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BackgroundThis is the first meta-analysis to analyze all reports of published pediatric cases of cervical aortic arch (CAA) by highlighting the clinical characteristics and treatment outcomes using the reported individual data of the patients. The aim of the study is to investigate the clinical features and surgical outcomes of such a rare disease in the pediatric population.MethodsA comprehensive search was conducted in various academic databases, including PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library, until June 2022 for case reports describing the presence of cervical aortic arch in the pediatric age. Case reports and series were included if the following criteria were met: (1) description of the cervical aortic arch; (2) patient of pediatric age; and (3) published in the English language. All other types of publications that lacked patient-specific information were excluded from the analysis. This systematic review was conducted in accordance with the PRISMA guidelines. The primary outcome measure of the analysis was early and late mortality.ResultsThe literature search identified 2,272 potentially eligible articles, 72 of which met our inclusion criteria with 96 patients including the author's institutional case. At a median of 365 (90–730) days, the overall cohort registered a 7.3% (7/96) mortality rate. In the subset of patients who underwent surgery, the mortality rate was also 7.3% (4/55), and the mortality rate following surgery to treat only CAA was 2.4% (1/42). Dyspnea was identified as an independent determinant of mortality by employing the univariable Firth bias-reduced logistic regression method.ConclusionCervical aortic arch is a rare congenital heart disease that poses treatment challenges due to the high anatomical variability, diverse clinical presentations, and the presence of other concomitant diseases. The surgical treatment appears to be a safe and effective approach for resolving the symptoms, although it needs to be tailored individually for each patient.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346826, Identifier: CRD42022346826.

With the growing rate of automated vehicles (AVs) at the lower level of automation, the experimental tests are also in progress with vehicles at higher levels. In the absence of extended digital infrastructures and deployment of level 5 full automated vehicles, the physical infrastructure is required to maintain a fundamental role to enable their introduction in public roads. This paper focuses on lane support system (LSS) whose operational design domain (ODD) is strongly connected to the road characteristics and conditions. An experimental test was carried out with a state of the art, and LSS and advanced technologies were used for road monitoring on different roads under various environmental conditions including dry, wet pavements and rain. We applied the generalized estimation equation for logistic regression to account within-cluster homogeneity which is induced by repeated measures on the same road sections. Statistical models allow the identification of variables that are significant for the LSS fault probability among various effects of road features including marking, pavement distress, weather conditions, horizontal curvature, and cross section. Results pointed out the relevance of the wet retro-reflection of marking (RLw) and the horizontal curvature in the definition of ODD for LSS. Threshold values have been proposed for the tested LSS. Wet pavement doesn't affect the LSS performance when compared to the dry condition. Rain was shown to be critical even with very good road characteristics.

Background: The increasing complexity of congenital cardiac surgery has led to greater utilization of extracorporeal membrane oxygenation (ECMO) support for children post‐surgery. This study aims to identify risk factors for mortality and brain injury in pediatric patients requiring post‐cardiotomy ECMO and to evaluate their neurological outcomes. Methods: This retrospective study includes pediatric patients with congenital heart diseases who required ECMO after surgery. Risk factors for in‐hospital mortality and brain injury were assessed. Neurodevelopmental status was determined using the Pediatric Cerebral Performance Category (PCPC) Scale at discharge and during follow‐up. Results: Between October 2014 and May 2021, 2651 pediatric patients underwent cardiac surgery, with 90 (3.4%) requiring ECMO. The mean age was 0.6 years, ranging from 1 day to 13 years and 7 months. ECMO was implemented for 45 patients due to CPB weaning failure (NW‐CPB), 24 due to postoperative low‐cardiac output syndrome (LCOS), and 21 for extracorporeal cardiopulmonary resuscitation (E‐CPR). ECMO weaning was achieved in 73 patients (81%), with an overall mortality rate of 36%. Pre‐implant lactate levels (OR: 1.13, 95% CI: 1.03–1.25; p = 0.009) and peak bilirubin levels (OR: 1.04, 95% CI: 0.87–1.24; p = 0.69) were risk factors for in‐hospital mortality. Survival rates were 79% for LCOS, 60% for NW‐CPB, and 48% for E‐CPR. Brain injury incidence was 33%, with E‐CPR being a significant risk factor (p = 0.006) and NW‐CPB being protective (p = 0.001). Follow‐up in November 2023 showed significant improvement in neurodevelopmental status (p < 0.001). Conclusion: Elevated pre‐implant lactate and elevated bilirubin levels during ECMO are major risk factors for mortality. E‐CPR is the primary risk factor for brain injury. Follow‐up revealed significant improvements in neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

We describe a case of a voluminous rhabdomyoma (R) detected by fetal echocardiography at 32 weeks’ gestation (w.g.) obstructing the left ventricular inflow and aortic outflow tract, with a moderate aortic gradient at birth, not needing immediate surgery. At follow-up, the mass progressively regressed, leaving the aortic valve partly damaged, with a gradient that increased to a maximum of 100 mmHg at 9 years. The girl was then operated on successfully by a plasty of the aortic valve. The literature regarding R is discussed.

The Mediterranean Basin is involved in a recurring phenomenon wherein air masses laden with dust from North Africa impact the southern regions of the European continent. Saharan dust has been associated with increased mortality and respiratory symptoms. Palermo is a large coastal city, and in addition to the impact of desert dust particles, it has a mixture of anthropogenic sources of pollutants. In this study, we collected Saharan dust samples during August 2022 and October 2023, following a high-intensity Saharan dust event, and measured concentrations of 33 major and trace elements as well as Rare Earth Elements (REE). The mineralogical characterization of the deposition dust collected during Saharan events revealed calcite, dolomite, quartz, and clay minerals. The presence of palygorskite is indicative of Saharan events. Seven elements (Ca, Mg, Al, Ti, Fe, K, and Na) account for 98% of the total analyzed inorganic burden. Elemental ratios are valuable tools in atmospheric sciences for estimating sources of air masses. The results highlight that the city of Palermo is mainly affected by dust from the north-western Sahara.

Minimally invasive surgeries for pediatric patients have been proposed for decades, with different approaches in mind. Minimal right axillary thoracotomy (MRAT), proposed two decades ago, allows the preservation of patients’ safety alongside faster aesthetic and functional recovery. The MRAT did not become widely adopted due to the prejudice that to follow a minimally invasive approach, safety and efficacy must be compromised. With this study, we aim to compare MRAT to the standard median sternotomy approach with a focus on safety and clinical outcomes. Between January 2017 and April 2021, 216 patients diagnosed with ASD, pAVSD, or PAPVD underwent surgical repair with different approaches in the same period. MRAT was used for 78 patients, and median sternotomy was used for 138 patients. In this last group, standard median sternotomy (SMS) was used for 116 patients, while a minimal skin incision (SMS mini) was used for 22 patients. There were no major complications overall nor in each specific approach. MRAT enabled the successful repair of simple heart defects, providing similar post-operative and cardiological recovery. MRAT does not compromise patients’ safety and does not prolong the duration of surgery once the learning curve is overcome, which is generally after 15–20 consecutive operations.

Human exposure to certain metals occurs indirectly through diet. This study was conducted to determine the content of Pt and Pd in fruiting bodies of Boletus aereus Bull. collected from several wooded areas of Sicily with different substrates (sedimentary and volcanic) with limited anthropogenic influence. Determinations were performed by coupled plasma-mass spectrometry (ICP–MS) to quantify Pt and Pd. The concentrations of investigated Pt and Pd in mushroom samples ranged from 0.31 to 3.09 ng g−1 for palladium and 0.21 to 4.22 ng g−1 for platinum. The results of the present study suggest that commonly consumed Boletus aereus mushrooms do not accumulate significant levels of Pt and Pd as demonstrated by bioconcentration factor (BCF) values, and their content is lower than in other food products. Additionally, based on the calculated daily intake rates of Pt and Pd, it can be concluded that occasional consumption of fruiting bodies of B. aereus collected in Sicily is safe. The proposed methodological approach appears to be fully adequate for the reliable quantification of Pt and Pd. The data obtained in this investigation confirm that mushrooms are probative of a significant portion of the total exposure to PGEs due to the diet.

Iron emissions from human activities, such as oil combustion and smelting, affect the Earth's climate and marine ecosystems. These emissions are difficult to quantify accurately due to a lack of observations, particularly in remote ocean regions. In this study, we used long‐term, near‐source observations in areas with a dominance of anthropogenic iron emissions in various parts of the world to better estimate the total amount of anthropogenic iron emissions. We also used a statistical source apportionment method to identify the anthropogenic components and their sub‐sources from bulk aerosol observations in the United States. We find that the estimates of anthropogenic iron emissions are within a factor of 3 in most regions compared to previous inventory estimates. Under‐ or overestimation varied by region and depended on the number of sites, interannual variability, and the statistical filter choice. Smelting‐related iron emissions are overestimated by a factor of 1.5 in East Asia compared to previous estimates. More long‐term iron observations and the consideration of the influence of dust and wildfires could help reduce the uncertainty in anthropogenic iron emissions estimates. Plain Language Summary: Human activities, such as smelting and oil combustion, release smoke and particles into the atmosphere. These particles often contain iron, which not only absorbs sunlight, contributing to atmospheric warming, but also serves as a nutrient for phytoplankton in various ocean regions. However, the precise extent of human‐induced iron emissions remains uncertain due to a lack of comprehensive monitoring data. In this study, we leverage a global data set of iron observations to refine our estimates of iron emissions attributed to human activities. Additionally, we examine other co‐released substances, such as carbon and nickel, to identify specific emission sources of iron. We employ statistical techniques to distinguish human‐caused iron emissions from those originating from natural sources like dust and wildfires. Moreover, we utilize iron oxide observations to constrain emissions originating from East Asia and Norway, which are estimated to originate largely from smelting emissions. Through the analysis of long‐term data sets, we provide lower and upper bounds to human‐caused iron emissions. Furthermore, we investigate the impact of reduced observation numbers and a sparse network on the range of estimated iron emissions. Our findings highlight the critical role of observation quality in accurately assessing iron emissions from human activities. Key Points: Anthropogenic total iron emissions are constrained to a factor of 3 in most global regions using long‐term aerosol observationsThe number of sites, interannual variability, and site selection filter can affect the model‐observation comparison uncertainty by 15%–50%Smelting‐related emissions are constrained to a factor of 1.5 using iron oxide observations from East Asia [ABSTRACT FROM AUTHOR]

BackgroundThe effectiveness of veno-arterial extracorporeal life support (V-A ECLS) in treating neonatal and pediatric patients with complex congenital heart disease (CHD) and requiring cardio-circulatory assistance is well-known. Nevertheless, the influence of left ventricle (LV) distension and its countermeasure, namely LV unloading, on survival and clinical outcomes in neonates and children treated with V-A ECLS needs still to be addressed. Therefore, the aim of this study was to determine the effects of LV unloading on in-hospital survival and complications in neonates and children treated with V-A ECLS.MethodsThe clinical outcomes of 90 pediatric patients with CHD under 16 years of age supported with V-A ECLS for post-cardiotomy cardiogenic shock (CS) were retrospectively reviewed in relationship with the presence or absence of an active LV unloading strategy.ResultsThe patient cohort included 90 patients (age 19.6 ± 31.54 months, 64.4% males), 42 of whom were vented with different techniques (38 with atrial septostomy (AS) or left atria cannula, two with cannula from LV apex, 1 with intra-aortic balloon pump (IABP), and one with pigtail across the aortic valve). The LV unloading strategy significantly increased the in-hospital survival (odds ratio [OR] = 2.74, 95% CI 1.06–7.08; p = 0.037). On the contrary, extracorporeal cardiopulmonary resuscitation decreased the related survival (OR = 0.32, 95% CI 1.09–0.96; p = 0.041). The most common complications were infections (28.8%), neurological injury (26%), and bleeding (25.6%). However, these did not differently occur in venting and no-venting groups.ConclusionIn pediatric patients with CHD supported with V-A ECLS for post-cardiotomy CS, the LV unloading strategy was associated with increased survival.

Abstract Background We aimed to evaluate the degree of realism and involvement, stress management and awareness of performance improvement in practitioners taking part in high fidelity simulation (HFS) training program for delivery room (DR) management, by means of a self-report test such as flow state scale (FSS). Methods This is an observational pretest-test study. Between March 2016 and May 2019, fourty-three practitioners (physicians, midwives, nurses) grouped in multidisciplinary teams were admitted to our training High Fidelity Simulation center. In a time-period of 1 month, practitioners attended two HFS courses (model 1, 2) focusing on DR management and resuscitation maneuvers. FSS test was administred at the end of M1 and M2 course, respectively. Results FSS scale items such as unambiguous feed-back, loss of self consciousness and loss of time reality, merging of action and awareness significantly improved (P

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

More than 4 millions of children with congenital heart disease (CHD) are waiting for cardiac surgery around the world. Few of these patients are treated only thanks to the support of many non-governmental organizations (NGOs). Starting in December 2019, the so-called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic and has dramatically impacted on all the international humanitarian activities for congenital heart disease. We analyzed data from all the Italian congenital cardiac surgery centers with the aim to quantify the impact of the pandemic on their charities. Fifteen Italian centers participated in the study and contributed to data collection. We analyzed and compared data regarding humanitarian activities carried out abroad and on site from two periods: year 2019 (pre-COVID-19) and year 2020 (COVID-19 pandemic). In 2019, 53 international missions were carried out by Italian congenital cardiac surgeons, resulting in the treatment of 471 CHD patients. In the same period 11 Italian cardiac centers operated on 251 foreign patients in Italy. In 2020, the pandemic led to a reduction of this activity by 96% for the surgery performed overseas and 86% for the interventions carried out in Italy. In conclusion our study shows the important quantitative impact of the pandemic on the Italian humanitarian cardiac surgical activity overseas and in Italy. This shocking result highlights the failure of the systems adopted so far to solve the problem of CHD in developing countries.

Mining is defined as an environmentally hazardous activity that releases metals and other elements to the environment. Bioremediation is a natural and sustainable technique for harnessing the potential of microorganisms and plants to remove, degrade, or stabilize pollutants from contaminated sites and enable cleanup and restoration of the environment. In the present study, following the investigation of pollution of heavy metals in soil samples collected from the Zarshuran mining area, the role of twenty native plant species in the bioaccumulation of heavy metals was evaluated. After preparation of soil and plant samples, inductively coupled plasma-mass spectroscopy (ICP-MS) was used to determine the concentrations of elements in the soil and plant samples. It was confirmed that the soil samples were highly contaminated by silver (Ag), zinc (Zn), cadmium (Cd), lead (Pb), and antimony (Sb). High amounts of Pb and Zn were accumulated in Eryngium billardieri and Astragalus rostratus. Further, these two plant species could uptake, transport, and accumulate Ag in their aerial parts and the enrichment coefficient of their shoots was more than 1. Scorzonera latifolia also had good potential to stabilise Ag, Zn, and Pb in its root. As a result, E. billardieri, A. rostratus, and S. latifolia may be suitable candidate species to clean heavy metals from soils in contaminated sites. Overall, augmentation of superoxide dismutase activity and the amounts of total phenols and flavonoids in different parts of E. billardieri and A. rostratus confirmed the induction of antioxidant defense systems in the plants (compared to the control plants) and an attempt by the plants to tolerate heavy metal pollution. [ABSTRACT FROM AUTHOR]

Nanostructured lipid carriers (NLC) have been widely studied as delivery systems for a variety of routes, including the skin. Their composition results in an imperfect lipid matrix, allowing increased drug encapsulation. Allopurinol (AP), a xanthine oxidase inhibitor, is characterized by low water solubility and high melting point, which has hampered its use through the topical route. In this work, AP was incorporated in a NLC formulation to enhance drug-carrier association and skin delivery as a topical approach to treat wounds. AP-NLC system was characterized in terms of size, charge, rheological behavior, and in vitro skin permeation. The in vitro cytotoxicity was evaluated using HaCaT cells. The wound healing efficacy of the AP-NLC formulation on animal skin lesions was evaluated in male Wistar rats. The AP-NLC presented a mean size of 193 ± 15 nm with a PdI of 0.240 ± 0.02, zeta potential values around −49.6 mV, and an encapsulation efficiency of 52.2%. The AP-NLC formulation presented an adequate profile to be used topically, since epidermal and dermal drug retention were achieved. No reduction in HaCaT cells viability was observed at the tested concentrations (AP < 10 μg/mL). The in vivo application of the AP-NLC formulation resulted in the regeneration of skin lesions when compared with non-treated controls.