the growth direction. The robot was constructed, and a kinematic model of its motion in the plane was created and compared with experimental data. The error in predicting the turning angle is only 5%, and the resulting predicted position differs on average by 55 mm on a total length of 850 mm.

In this work, the mechanisms leading to the pore closure in reactive melt infiltration (RMI) of carbon by pure silicon and a near eutectic Si-8 at-pct Zr alloy at 1500 and 1700 degrees C under vacuum were studied. Various geometrical configurations of microchannels were fabricated via laser ablation of glassy carbon plates. The micron size capillary channels allowed simplifying the complicated porosity distribution in the infiltration of powder or fibres based porous preform while keeping the physical dimensions in the range of where the physical phenomenon of pore closure takes place. The extent of infiltration was analysed by means of X-ray radiography. For RMI of pure Si, the widely accepted decrease in capillary radius by the formation of a solid state SiC layer by the reaction of liquid Si and C was observed, but did not lead to closure and it is hence not the infiltration limiting step in channels as small as 10 mu m. However, in the case of the Si-Zr alloy infiltration, another mechanism of pore closure was observed, namely the precipitation of zirconium silicides at the infiltration front, due to Zr enrichment in the alloy by the continuous consumption of Si for the formation of SiC.

To compare in-hospital outcome of Evolut-R 34 mm vs. smaller Evolut-R devices and to identify predictors of paravalvular leak (PVL) and deep implantation specific for Evolut-R 34 mm.This single-center retrospective study included 359 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with Evolut-R 34 mm (N = 84,23.4%) and Evolut-R 23/26/29 mm (N = 275,76.6%) between 2016 and 2019.Patients in Evolut-R 34 mm group were more frequently males, had lower STS score, ejection fraction, and mean aortic gradient compared to the Evolut-R 23/26/29 mm group. Horizontal aorta and large LVOT were more frequent findings in the Evolut-R 34 mm group, whereas calcium volume was comparable among the groups. During TAVR, mean implantation depth and contrast volume were greater in the Evolut-R 34 mm group, compared to the Evolut 23/26/29 mm group. Post-procedurally, 30-day mortality, ≥moderate PVL, device success and pacemaker implantation (PM) rates were comparable between groups. Among independent predictors of ≥moderate PVL, calcium volume (OR:1.04; p0.001) was predictive with different thresholds in both groups, whereas aortic angulation (OR:1.40; p = 0.005) was predictive only in Evolut-R 34 mm group at a cutoff of 60° (AUC:0.73; p = 0.043). Body weight (OR:1.03; p = 0.027), left ventricular outflow tract (LVOT) diameter (OR:1.34; p = 0.001), and mean aortic gradient (OR:0.96; p = 0.006) were independent predictors of deep implantation (mean depth ≥ 6 mm), with LVOT27 mm being predictive specifically for Evolut-R 34 mm (AUC:0.66; p = 0.024).TAVR with Evolut-R 34 mm and Evolut-R 23/26/29 mm showed comparable in-hospital outcome. Aortic angulation60° and LVOT27 mm were predictive respectively of ≥moderate PVL and deep implantation specifically in Evolut-R 34 mm patients.

To evalue the short-term results obtained in endovenous laser ablation (EVLA) procedure of the varicose insufficiency of the lower limbs with Diode 1470 μm laser compared to Diode 1940 μm laser.A total of 55 patients were enrolled in the study. The patients were divided into two groups: those subjected to 1470 μm laser treatment in group A and those with 1940 μm laser treatment in group B. The endpoints were: Closure of the target vessel, complications and post-operative pain.There are no intra-and post-operative complications. The occlusion rate of the target veins was 100% at 7- and 60-day controls. The pain perceived in the immediate post-operative and at the controls showed no statistically significant differences between the two groups. However in group B it was necessary to apply lower values of Power (W) and Linear Energy Density (LEED) with a statistically significant difference compared to group A.Short-term results demonstrate closure rates comparable to those obtained with 1470 μm lasers. There were no statistically significant differences in the two groups in terms of primary and secondary endpoints. The advantage of using 1940 μm laser technology is that it is possible to dispense a lower linear energy density (LEED) at a lower power (Watt).Endovenous laser ablation with Diode 1940 μm is particularly suitable and advantageous in the treatment of superficial and small vessels, as well as venous segment adjacent to nerve structures.Diode laser, Intravenous ablation, Varicose, Venous insufficiency, Veins.La termoablazione laser (EVLA) rappresenta oggi la tecnica di prima scelta nel trattamento dell’insufficienza venosa. In questo articolo riportiamo l’analisi retrospettiva dei risultati a breve termine ottenuti dal trattamento laser endovenoso (EVLA) della patologia varicosa degli arti inferiori con laser 1470 μm e laser 1940 μm.Sono stati arruolati nello studio un totale di 55 Pazienti. I pazienti sono stati divisi in due gruppi: quelli sottoposti a trattamento con laser 1470 μm nel gruppo A e quelli con laser 1940 μm nel gruppo B. Gli endpoint sono stati: closure del vaso target, complicanze e dolore post-operatorio.Non si riportano complicanze intra e postoperatorie. Il tasso di occlusione delle vene target è stato del 100% ai controlli a 7 e 60 giorni. Il dolore percepito nell’immediato postoperatorio ed ai controlli non ha mostrato differenze statisticamente significative tra i due gruppi. Tuttavia nel gruppo B è stato necessario applicare minori valori di Potenza (W) e Densità di Energia Lineare (LEED) con una differenza statisticamente significativa rispetto al gruppo A.I risultati a breve termine dimostrano tassi di closure sovrapponibili a quelli ottenuti con laser 1470 μm. Non si sono registrate differenze statisticamente significative nei 2 gruppi in termini di endpoint primari e secondari. Il vantaggio dell’utilizzo della tecnologia laser 1940 μm deriva dalla possibilità di erogare una minore densità di energia lineare (LEED) ad una minore potenza (Watt). Per tale motivo questa metodica risulta particolarmente indicata e vantaggiosa nel trattamento di vasi di calibro più piccolo, più superficiali e attigui a strutture nervose.

AIMS The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid-term outcomes, and clinical and echocardiographic predictors of mid-term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR). METHODS AND RESULTS Between January 2016 and March 2020, 1659 patients were prospectively included in the GIOTTO registry (FMR 59.4% vs. DMR 40.6%). Acute Mitral Valve Academic Research Consortium (MVARC) technical success was achieved in 97.2% of patients, without differences between FMR and DMR and with sustained results at 30 days. In the study population, all-cause mortality was 4.0%, 17.5% and 34.6% at 30 days, 1 year and 2 years, respectively. Cardiovascular death was the most frequent cause of mortality. Overall hospitalization rates were 6.3%, 23.4% and 31.7% at 30 days, 1 year and 2 years, respectively. The most frequent cause of hospitalization was heart failure, particularly in the first 30 days. FMR and MVARC structural and functional failure were strongly associated with 1-year mortality. Residual mitral regurgitation 1+ (rMR) was independently related to a reduced risk of 1-year mortality (hazard ratio 0.62; P = 0.005). Coherently, at 2-year follow up, FMR was associated with worse outcomes than DMR, and Kaplan-Meier all-cause mortality was related to rMR. CONCLUSIONS Functional mitral regurgitation aetiology affects 1-year mortality after MitraClip implantation, and differences in mortality and hospitalization rates between FMR and DMR can be observed within 2 years. Optimal rMR 1+ was correlated to a more favourable mid-term outcome, particularly in FMR.

Two-side accurate analytical estimates of the pull-in parameters of a carbon nanotube switch clamped at one end under electrostatic actuation are provided by considering the proper expressions of the electrostatic force and van der Waals interactions for a carbon nanotube, as well as the contribution of the charge concentration at the free end. According to the Euler–Bernoulli beam theory, the problem is governed by a fourth-order nonlinear boundary value problem. Two-side estimates on the centreline deflection are derived. Then, very accurate lower and upper bounds to the pull-in voltage and deflection are obtained as function of the geometrical and material parameters. The analytical predictions are found to agree remarkably well with the numerical results provided by the shooting method, thus validating the proposed approach. Finally, a simple closed-form relation is proposed for the minimum feasible gap and maximum realizable length for a freestanding CNT cantilever.

Among all aquatic species, mantas and rays swim by flapping their pectoral fins; this motion is similar to other fishes in terms of efficiency, but it gives better maneuverability and agility in turning. The fin's motion is featured by a traveling wave going opposite to the forward motion, producing a force thanks to momentum conservation. This article aims at understanding the swimming dynamics of rays, focusing on energy efficiency. A computational fluid dynamics (CFD) model of the swimming motion of a cownose ray has been implemented in openfoam, simulating the acceleration of the fish from still to the steady-state velocity using an overset mesh. In this analysis, the one degree-of-freedom dynamics of forward swimming is solved together with the fluid velocity and pressure. The effect of frequency and wavelength of fin motion on thrust, power, and velocity has been investigated and an analysis of the vortices in the wake showed has been performed. The energy efficiency of a self-propelled body has been defined in a novel way and it has been calculated for different motion conditions. The results showed that batoid fishes swim with high energy efficiency and that they are a promising source of inspiration for biomimetic autonomous underwater vehicles.

This paper shows the design of an underwater autonomous robot. The challenges of this activity are mainly linked to motion design and to energy efficiency. Therefore, a bioinspired approach has been used. Batoid fishes swim moving their pectoral fins, they produce a wave travelling in the direction opposite to their motion, pushing water backwards and gaining thrust as a consequence of momentum conservation. The motion of the fin has been studied and reproduced with a series of articulated mechanisms. In this work the optimization of the mechanism’s geometry is described and the experimental results on the reconstructed fin are presented., https://youtu.be/72AKxWktQBI

The study of fish swimming is of great interest for engineers and researchers because the investigation of novel propulsion mechanisms is functional to the development of autonomous underwater vehicles. Among the different locomotion strategies adopted by fish species, the one characterizing the cownose ray is known to be very efficient. These fishes move their large pectoral fins and create a wave travelling in a direction opposite to the swimming direction. Thus, thanks to momentum conservation, the fish receives a propulsive thrust. This mechanism has been reproduced in a bioinspired robot mimicking a cownose ray, which has been designed and built. Before testing the robot underwater, some preliminary experiments in a small wind tunnel have been performed on a single fin. These tests are aimed at assessing the fluid dynamics of the fin shape and at verifying the effectiveness of this propulsive strategy. The fluid dynamic forces acting on the profile are measured with the fin still; the velocity of the incoming air is such that the Reynolds number is the same as for the fish swimming in water. Then, the propulsive strategy is tested with the fin in motion; the velocity of the incoming air is the same as the relative velocity of water for the fish during forward swimming, and several experiments were carried out with different frequencies and wavelengths of fin motion. Finally, having the fluids different densities, the measured forces and moments are scaled. These tests have confirmed that the cownose ray swimming strategy is effective and a relation between the measured forces with frequency and wavelength of fin motion has been found.

Background: Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with a degenerated TAV treated by means of a second TAVR. Methods: The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40 000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%. Results: Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded. Conclusions: Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04500964.

Objectives The aim of this study was to compare transcatheter aortic valve replacement (TAVR) with the Acurate neo (NEO) and Evolut PRO (PRO) devices. Background The NEO and PRO bioprostheses are 2 next-generation self-expanding devices developed for TAVR. Methods The NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) registry retrospectively included patients who underwent transfemoral TAVR with either NEO or PRO valves at 24 centers between January 2012 and March 2018. One-to-one propensity score matching resulted in 251 pairs. Pre-discharge and 30-day Valve Academic Research Consortium (VARC)–2 defined outcomes were evaluated. Binary logistic regression was performed to adjust the treatment effect for propensity score quintiles. Results A total of 1,551 patients (n = 1,263 NEO; n = 288 PRO) were included. The mean age was 82 years, and the mean Society of Thoracic Surgeons score was 5.1%. After propensity score matching (n = 502), VARC-2 device success (90.6% vs. 91.6%; p = 0.751) and pre-discharge moderate to severe (II+) paravalvular aortic regurgitation (7.3% vs. 5.7%; p = 0.584) were comparable between the NEO and PRO groups. Furthermore, there were no significant differences in any 30-day clinical outcome between matched NEO and PRO pairs, including all-cause mortality (3.2% vs. 1.2%; p = 0.221), stroke (2.4% vs. 2.8%; p = 1.000), new permanent pacemaker implantation (11.0% vs. 12.8%; p = 0.565), and VARC-2 early safety endpoint (10.6% vs. 10.4%; p = 1.000). Logistic regression on the unmatched cohort confirmed a similar risk of VARC-2 device success, paravalvular aortic regurgitation II+, and 30-day clinical outcomes after NEO and PRO implantation. Conclusions In this multicenter registry, transfemoral TAVR with the NEO and PRO bioprostheses was associated with high device success, acceptable rates of paravalvular aortic regurgitation II+, and good 30-day clinical outcomes. After adjusting for potential confounders, short-term outcomes were similar between the devices.

The problem of pull-in instability of a cantilever micro- or nano-switch under electrostatic forces has attracted considerable attention in the literature, given its importance in designing micro- and nano-electromechanical systems (MEMS and NEMS). The non-linear nature of the problem supports the typical approach that relies on numerical or semi-analytical tools to approximate the solution. By contrast, we determine fully analytical upper and lower bounds to the pull-in instability phenomenon for a cantilever beam under the action of electrostatic, van der Waals or Casimir forces. In particular, the novel contribution of this works consists in accounting for size effects analytically, in the spirit of surface elasticity, which adds considerable complication to the problem, allowing for a nonconvex beam deflection. Surface energy effects are generally ignored in classical elasticity, although they are known to become relevant for very small structures and especially at the nano-scale, owing to their large surface/volume ratio. Closed form lower and upper bounds are given for the pull-in characteristics, that allow to discuss the role of several tuneable parameters. Indeed, the evolution of the cantilever tip deflection is presented as a function of the applied voltage up to the occurrence of pull-in and the contribution of van der Waals and Casimir intermolecular interactions is discussed. It is found that intermolecular forces strongly decrease the pull-in voltage, while surface elasticity works in the opposite direction and stabilizes the system. The accuracy of the bounding solutions, measured in terms of the difference between upper and lower analytical bounds, is generally very good, although it rapidly deteriorates as the effect of surface elasticity becomes more pronounced. Finally, approximated closed-form relations are developed to yield simple and accurate design formulae: in particular, they provide estimates for the minimum theoretical gap and for the maximum operable length for a free-standing cantilever in the presence of the effects of surface elasticity and intermolecular interactions. Results may be especially useful for designing and optimizing NEMS switches.

Objectives To investigate paravalvular leak (PVL) and devices success rates according to aortic angle (AA) in patients undergoing transcatheter aortic valve implantation (TAVI) with three new-generation self-expanding devices. Background The impact of aortic angle (AA) on TAVI device success and PVL rates is controversial. Methods This retrospective study included 392 patients submitted to TAVI for severe aortic stenosis with Portico, Evolut-R and Acurate-NEO, and available AA measurements at computed tomography (CT) angiography. AA was calculated from the implantation projection and was defined as the angle between the plane of aortic annulus and an ideal horizontal plane. Aorta was defined horizontal if AA>57° (75th percentile). Results In the horizontal group, the rates of moderate/severe PVL was higher in the Evolut-R group (20.8%), which was also characterized by a lower implant compared to that of Acurate-NEO, whereas device success was comparable among the three devices. AA was a significant predictor of moderate/severe PVLs (AUC 0.72, p = .002) only in the Evolut-R population. On multivariate analysis, calcium volume 850HU, bicuspid aortic valve, and implantation depth at the level of left coronary cusp were independent predictors of moderate/severe PVL. On univariate analysis in the horizontal aorta population, implantation depth was confirmed among the most significant predictors of moderate/severe PVL. Conclusions Despite comparable device success rates, horizontal aorta represented a technical challenge only in the Evolut-R subgroup, which showed higher rates of moderate/severe PVL than Portico and Acurate-NEO, and was associated with a low implant.

Although plants are usually seen as static organisms, they exhibit a wide range of movements that only in recent years have been considered as a source of inspiration for robots. The motion of roots is one of the most interesting, because they are extraordinary diggers, able to navigate in unstructured environments, finding their way around obstacles. Moreover, root growth is featured by high energy efficiency because they penetrate the soil adding new material at their tip, without moving the already grown part, preventing friction from dissipating energy and reducing the inertia. A robot inspired to roots’ growth could be employed in search and rescue operations or in environmental monitoring. In this work the design of a soft robot inspired to root’s growth is presented. The body of the robot consists of a cylindrical plastic membrane folded inside itself. When air is blown from the base, the body of the robot is inflated, and its tip is everted increasing its length. On the external surface some Velcro stripes are mounted, which keep the membrane folded. Inside the tip a head is mounted, where the mechanism controlling the direction of growth is placed. It consists of a housing for some balloons, which can be inflated selectively, and their expansion exerts a pressure on the external surface able to open the Velcro stripes. The direction of growth is controlled by selecting which balloon to inflate. The robot has been built and a kinematic model of its motion in the plane has been developed and compared with experimental results.

Objective Transcatheter Aortic Valve Implantation (TAVI) is a consolidated procedure showing a low operative risk and excellent long-term outcomes in patients with aortic stenosis. Patients presenting a bicuspid aortic valve (BAV) often require valve replacement due to the highly calcific nature of the aortic leaflets. However, BAV patients have usually been contraindicated for TAVI due to their complex valve anatomy. The aim of this work was to compare the performance of devices featuring high conformability (HC) against those with high radial force (HRF). Methods Four BAV patients undergoing TAVI were retrospectively selected. The aortic roots including the native leaflets and calcifications were reconstructed from pre-operative Computed Tomography scans. In each patient, both HC and HRF devices were virtually implanted using Finite Element Analysis simulations. After implantation, paravalvular orifice area, von Mises stress distribution, root contact area, and device eccentricity were calculated. Results Simulations showed good agreement with intraoperative imaging. In 3 out of 4 patients, the HRF device resulted in a lower paravalvular area than the HC. Stress distribution was also more homogeneously distributed in the HRF group as compared with the HC group. Despite their lower adaptability, HRF devices showed consistently higher stent-root contact area. Conclusion HRF devices showed improved results with respect to HC valves after being deployed in BAV anatomies. We hypothesize that the ability to reshape the annulus is the major determinant of success in this subgroup of patients featuring highly calcified leaflets.

Among all aquatic species, mantas and rays swim by oscillating their pectoral fins; this motion is similar to other fishes in term of efficiency, but it gives better agility in turning with respect to fishes moving their caudal fin. The fin motion is featured by a travelling wave going opposite to the forward motion, producing a force thanks to momentum conservation. Another contribution to the generation of thrust is given by the generation of a vortex in correspondence of the leading edge of the fin, which pulls the fish forward thanks to the lower pressure in its centre. In literature these contributions have been highlighted, but it remains to understand which one of these two mechanisms is prevailing according to different conditions of swimming, how they affect each other and what is the influence of the two on energetical efficiency. The object of this activity is to investigate how thrust generation is influenced by geometrical characteristics of the fin, such as size, geometry and flexibility and by parameters of motion, such as speed, amplitude and frequency of fin oscillation and velocity of the travelling wave. A CFD model of the fish has been implemented in OpenFOAM, not only confirming that both upstroke and downstroke contribute positively to the forward movement according to the momentum conservation principle, but also highlighting the formation of a leading-edge vortex enhancing thrust generation. The description of how thrust generation is linked to motion parameters is simulated also coupling the CFD with a multibody to simulate the whole motion in its complexity.

One field in which nature outperforms current technology is fish swimming, because its efficiency, manoeuvrability and noise are far better than those of typical ship propellers. These advantages are not only due to the streamlined shape and the low-drag skin, but also and above all to the propulsion mechanism, which makes thrust generation possible with small energy dissipation in vortices. Nowadays the interest in autonomous underwater vehicles is in constant increase following the emerging needs of underwater mining and fish farming. Batoid fishes produce thrust with their pectoral fins, they essentially produce a wave travelling in the direction opposite to their motion, pushing water backwards and gaining thrust as a consequence of momentum conservation. The motion of the fin has been studied and reproduced with a series of articulated mechanisms. In this work the optimization of the mechanism’s geometry is described and the experimental results on the reconstructed fin are presented. Moreover, a bioinspired robot mimicking cownose ray locomotion has been designed and built. In this paper the functioning of this robot is shown.

Roots are extraordinary diggers because they penetrate the soil adding new material on their tip without moving the already grown part, preventing friction from dissipating too much energy and minimising inertial forces during motion. A robot exploiting this principle can assist operations of search and rescue digging in mud or snow to find people in danger. In this work a soft pneumatic robot inspired to roots’ growth is presented. The body of the robot consists of a cylindric plastic membrane folded inside out; one extremity is kept fixed to the base, whereas the other one is folded inside itself. When air is blown from the base, the body of the robot is inflated, and its tip is everted increasing its length. Inside the tip a head is mounted, where the mechanism controlling the direction of growth is placed. On the external surface of the membrane some hooks are mounted, and tensioned wires connects them longitudinally while they are folded before being everted. These wires are cut when they pass next to the head allowing the robot to unfold; since series of hooks are distributed radially on the body of the robot, the direction of growth is controlled by selecting which wires are to be cut. On the head of the robot can be mounted an infrared sensor or a video-camera needed for the specific application.

Background Available scientific evidence of transcatheter mitral valve repair with the MitraClip comes from randomized controlled trials, which showed controversial results that hardly translate into real-world practice, and from registries of relatively small sample size. Aim To collect real-world data in a multicenter, prospective, country-level registry. Methods and result The Italian Society of Interventional Cardiology (GIse) Registry Of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) is an ongoing single-arm, multicenter, prospective registry that started enrollment in February 2016. Clinical end points were defined according to the Mitral Valve Academic Research Consortium (MVARC) criteria. From February 2016 to December 2018, 1189 patients (mean age 76 ± 9.1 years) were enrolled. The main MR etiology was functional (64.9%). MVARC technical success was 96.6%. At 30-day follow-up ( n = 1131), MVARC device and procedural success were 92.5% and 87% respectively, and all-cause death was 3%. The majority of patients who died at 30-day had functional MR (69.7%). Mixed etiology (OR 0.94, 95% CI 0.02–0.61) and prolonged length of stay in ICU (OR 0.97, 95% CI 0.95–0.99) were found to be negative independent predictors of device success at 30-day. The EuroSCORE II (OR 0.96, 95% CI 0.93–0.99), LVEDV-I (OR 0.99, 95% CI 0.98–0.99) and prolonged length of stay in ICU (OR 0.98, 95% CI 0.97–0.99) were negative independent factors of MVARC procedural success at 30-day. Conclusions The GIOTTO registry is one of the largest prospective registries available on MitraClip and shows favorable acute and 30-day safety and efficacy.

This paper describes a novel technique to produce net shape ceramic matrix composites (CMC) artefacts by a modified injection moulding technique called composite flow moulding, (CFM) followed by pyrolysis and reactive silicon infiltration. The peculiarity of the produced components stands in their microstructure which is characterized by fibres crossing the part without interruption. This new method will open the use of CMCs to complex geometries for structural applications because they can be produced to net shape without machining and thus interrupting the fibres. A net shape CMC screw was manufactured, but other shapes, such as: bolts, nuts, rivets, springs and even turbine blades can be easily produced.

SiC foams sandwiched between two Ceramic Matrix Composite (CMC) skins are of interest for several high temperature applications ranging from aeronautics to energy production. In this paper, SiC foams were joined to C/SiC composites by the “Mo-wrap” method to obtain sandwich structures. The Mo-wrap method is a recently developed joining technique: it consists of wrapping Si foils inside a Mo wrap in order to prevent molten silicon leaking from the joined area and infiltrating SiC foam and C/SiC during the joining process. Compression and thermal shock resistance tests were performed on the C/SiC – SiC foam – C/SiC sandwich obtaining sound results.