[Devices for the prevention of contrast-induced acute kidney injury in interventional cardiology]

Contrast-induced acute kidney injury (CI-AKI) consists in acute decline in renal function following iodinated contrast media exposure. It has a significant impact on long-term prognosis and mortality, development of chronic kidney disease and on the rate of hospitalization due to cardiovascular or renal events. Anamnestic and procedural aspects linked to higher risk of CI-AKI have been investigated and new devices have been designed in order to prevent it. This paper deals with CI-AKI in interventional cardiology, focusing on patients' risk stratification, contrast media agent selection and contrast media volume reduction strategies, in order to suggest a standardized algorithm.

Ultrasound versus fluoroscopy-guided femoral access for percutaneous coronary intervention of chronic total occlusions: Insights from FOUND BLOOD CTO Registry

OBJECTIVE

To compare vascular complications in patients undergoing percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) using ultrasound guidance (USG) versus fluoroscopy guidance (FSG) for femoral access.

BACKGROUND

In patients undergoing PCI, using the arterial femoral access increases the risk of vascular complications compared using the radial access. USG reduces time to access, number of attempts, and vascular complications compared with FSG, but the efficacy of USG has never been tested in the setting of CTO-PCI.

METHODS

A total of 197 patients undergoing CTO-PCI using at least a femoral vascular access from November 2015 to September 2020 were screened. The primary outcome was a composite of local hematoma, pseudoaneurysm, retroperitoneal hemorrhage, arteriovenous fistula or hemoglobin drop ≥3 g/dL during hospitalization. The independent association between USG and the primary outcome of interest was explored.

RESULTS

The primary outcome occurred in 17.3% of patients. Patients in the USG group had a significantly lower incidence of vascular complications compared with patients in the FSG group (8.5% vs. 21.0%, p = 0.039), driven by a reduction of localized hematomas (3.4% vs 13.0%, p = 0.042). After adjustment for type of CTO approach and heparin dose, USG was significantly associated with a reduced relative risk of the composite primary outcome (adjusted odds ratio 0.16, 95% confidence interval 0.05 to 0.51; p = 0.002).

CONCLUSION

USG in CTO-PCI is associated with a decreased risk of vascular complications, primarily driven by a reduction in local hematomas, especially in complex CTO-PCI where the larger use of heparin increases the risk of vascular complications.

Does the left circumflex coronary artery location impact on the success of chronic total occlusion recanalization? A single-center cohort study

We sought to determine whether the chronic total occlusions (CTO) recanalization results differ between circumflex artery (CX) and other coronary arteries in our center. The study dataset encompassed 428 consecutive procedures. J-CTO score was highest in the right coronary artery (RCA) and lowest in CX lesions. After adjusting for the J-CTO score, age, body mass index, baseline creatinine, diabetes, dyslipidemia and hypertension the odds ratio for procedural success in CX compared to the other arteries was not statistically significant. We found no difference in success rates of recanalizing CTO in CX compared to other coronary arteries.

Using the coronary lithotripsy system for coronary artery disease

Severe coronary artery calcification increases percutaneous treatment complexity and the risk of intraprocedural complications, affecting acute and long-term outcomes. Current use of specialty balloons and atherectomy technologies is limited due to the higher risk of complications, degree of technical difficulty and operator experience. Intravascular lithotripsy (IVL) is a novel technology for severe calcified coronary artery disease that facilitates vessel preparation, enhancing vessel compliance. IVL system emits sonic waves that penetrate through vascular layers and disrupt both superficial and deep calcium, leaving the soft tissue unharmed. The purpose of the present review is to provide a summary of the evidence currently available on this therapy, including a practical description of the components and function of the shockwave coronary IVL system.

[Management of coronary perforations during angioplasty]

Coronary perforation represents a terrible complication of percutaneous coronary intervention (PCI) which, if not promptly recognized and treated, can lead to catastrophic consequences for the patient. Hence, acquisition of the basic techniques for the treatment of coronary perforations is critical for the interventional cardiologist in order to safely perform PCIs. Although the incidence of coronary perforations remains low during PCI, it is possible to recognize some subgroups of patients and some types of coronary lesions, such as chronic coronary total occlusions, that are associated with increased risk. The treatments currently available depend on the type and site of coronary perforation, therefore timely recognition is of paramount importance in order to be able to quickly establish the most appropriate treatment.

New forensic anthropological approachment for the age determination of human fetal skeletons on the base of morphometry of vertebral column

The anthropometrical study was carried out on 107 human fetal/newborn skeletons (54 male, 43 female, and 9 of unknown sex). The age of the individuals ranged from 4 to 10 lunar months. Each fetal or newborn vertebral region (cervical, thoracal and lumbar) has its own distinguishing features that are easily identifiable even in fragmentary bones. With our large sample size and extension of the age range studied, we are able to determine the fetal age with a considerable degree of accuracy from measurements defined in the vertebral ossification centers using regression equations. A simple rapid method for the identification and classification of fetal vertebral column bones has been contributed. The identification and classifications were carried out using discriminant functions. Knowledge of changes in vertebral column bones during fetal development is important in applied contexts of forensic and anthropology researches.

A multivariate method for classifying third to seventh cervical newborn vertebrae using bone measurements

This research provides a method to classify human newborn (9 to 10 lm) third to seventh cervical ossification centers. Nine linear measurements on the cervical neural arch were defined from 35 human neonates. Four discriminant functions were performed using the stepwise method. The model classifies 82.8% of grouped cases and 77.9% of cross-validated cases correctly. The model is useful in cases with isolated or commingled remains during anthropological or forensic investigations.

Estimation of fetal age from dimensions of atlas and axis ossification centers

The atlas and axis ossification centers of 106 human fetal and neonate skeletons were measured. The skeletons belong to the collection in the Department of Forensic Medicine of the Albert Szent-Györgyi Medical University, Szeged, Hungary. The age of the skeletons ranged from 4 to 10 lunar months. Nine linear measurements on the atlas, seven on the axis neural arches ossification centers and three on each one of the axis centra ossification centers were taken. We did simple and multiple linear regression analysis to estimate the age of fetuses. The results show that it is possible to use regression equations to estimate the fetal body length and age from atlas and axis ossification centers measurements during the whole period of development studied. The study of size and shape of the ossification centers using factorial analysis (principal component analysis) shows that the shape of the dens of the axis might be useful to estimate fetal viability.

Morphology of the cervical vertebrae in the fetal-neonatal human skeleton

The gross anatomical features of human cervical vertebrae during the fetal-neonatal period were investigated in order to develop morphological standards for the individual ossification centres for use in forensic and anthropological osteology. It was found that the morphology of the cervical vertebral arches and the centra cannot be used for the determination of fetal age although the dens of the axis displays some developmental differences which may be useful for the determination of fetal maturity.

Novel heterocyclic-fused pyridazinones as potent and selective phosphodiesterase IV inhibitors

A series of 6-aryl-4,5-heterocyclic-fused pyridazinones were designed and synthesized as selective phosphodiesterase (PDE) IV inhibitors. Biological evaluation of these compounds demonstrated a good selectivity profile toward the PDE IV family and greatly attenuated affinity for the Rolipram high-affinity binding site that seems to be responsible for undesiderable side effects. Structure-activity relationships (SARs) studies showed that the presence of an ethyl group at pyridazine N-2 is associated with the best potency and selectivity profile.

Enzymatic characterization of E.U.E. (embryonal human explants) cells adapted to hypertonic media

E.U.E. cells (general population) were submitted to biochemical and cytoenzymatic tests to compare the enzymatic profile of E.U.E. cells (controls) with that of E.U.E. adapted to hypertonic medium. The adapted cells are characterized by very high oxoreductase activity (LDH, HBDH, G-6-P DH) and very high alkaline-phosphatase activity. Clones derived from general population were also submitted to biochemical tests to characterize those more strictly related to the enzymatic profile of adapted cells. The profile of clone N. 13 resembles on this respect that of the adapted cells. The high redox activity is a prerequisite supporting energy supply for osmotic work. The increased activity of plasma membrane enzymes of the adapted cells is also demonstrable in cells exposed for short time to salinity.

[Atherosclerosis: a childhood problem]

The project "Precursors of Atherosclerosis (ATS) in Children" following the protocol of WHO started in Modena in 1981/82. A total of 527 schoolchildren of 6, 9, 12 and 15, living in the area around Modena, Emilia Romagna Region, were examined, sampled from whole schools or classes. Each group exceeds the minimum of 100 children with the exception of the group including subjects of 15. The population sampled is fairly homogeneous. There are no immigrants to the area and the intra-population differences due to social-classes are minimal. The standard of life is very high: the rate of income is one of the highest in Italy and the incidence of ATS manifestations is very high. The children will be reexamined each year for three years at the same season and the study will be over in 1984. A questionnaire with family story has been filled by the parents and the parents were directly examined about: height, blood pressure, cholesterolemia, triglyceridemia, smoking habit. Following the protocol in each child are determined: height, weight, Quetelet's index (kg/m2), skinfold thickness, blood pressure, cholesterolemia, triglyceridemia, sexual maturity and smoking habit. The statistical elaboration methods of data are chosen in cooperation with the "Centro di Calcolo" of the University of Modena, and elaborated with the Statistical Package for the Social Science (SPSS) method.