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Muons are constantly produced in cosmic-rays and reach the Earth surface with a flux of about 160 particles per second per square meter. The abundance of muons with respect to other cosmic particles and their capability to cross dense materials with low absorption rate allow them to be exploited for large scale geological or human-made object imaging. Muon radiography is based on similar principles as X-ray radiography, measuring the surviving rate of muons escaping the target and relating it to the mass distribution inside the object. In the course of decades, after the first application in 1955, the methodology has been applied in several different fields. Muography allows us to measure the internal density distribution of the investigated object, or to simply highlight the presence of void regions by observing any excess of muons. Most of these applications require the detector to be installed below the rock being probed. In case that possible installation sites are not easily accessible by people, common instrumentation cannot be installed. A novel borehole cylindrical detector for muon radiography has been recently developed to deal with these conditions. It has been realized with a cylindrical geometry to fit typical borehole dimensions. Its design maximizes the geometrical acceptance, minimizing the dead spaces by the use of arc-shaped scintillators. The details of the construction and preliminary results of the first usage are described in this paper. © 2022 by the authors.

Background The risk of death in patients affected by ST-elevation segment myocardial infarction (STEMI) is well known, but more data are required to define the in-hospital mortality in special subsets. We sought to assess the prognostic value of indicators in patients with large anterior STEMI as a first acute coronary event, undergoing percutaneous coronary intervention (PCI) and intra-aortic balloon pump (IABP). Methods and results We evaluated 48 consecutive large anterior STEMI patients admitted as first acute coronary event, undergoing in acute phase both PCI and IABP. Patient demographics, clinical, noninvasive and invasive findings, together with in-hospital complications, were collected. Moreover, findings obtained after a 24-month follow-up were reported. The primary endpoint was in-hospital mortality, whereas the secondary endpoints were out of hospital mortality, rehospitalization for heart failure or reinfarction, and New York Heart Association (NYHA) class at least 2 at follow-up visit. The univariate analysis showed a significant association with symptom to balloon, left anterior descending coronary artery, myocardial blush grade, and wall motion score index. Results of the multivariable analysis revealed the strongest predictive power for in-hospital mortality of proximal left anterior descending coronary artery (odds ratio: 6.9; 95% confidence interval: 1.1-67.7) and of myocardial blush grade 0-1 (odds ratio: 5.5; 95% confidence interval: 1.0-38.8). In-hospital death occurred in 13 patients (27% of total cases), whereas, at follow-up, the mean of survival was 66.7 ± 7.0%. Conclusion The patients with large anterior STEMI as a first acute coronary event, undergoing PCI and IABP, had a very high in-hospital mortality, whereas the mortality rate over the follow-up period was lower. The involvement of a large territory at risk and the ineffective treatment in terms of myocardial reperfusion were the main predictors of in-hospital mortality.

The decay $K^+$ $\rightarrow$ $\pi^+$ $\nu\overline{\nu}$ with a very precisely predicted branching ratio of less than $10^{-10}$ is one of the best candidates to reveal indirect effects of new physics at the highest mass scales. The NA62 experiment at CERN SPS is designed to measure the branching ratio of the $K^+$ $\rightarrow$ $\pi^+$ $\nu\overline{\nu}$. In 2016, the first data set good for physics has been collected. The preliminary result on BR($K^+$ $\rightarrow$ $\pi^+$ $\nu\overline{\nu}$) from the full 2016 data set is presented here. Due to the high beam energy and hermetic detector coverage, NA62 has also the opportunity to directly search for a multitude of long-lived beyond- Standard-Model particles, such as dark photons, dark scalars, axion-like particles, and heavy neutral leptons. An overview of the broader NA62 physics program with status and prospects will be illustrated.

Introduction Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed. Methods We used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition. Results A total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count

We used high-resolution phylogenetic methods in the context of mother-to-child transmission to obtain information on the timing of the infection and on the transmission network. A total of 33 pol sequences (from maternal peripheral blood, from breast milk, and from plasma of children) belonging to five cases of HIV infant transmission were studied. Using time-scaled phylogeny we were able to estimate that in two cases the transmission occurred after the recommended duration of breastfeeding, supporting a longer, not reported, duration of breastfeeding as a significant factor associated with HIV infant acquisition in this cohort. Among the postnatal infections we were also able to demonstrate that the cell-free virus in breast milk was the most likely population associated with the event of transmission. Our study showed that a coalescent-based model within a Bayesian statistical framework can provide important information that can contribute to optimizing preventive strategies.

Aims The aim of this study was to assess the echocardiographic distribution of regional wall motion abnormalities (RWMA) in patients with tako-tsubo cardiomyopathy (TTC) compared with anterior ST-elevation myocardial infarction (ant-STEMI). Methods and results Thirty-seven TTC and 37 ant-STEMI patients underwent standard echocardiographic examination at the time of hospital admission. RWMA and the involvement of the left ventricular territories supplied by each coronary artery according to the American Society of Echocardiography classification were reported. TTC patients showed a lower left ventricular ejection fraction (37.6 ± 5.1 vs. 40.9 ± 3.7%; P = 0.002) and a higher wall motion score index (WMSI; 1.98 ± 0.2 vs. 1.51 ± 0.14; P < 0.001) compared with ant-STEMI patients. No significant differences were observed between groups with regard to detection of RWMA in the territory supplied by the left anterior descending coronary artery (LAD) (37 vs. 37; P = 1). Conversely, in TTC patients, the territories supplied by the LAD/left circumflex coronary artery (LCX) (37 vs. 31; P = 0.011), LAD/right coronary artery (RCA) (34 vs. 13; P < 0.001), RCA (33 vs. 5; P < 0.001), and RCA/LCX (31 vs. 2; P < 0.001) were more frequently involved. A cut-off value of WMSI ≥1.75 (area under the curve 0.956) and for the number of territories with RWMA ≥4 (AUC = 0.928) predicted TTC with a sensitivity of 83 and 84% and a specificity of 100 and 97%, respectively. Conclusion Echocardiography revealed a distinctive pattern of contractility in TTC patients, characterized by symmetrical RWMA extending equally into the territory of distribution of all coronary arteries.

A young woman undergoes Caesarean section at the 39th week of pregnancy: shortly after she develops acute cardiorespiratory failure. The electrocardiography shows sinus tachycardia and right bundle branch block. The ventriculography confirms the decrease of the pump function and the mid-ventricular ballooning of the left ventricle; the differential diagnosis is between peri-partum cardiomyopathy and stress induced tako-tsubo cardiomyopathy: the sudden onset, the results of the ventriculography and the complete recovery after 11 days of treatment for acute heart failure led the diagnosis towards tako-tsubo cardiomyopathy.

M Lauriola1, R Murri3, M Massella4, M Mirra4, S Donnini4, V Fragola4, J Ivanovic5, M Pavoni6, G Mancini2, R Bucciardini41Department of Social and Developmental Psychology, 2Department of Infectious and Tropical Diseases, University of Rome “La Sapienza”, Rome, Italy; 3Catholic University of “Sacro Cuore”, Rome, Italy; 4Istituto Superiore di Sanità, Rome, Italy; 5National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy; 6Ospedale Civile Santa Maria delle Croci, Ravenna, ItalyObjectives: The Italian National Institute of Health Quality of Life – Core Evaluation Form (ISSQoL-CEF) is a specific questionnaire measuring health-related quality of life for human immunodeficiency virus-infected people in the era of highly active antiretroviral therapy. The main goal of this study was to examine the construct validity of this questionnaire by confirmation of its hypothesized dimensional structure.Methods: Baseline quality of life data from four clinical studies were collected and a confirmatory factor analysis of the ISSQoL-CEF items was carried out. Both first-order and secondorder factor models were tested: Model 1 with nine correlated first-order factors; Model 2 with three correlated second-order factors (Physical, Mental, and Social Health); Model 3 with two correlated second-order factors (Physical and Mental/Social Health); Model 4 with only one second-order factor (General Health).Results: A total of 261 patients were surveyed. Model 1 had a good fit to the data. Model 2 had an acceptable fit to the data and it was the best of all hierarchical models. However, Model 2 fitted the data worse than Model 1.Conclusions: The findings of in this study, consistent with the results of previous study, pointed out the construct validity of the ISSQoL-CEF.Keywords: confirmatory factor analysis, HRQoL, patient-reported outcomes

Background To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). Methods The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. Results The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. Conclusions The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.

This work has been performed into the frame of the NA62 experiment at CERN that aims at measuring the Branching-Ratio of the ultra-rare kaon decay K+→π+ nu nubar with 10% uncertainty - using an unseparated kaon beam of 75GeV/c - in order to test the Standard Model (SM), to look for physics beyond SM and to measure the |Vtd| element of the Cabibbo-Kobayashi-Maskawa (CKM) flavor mixing matrix. Backgrounds, which are up to 10^10 times higher than the signal, will be suppressed by an accurate measurement of the momentum of the K+ (with a silicon beam tracker named GigaTracker) and the π+ (with a straw tracker) and by a complex system of particle identification and veto detectors. A critical background can be induced by inelastic interactions of the hadron beam with the GigaTracker. Pions produced in these interactions, emitted at low angle, can reach the straw tracker and mimic a kaon decay in the fiducial region, if no other track is detected. In order to suppress this background a CHarged track ANTIcounter (CHANTI) has been designed and built in Naples. The detector consists of a series of six guard counters surrounding the beam and placed immediately after the silicon tracker. Each guard counter is made up of two layers, X and Y. Y (X) layer is composed of 24 scintillator bars arranged parallel to X (Y) direction. Each bar is triangularly shaped with a 1.7 mm diameter hole. In order to collect the light of the scintillator, a wavelength shifting (WLS) fiber is inserted into the hole of each bar. The fiber is mirrored at one side and is read by a Hamamatsu silicon photomultiplier (SiPM) at the other side. In this thesis the design philosophy, the construction procedure and the quality tests, adopted during the assembly of the detector, are reported. A careful calibration procedure of the frontend electronics has been setup. It is made up of two different stage. The first one is used to set bias voltage of the SiPMs and to read their current; it also gives a fast amplification of the signal before passing them to the second stage in which a comparator gives an LVDS output of duration equal to the time a signal is above a given threshold. A simulation of the scintillation bar, that includes all the optical processes inside this single channel of the CHANTI, and the complete digitization of the signals have been developed. The performance of the detector have been evaluated both in the laboratory facilities in Naples, with cosmic rays, and in the experimental area of the NA62 experiment with real beam condition. In particular the efficiency, time and space resolutions and accidental veto rate of the detector have been determined analysing the data collected during the first NA62 physics run in 2015.

Introduction We report a case of a 66-year-old man with previous anterior ST-elevated myocardial infarction, treated with primary percutaneous coronary intervention and insertion of drug eluting stent on the left anterior descending coronary artery, and left ventricular (LV) apical aneurysm due to no-reflow. After 2 months follow-up contrast echocardiography allowed to detect giant apical LV thrombosis and to exclude impending LV wall rupture. Anticoagulant oral therapy failed to dissolve the thrombus. Aneurismectomy with left ventricular remodeling and excision of the thrombus was performed successfully and the patient was discharged in good condition. Conclusions Contrast echocardiography was fundamental in diagnosis of LV thrombus excluding an impending LV wall rupture and to guide treatment.

Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. She was not pregnant or in a postpartum state. Subsequent cardiac angiography revealed spontaneous left anterior descending coronary artery dissections, managed by conservative approach. The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.

Background\ud \ud There is consensus that Heart Rate Variability is associated with the risk of vascular events. However, Heart Rate Variability predictive value for vascular events is not completely clear. The aim of this study is to develop novel predictive models based on data-mining algorithms to provide an automatic risk stratification tool for hypertensive patients.\ud \ud Methods\ud \ud A database of 139 Holter recordings with clinical data of hypertensive patients followed up for at least 12 months were collected ad hoc. Subjects who experienced a vascular event (i.e., myocardial infarction, stroke, syncopal event) were considered as high-risk subjects. Several data-mining algorithms (such as support vector machine, tree-based classifier, artificial neural network) were used to develop automatic classifiers and their accuracy was tested by assessing the receiver-operator characteristics curve. Moreover, we tested the echographic parameters, which have been showed as powerful predictors of future vascular events.\ud \ud Results\ud \ud The best predictive model was based on random forest and enabled to identify high-risk hypertensive patients with sensitivity and specificity rates of 71.4% and 87.8%, respectively. The Heart Rate Variability based classifier showed higher predictive values than the conventional echographic parameters, which are considered as significant cardiovascular risk factors.\ud \ud Conclusions\ud \ud Combination of Heart Rate Variability measures, analyzed with data-mining algorithm, could be a reliable tool for identifying hypertensive patients at high risk to develop future vascular events.

Objectives: To evaluate the quality of life outcomes in antiretroviral-naive patients randomized to zidovudine plus didanosine versus zidovudine plus didanosine plus nevirapine for treatment of advanced HIV disease (the Istituto Superiore di Sanita 047 trial). Design: A 48-week randomized, double-blind trial. Methods: Sixty patients were enrolled and evaluated over 24 weeks. Quality of life was assessed using a modified version of the Medical Outcomes Study-HIV Health Survey. For analysis, we calculated two summary scores reflecting the physical (PHS) and the mental (MHS) components of health. Results: Although the three-drug combination was superior at inducing immunologic and virologic responses, the two-drug regimen was superior for both PHS and MHS, especially at week 8 where differences were both statistically and clinically significant (5.8 and 9.2 points, respectively, P < 0.02 for both). Quality of life changes paralleled trends in body weight and Karnofsky performance status score. Conclusion: Although a three-drug antiretroviral therapy regimen was superior in terms of short term virologic/immunologic response, the two-drug regimen was better in terms of quality of life. In general, triple therapy remains the most effective treatment option. However, quality of life assessments can yield results that may be discordant with and complementary to those obtained using conventional endpoints. Comparative trials should collect a comprehensive range of outcome measures, including patient-reported quality of life, in order to provide clinicians and patients with additional information that may influence treatment decisions.

Transradial approach in cardiac catheterization is increasing. In daily practice, coronary angiography via radial artery is usually performed by using catheters designed for femoral approach. The aim of this study was to evaluate advantages in the use of a workbench reshaped AR1 mod catheter, in terms of procedural duration time, number of catheters per procedure, fluoroscopy time, contrast agent administered volume, images quality and costs. Two hundred patients, submitted to coronary angiography via right radial artery in our institution, have been retrospectively reviewed. Patients have been divided in two groups, depending on whether a workbench reshaped Cordis Amplatz AR1 mod catheter (rAR1 mod), or catheters in their original shape (OC) have been employed. In the rAR1 mod group (100 patients) a lower number of catheters per procedure (1.07 ± 0.25 vs. 1.47 ± 1.65; p < 0.001), a more frequent right coronary selective engagement (76.76% vs. 53.12%; p < 0.001), a smaller amount of contrast agent (63.02 ± 27.77 vs. 80.85 ± 29.22 ml, p < 0.001), a reduced fluoroscopy and global procedural time (4.19 ± 2.91 vs. 5.69 ± 3.85 min, p = 0.004; and 34.58 ± 17.05 vs. 42.58 ± 17.26 min, p = 0.001, respectively) were observed. According to our experience, when right coronary angiography via right radial approach is performed, the utilization of rAR1 mod catheter correlates with multiple advantages in terms of procedural parameters.

ObjectivesThe purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients.BackgroundDespite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients.MethodsThe study population consisted of 227 patients (66.2 ± 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up (4.3 [4 to 6] weeks). Patients were divided into two groups according to the presence or absence of major adverse events, a composite of acute heart failure, cardiogenic shock, and in-hospital mortality.ResultsMajor adverse events occurred in 59 patients (25.9%). The variables for elderly patients ≥75 years of age (42.4% vs. 23.8%; p = 0.011): left ventricular (LV) ejection fraction (35.1 ± 5.9% vs. 38.4 ± 4.6%, p < 0.001), wall motion score index (1.9 ± 0.2 vs. 1.7 ± 0.2, p < 0.001), E/e′ ratio (13.5 ± 4.3 vs. 9.9 ± 3.3 [where E/e′ is ratio of mitral E peak velocity and averaged e′ velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p = 0.006), pulmonary artery systolic pressure (47.4 ± 12.3 mm Hg vs. 38.0 ± 9.2 mm Hg; p

Background HIV/AIDS represents one of the major health challenges of Ethiopia, despite a proven record of universal access to HIV care and treatment. Long-term antiretroviral therapy (ART) retention is a key factor for personal and public health benefits. Identification of determinants of attrition is needed to design appropriate interventions. Methods We used data from the CASA project, a prospective, multisite study of a cohort of HIV-infected patients who started ART in seven urban and rural health facilities located in the Tigray. We analysed the retention in care and its associated determinants in over 1000 patients followed for two years. The main outcome measure was the retention in care rate, defined as the proportion of patients alive and receiving ART at the same health facility as at ART initiation. Kaplan-Meier method was used to estimate the probability of retention at different time points. Cox Proportional Hazards model with robust sandwich estimates to account for within health facility correlation was used to identify factors associated with retention. Results Kaplan–Meier estimates of retention in care were 83.9%, 80.6% and 77.6% at 12, 18 and 24 months of follow-up, respectively. Attrition was mainly due to lost-to-follow-up and transferred-out patients. Multivariate Cox proportional hazard model showed that being male (HR 1.35, 95% CI: 1.04–1.75), CD4 count Conclusions According to our prospective data, combined interventions aimed to improve ART retention shall include expansion of HIV testing and earlier initiation of therapy, nutrition supplementation, early detection and treatment of TB. Observed retention differences among health facilities and according to gender suggest that innovative models of HIV care shall also be explored.

following classes this dependence progressively increased up to the extremely high level in hrv7 class. Thiswaywe have obtained a set of HRV indiceswhich are associated in different extent with HR. Such parameters constitute a perfect material for investigations of the HR contribution to the HRV prognostic power [5]. Moreover, this may be applied not only to the spectral HRV analysis but also to any other analysis of heart rate dynamics which parameters are associated with HR — in such instances the RR-interval tachograms should rather be modified (i.e. divided or multiplied by avRRs) before a given heart rate dynamics is analyzed. Importantly, if one calculates average HRV indices from the indices corresponding to short RR interval segments (e.g. from Holter recordings), one should first obtain the global average HRV indices of all RR interval segments and then divide or multiply them by a global avRR — the division or multiplication for each segment separately may create the situation where a single RR interval segment with unusually slow or fast HR determines the results for a given patient (it is especially likely if one employs high powers of avRR). To conclude, the described approach opens new perspectives for the analysis of HR dynamics, i.e. it makes possible to separate clinical (e.g. prognostic) information coming from average heart rate and from its dynamics.

We report an unusual case of endocarditis occurring in a 74-year-old man with a history of systemic hypertension, diabetes mellitus and minor amputation for left forefoot ulcer. The patient was hospitalized for vacuum-assisted closure therapy to aid in wound healing. After the first treatment session, the patient reported abdominal pain with haematemesis and fever (40 °C). Owing to persistent fever, three blood cultures were performed, all positive for Kocuria kristinae. The identification was based on biochemical tests and automated systems. The speciation of the micro-organism was achieved with MALDI-TOF and then confirmed by 16S rRNA gene sequencing. Transthoracic echocardiographic examination showed the presence of a large vegetation (38×20 mm) on the posterior mitral leaflet and moderate mitral regurgitation. Since there are no current guidelines for the treatment of K. kristinae endocarditis, empiric antibiotic therapy with intravenous sulbactam/ampicillin (1.5 g twice daily) and gentamicin (6 mg kg−1 per day) was started. After 7 days of hospitalization, the patient’s condition suddenly worsened because of the occurrence of haemorrhagic stroke. Despite inotropic support and rifampicin infusion, the haemodynamic status progressively deteriorated. After an initial improvement, he worsened again, becoming stuporous, hypotensive and dyspnoeic. In the following days, the patient developed compartment syndrome resulting in right foot ischaemia. Unfortunately, 25 days after hospitalization, the patient died of multiple organ failure from overwhelming sepsis. To the best of our knowledge, this is the first case of K. kristinae endocarditis on a native valve that is not related to a central venous catheter but associated with diabetic foot infection.

Aims To conduct a systematic review of case reports about Tako-tsubo syndrome (TTS)after delivery in order to assess whether TTS in the postpartum period is a peculiar entity or only a variant form of peripartum cardiomyopathy. Methods We perform a systematic literature search on the occurrence of TTS after cesarean section or spontaneous delivery using the scientific literature databases Medline, EMBASE and the Cochrane library. We selected 14 case reports in English. Primary/elective cesarean section or spontaneous delivery; absence of preexisting cardiovascular disease or fetal malformations; identification of diagnostic criteria for TTS; onset of TTS symptoms after delivery were the inclusion criteria. Results Fifteen cases were selected. Cesarean section 24h before the onset of TTS was reported in 13. All patients presented dyspnea or chest pain. The majority had mild troponin elevation, non-ST-segment elevation. Apical ballooning was observed in 60% of cases, midventricular ballooning in 33%, basal ballooning in 7%. Despite 13 patients experienced acute cardiac complications (pulmonary edema, cardiogenic shock, cardiac arrest) in all left ventricular systolic function normalized within 13.43W10.96 days. Conclusion Women in the postpartum period, notably after cesarean delivery, may represent another new vulnerable group at increased risk for TTS. TTS in postpartum period should be considered a clinical entity different from peripartum cardiomyopathy with specific clinical, therapeutic and prognostic implications. J Cardiovasc Med 2013, 14:000–000

We report a case of type A intramural aortic hematoma (IMH) occurred in a 78 years old female. The clinical scenario (medical history of hypertension, severe substernal chest pain, early diastolic decrescendo murmur as for aortic insufficiency), the laboratory results (no significant troponin level), ECG and transthoracic echocardiography findings (no signs of myocardial ischemia) shifted the initial diagnostic suspicion from acute coronary syndrome to the acute aortic syndrome (AAS) and triggered further imaging tests. Computed tomography revealed an aneurismatic dilatation with thickening of the wall of the ascending aorta without intimal flap. No particular “warning message” for evidence of AAS was sent to the clinician on call. Subsequently, due to the persisting high clinical suspicion transesophageal echocardiography (TEE) was performed. TEE confirmed the aneurysm of the ascending aorta and highlighted an extended and marked aortic wall thickness, consisting with the diagnosis of type A IMH. Patient underwent urgent cardiac surgery that confirmed the diagnosis.

We assessed the safety and efficacy of reconstructive therapy with facial fillers for the treatment of HIV-associated facial lipoatrophy (FLA) through a randomized, controlled, open-label single-center study. A total of 134 HIV-infected patients with severe FLA were randomly assigned to receive immediate (67 patients) or delayed (67 patients) facial injections of poly-l-lactic acid (PLA) or polyacrylamide gel (PAIG). Outcome measures included changes in physician and patient FLA severity scale, adverse events, and changes in health-related quality of life (HRQoL) and anxiety using validated measures. The mean average study follow-up was 27 weeks for the immediate and 25 weeks for the delayed subjects. Adverse events were mild and resolved after a mean of 4 days. Compared to patients randomized to the delayed treatment group, patients assigned to the immediate treatment group had significantly lower physician-rated (0.0 versus -3.0; p0.0001) and patient-rated (0.1 versus -1.8; p0.0001) FLA severity scores. By contrast, measures exploring HRQoL and anxiety did not show any significant difference between patients randomized to the immediate and deferred groups. Reconstructive therapy with facial fillers was effective and safe and led to significant improvements in FLA severity. However, no significant gains in HRQoL, relational and psychological consequences of body changes, and anxiety-related concerns were observed. Studies should be performed to identify patients who could maximally benefit from filling interventions for FLA.

R Bucciardini1, M Massella1, A Corpolongo2, P Narciso2, V Fragola1, M Mirra1, S Donnini1, O Viganò3, S Costarelli4, V Tozzi21Istituto Superiore di Sanità, Rome, Italy; 2IRCCS L. Spallanzani, Rome, Italy; 3Ospedale L. Sacco, Milan, Italy; 4Spedali Civili di Brescia, Brescia, ItalyAim: To evaluate the impact of health-related quality of life (HRQoL) enfuvirtide-based (ENF-based) salvage regimens of treatment-experienced HIV patients, in an observational multicenter cohort study.Methods: HRQoL was measured in a cohort of 16 patients over a 6-month follow-up using 2 instruments: the ISSQoL (Istituto Superiore di Sanità Quality of Life), a recently validated HIV-specific questionnaire; the EQ-5D (EuroQol), a generic widely used instrument. ENF was given at standard dosage along with an optimized background regimen.Results: Most of HRQoL dimensions showed improvement in ENF-treated patients at the post-baseline time points. Social functioning was the only dimension showing a negative effect. Monthly care costs of antiretroviral drugs for HIV patients taking ENF plus an optimized background regimen were approximately €2,348 per patient-month (range €382– €2,940).Conclusion: Our results show that the addition of ENF to an optimized background salvage-HAART may positively affect HRQoL not only in clinical trials but also in a sample population of patients used in a routine clinical practice.Keywords: enfuvirtide, HRQoL, HIV

The health-related quality of life (HRQoL) outcomes in HIV-infected, treatment-naive patients starting different HAART regimens in a 3-year, randomized, multinational trial were compared. HRQoL was measured in a subgroup of patients enrolled in the INITIO study (153/911), using a modified version of the MOS-HIV questionnaire. The regimens compared in the INITIO trial were composed by two NRTIs (didanosine + stavudine) plus either an NNRTI (efavirenz) or a PI (nelfinavir), or both (efavirenz + nelfinavir). Primary HRQoL outcomes were Physical and Mental Health Summary scores (PHS and MHS, respectively). During follow-up, an increase of PHS score was observed in all treatment arms. The MHS score remained substantially unchanged with the four-drug combination and showed with both NNRTI- and PI-based three-drug regimens a marked trend toward improvement, which became statistically significant when a multiple imputation method was used to adjust for missing data. Overall, starting all the combination regimens compared in the INITIO study was associated with a maintained or slightly improved HRQOL status, consistently with the positive immunological and virological changes observed in the main study. The observed differences in the MHS indicate a possible HRQoL benefit associated to the use of three-drug, two-class regimens and no additional benefit for the use of four-drug, three-class regimens, confirming that three-drug, two-class regimens that include two NRTIs plus either an NNRTI or a PI should be preferred as initial treatment of HIV infection.

We describe a case of a 72-year-old man, without known cardiovascular risk factors, who was referred to our hospital for new onset worsening angina. ECG on admission showed repolarization abnormalities in anterior leads without a noticeable increase in serum troponin levels. On the basis of clinical and instrumental findings, a coronary angiography was planned. The right femoral approach was intended for the procedure, as it was the standard and preferred access performed in our cathlab. Only a hydrophilic 0.35 in wire (Zip-wire, Boston, USA) was able to the progress along the vessel, due to a tortuosity of the common iliac artery. Not even the placement of a 6 F, 45-cm-long sheath (Arrow-Flex) was able to straighten a wide circular coil. An angiography confirmed this elongation, in a very peculiar shape of a ‘violin key’ (Panel A). It was, anyhow, possible to perform the coronary angiography, and a bare metal stent was implanted in the proximal tract of left anterior descending coronary artery to treat an ulcerated plaque, without complications (Panel B). Total procedural time was 32 min, and radiation dose was 92,657 Gy cm2. Due to a progressive reduction of hemoglobin from 12 g/‌dL to 10 g/dL, in order to exclude a hemorrhage, an angio-CT was performed which excluded any bleeding originating from iliac artery or aorta, and confirmed the wide loop of the common iliac artery (Panels C and ​DD). The contralateral iliac artery appeared only moderately sinuous. The etiology for the sudden drop in hemoglobin was ultimately not found. In our opinion, this occasional finding, neither common nor clinically significant, deserves to be reported because of its originality even though it did not impede to perform the planned coronary angiography. Fig. 1. Panel A: Peripheral angiography showing an elongated and ectatic right common iliac artery, assuming a ‘violin key’ shape. The arrow indicates the tip of a 45-cm-long sheath; Panel B: Angiography after bare metal stent implantation in ...

The NA62 experiment at the CERN SPS aims to measure the branching ratio of the very rare kaon decay $K^+ \rightarrow \pi^+ \nu \bar{\nu}$, collecting $\sim 100$ events with a 10\% background to make a stringent test of the Standard Model. The calorimeter level 0 trigger is used to suppress one of the main backgrounds, the $K^+ \rightarrow \pi^+ \pi^0$ decay, and to select events with a $\pi^+$ in the final state. The calorimeter level 0 trigger identifies clusters in the electromagnetic and hadronic calorimeters. It prepares time-ordered lists of reconstructed clusters together with the arrival time, position, and energy measurements of each cluster. It also provides trigger decisions based on complex combinations of energy and cluster multiplicity. The main parameters of the trigger processor are the high design hit rate (30 MHz) and the required single cluster time resolution (1.5 ns). The calorimeter trigger processor is a parallel system composed of 37 boards, 111 mezzanines and 221 high-performance programmable devices housed in three 9U crates. The design, operation and performances of the calorimeter level 0 trigger are presented.