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ObjectiveTo characterise in vivo the microstructural abnormalities of multiple sclerosis (MS) normal-appearing (NA) cortex and cortical lesions (CLs) and their relations with clinical phenotypes and disability using neurite orientation dispersion and density imaging (NODDI).MethodsOne hundred and seventy-two patients with MS (101 relapsing–remitting multiple sclerosis (RRMS), 71 progressive multiple sclerosis (PMS)) and 62 healthy controls (HCs) underwent a brain 3T MRI. Brain cortex and CLs were segmented from three-dimensional T1-weighted and double inversion recovery sequences. Using NODDI on diffusion-weighted sequence, intracellular volume fraction (ICV_f) and Orientation Dispersion Index (ODI) were assessed in NA cortex and CLs with default or optimised parallel diffusivity for the cortex (D//=1.7 or 1.2 µm2/ms, respectively).ResultsThe NA cortex of patients with MS had significantly lower ICV_f versus HCs’ cortex with both D// values (false discovery rate (FDR)-p 2/ms. No CL microstructural differences were found between MS clinical phenotypes. MS NA cortex ICV_f and ODI were significantly correlated with disease duration, clinical disability, lesion burden and global and regional brain atrophy (r from −0.51 to 0.71, FDR-p from ConclusionsA significant neurite loss occurs in MS NA cortex. CLs show a further neurite density reduction and a reduced ODI suggesting a simplification of neurite complexity. NODDI is relevant to investigate in vivo the heterogeneous pathology affecting the MS cortex.

Neuropsychiatric manifestations are highly prevalent in systemic lupus erythematosus (SLE)-patients. We aimed to unravel the substrates of these manifestations by investigating abnormalities of resting state (RS) functional connectivity (FC) and their correlations with neuropsychiatric variables in SLE-patients. Thirty-two SLE-patients and 32 age- and sex-matched healthy controls (HC) underwent brain 3T RS fMRI. Neuropsychological assessment was performed for all SLE-patients. The main large-scale cognitive and psychiatric functional networks were derived and between-group comparisons and correlations with neuropsychological measures were performed. Compared to HC, SLE-patients exhibited increased RS FC in the right middle cingulate cortex and decreased RS FC in the left precuneus within default-mode network (DMN). They also showed increased RS FC in the left cerebellar crus I and left posterior cingulate cortex, and decreased RS FC in the left angular gyrus within working-memory networks (WMN). Compared to HC, SLE-patients exhibited increased RS FC in the left insular cortex and decreased RS FC in the right anterior cingulate cortex within salience network (SN), as well as decreased RS FC in the right middle frontal gyrus within executive-control network (ECN). Correlation analysis indicated a maladaptive role for left angular gyrus and cerebellar RS FC abnormalities in WMN, affecting memory and executive functions; and for precuneus and insular abnormalities in DMN and SN for psychiatric symptoms. Cingulate cortex modifications within DMN and SN correlated with better memory and global cognitive performance. Significant RS FC alterations in relevant cognitive and psychiatric networks occur in SLE-patients and participate in the pathophysiology of neuropsychiatric symptoms.

Objective: To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration.Design: Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years.Setting: In-hospital, early, and mid-term outcomes.Participants: Eighty-eight patients were included in the analysis.Interventions: Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR.Measurements and Main Results: In the ViV-TAVI group, patients were older (79.1 +/- 7.4 v 67.2 +/- 14.1, p < 0.01). The total operative time, intubation time, intensive care unit length of stay, total hospital length of stay, inotropes infusion, intubation >24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI = 3.2% v re-SAVR = 8.8%, p = 0.27), patient-prosthesis mismatch (ViV-TAVI = 12 patients [mean 0.53 +/- 0.07] and re-SAVR = ten patients [mean 0.56 +/- 0.08], p = 0.4), stroke (ViV-TAVI = 3.2% v re-SAVR = 7%, p = 0.43), acute kidney injury (ViV-TAVI = 9.7% v re-SAVR = 15.8%, p = 0.1), and all-cause infections (ViV-TAVI = 0% v re-SAVR = 8.8%, p = 0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p = 0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI = 0 v re-SAVR = 13.4%, p < 0.01). There were no differences in reintervention (ViV-TAVI = 3.8% v re-SAVR = 0%, p = 0.32) and survival (ViV-TAVI = 83.9% v re-SAVR = 93%, p = 0.10) between the two cohorts.Conclusions: ViV-TAVI is a safe, feasible, and reliable procedure. (c) 2021 The Authors. Published by Elsevier Inc.

Objective The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG). Methods We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method. Results The incidence of death (1.2% [95% confidence interval, CI: –0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: –1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: –3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: –0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: –0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: –0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group. Conclusions The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.

Acute cholecystitis in severely cardiopathic patients after major cardiac surgery represents a challenge for surgeons. Treatment with cholecystostomy, may offer a chance to these patients, however there is still a number of controversial issues on the topic: performance surgical techniques (transhepatic or transpapillary), optimal duration and timing of drain removal, the need for further tests before removal as well as the timing for definitive surgery. We therefore deemed it important to share our experience of a multidisciplinary approach for the definitive treatment of this patient with severe heart disease. A percutaneous cholecystostomy was the chosen strategy for a 58-year-old cardiopathic patient who had undergone surgery for hip replacement and had developed acute calculous cholecystitis a few days after surgery. Two weeks after discharge, a cholangiography through the cholecystostomy and an MRI cholangiopancreatography revealed the presence of stones in the cystic duct and in the ductus choledochus. The definitive treatment was decided after consulting with a multidisciplinary team. The choice was to perform an open cholecystectomy with simultaneous removal of the cholecystostomy, endoscopic removal of stones and sphincterotomy of the Oddi papilla. Currently, the patient is healthy and his heart function satisfactory. Although early cholecystectomy is the recommended choice for acute cholecystitis, a patient with severe co-morbidities may benefit from a bridging therapy before definitive surgery and a multidisciplinary approach can provide a safer solution.

Objective To analyze predictors that influence the learning curve of minimally invasive mitral valve surgery (MIMVS). Methods Patients who underwent MIMVS between March 2010 to March 2015 were retrospectively analyzed. Predictive factors that influence the learning curve were analyzed. Results One hundred and five patients were included in the analysis. Cardiopulmonary bypass (CPB) time in minutes was 158.72 +/- 40.98 and the aortic cross-clamp (ACC) time in minutes was 114.48 +/- 27.29. There were three operative mortalities, one stroke and five >2+ mitral regurgitation. ACC time in minutes was higher in the low logistic Euroscore II (LES) group (LES = 5 = 88.66 +/- 22.26),P = 5% = 41.66 +/- 17.14), (P

The aim was to use a propensity score-based analysis to determine the impact of peripheral artery disease (PAD) on early outcomes after coronary artery bypass surgery grafting (CABG) in patients with PAD.We conducted a multicentre retrospective analysis of 11,311 consecutive patients who underwent CABG between 1997 and 2017. Patients with previous or concomitant vascular surgery were excluded. The main endpoints were death, stroke, and limb ischaemia requiring percutaneous or surgical revascularisation. Subgroup analyses were performed to test the interaction of PAD with concomitant factors.There was no difference in mortality in patients with and without PAD (p=0.06 and p=0.179, respectively). Patients with PAD had a greater incidence of stroke (p=0.04), acute kidney disease (p=0.003), and limb ischaemia requiring interventions (p0.001) than those without PAD. The use of off-pump or no-touch aortic techniques did not influence the effect of PAD on the outcomes. Early mortality rate increased in patients with PAD when associated with long cardiopulmonary bypass, cross-clamp times (both p0.001), and postoperative low cardiac output (p=0.01).The presence of PAD is associated, independently of other factors, with greater incidence of stroke, acute kidney disease, and limb ischaemia following CABG, irrespective of the technique employed. Operative mortality was greater in patients with PAD only when associated with long cardiopulmonary bypass and aortic cross-clamp times, and low cardiac output.

OBJECTIVES: Ministernotomy and right anterior minithoracotomy are the 2 main techniques applied for minimally invasive aortic valve replacement. The goal of this study is to compare early and long-term outcomes of both techniques.METHODS: The data of 2419 patients undergoing isolated minimally invasive aortic valve replacement between 1999 and 2019 were prospectively collected. Retrospectively, patients were divided into the ministernotomy group (n = 1352) and the minithoracotomy group (n = 1067).RESULTS: After propensity score matching, 986 patients remained in each group. Operation time and rate of conversion to full sternotomy were significantly higher in the minithoracotomy group than in the ministernotomy group (184.6 ± 45.2 vs 241.3 ± 68.6, relative risk, 2.54, P = .005 and .09 vs .23, relative risk, 1.45, P = .013, respectively). The 30-day mortality, excluding cardiac death, was lower in the ministernotomy group than in the minithoracotomy group (0.012 vs 0.028, relative risk, 1.41, P = .011, respectively); the intensive care unit length of stay (12.4 vs 16.5, relative risk, 1.62, P = .037, respectively) and hospital length of stay (5.4 vs 8.7, relative risk, 1.74 P = .028, respectively) were significantly longer in the minithoracotomy group. The minithoracotomy surgical approach was the strongest independent predictor of early mortality (odds ratio, 4.24 [1.67-7.35], P = .002). The actuarial survival by Kaplan-Meier analysis at 1, 3, 5, 10, and 20 years was significantly better in the ministernotomy group than in the minithoracotomy group (P = .0001). Actuarial freedom from reoperation at 5 years was 97.3% ± 4.4% in the ministernotomy group versus 95.8% ± 5.2% in the minithoracotomy group (P = .087).CONCLUSIONS: Minimally invasive aortic valve replacement using ministernotomy is associated with reduced operative time, intensive care unit stay, hospital length of stay, and postoperative morbidities and incisional pain, and improves early and long-term mortality.

This article presents a conceptual and methodological framework to study heritage-based tribalism in Big Data ecologies by combining approaches from the humanities, social and computing sciences. We use such a framework to examine how ideas of human origin and ancestry are deployed on Twitter for purposes of antagonistic ‘othering’. Our goal is to equip researchers with theory and analytical tools for investigating divisive online uses of the past in today’s networked societies. In particular, we apply notions of heritage, othering and neo-tribalism, and both data-intensive and qualitative methods to the case of people’s engagements with the news of Cheddar Man’s DNA on Twitter. We show that heritage-based tribalism in Big Data ecologies is uniquely shaped as an assemblage by the coalescing of different forms of antagonistic othering. Those that co-occur most frequently are the ones that draw on ‘Views on Race’, ‘Trust in Experts’ and ‘Political Leaning’. The framings of the news that were most influential in triggering heritage-based tribalism were introduced by both right- and left-leaning newspaper outlets and by activist websites. We conclude that heritage-themed communications that rely on provocative narratives on social media tend to be labelled as political and not to be conducive to positive change in people’s attitudes towards issues such as racism.

Objective The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis.Methods Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. A 9-year clinical follow-up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9-year outcomes.Results Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, p = 0.02) and high-efficacy treatment exposure (HR = 0.31, p = 0.005). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (beta = -0.15, p < 0.001), cervical cord lesions (beta = 0.16, p = 0.003), and high-efficacy treatment exposure (beta = -0.14, p = 0.01); considering also 1-year variables, number of relapses (beta = 0.14, p = 0.002), and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year: beta = -0.12, p = 0.01) entered, whereas high-efficacy treatment exposure exited the model. Predictors of 9-year disability worsening were: at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, p = 0.01); considering 1-year and 2-year variables, Expanded Disability Status Scale (EDSS) changes (1-year: OR = 26.05, p < 0.001; 2-year: OR = 16.38, p = 0.02), and >= 2 new T2-lesions in 2 years (2-year: OR = 4.91, p = 0.02). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (beta = 0.58, p < 0.001), presence of brainstem lesions (beta = 0.31, p = 0.04), and number of cervical cord lesions (beta = 0.22, p = 0.05); considering 1-year and 2-year variables, EDSS changes (1-year: beta = 0.79, p < 0.001; 2-year: beta = 0.55, p < 0.001), and >= 2 new T2-lesions (1-year: beta = 0.28, p = 0.03; 2-year: beta = 0.35, p = 0.01).Interpretation A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021

Importance: Cognitive impairment is a common and disabling feature of multiple sclerosis (MS), but a precise characterization of cognitive phenotypes in patients with MS is lacking. Objectives: To identify cognitive phenotypes in a clinical cohort of patients with MS and to characterize their clinical and magnetic resonance imaging (MRI) features. Design, Setting, and Participants: This multicenter cross-sectional study consecutively screened clinically stable patients with MS and healthy control individuals at 8 MS centers in Italy from January 1, 2010, to October 31, 2019. Patients with MS and healthy control individuals who were not using psychoactive drugs and had no history of other neurological or medical disorders, learning disability, severe head trauma, and alcohol or drug abuse were enrolled. Main Outcomes and Measures: Participants underwent a neurological examination and a cognitive evaluation with the Rao Brief Repeatable Battery and Stroop Color and Word Test. A subgroup of participants also underwent a brain MRI examination. Latent profile analysis was used on cognitive test z scores to identify cognitive phenotypes. Linear regression and mixed-effects models were used to define clinical and MRI features of each phenotype. Results: A total of 1212 patients with MS (mean [SD] age, 41.1 [11.1] years; 784 women [64.7%]) and 196 healthy control individuals (mean [SD] age, 40.4 [8.6] years; 130 women [66.3%]) were analyzed in this study. Five cognitive phenotypes were identified: Preserved cognition (n = 235 patients [19.4%]), mild-verbal memory/semantic fluency (n = 362 patients [29.9%]), mild-multidomain (n = 236 patients [19.5%]), severe-executive/attention (n = 167 patients [13.8%]), and severe-multidomain (n = 212 patients [17.5%]) involvement. Patients with preserved cognition and mild-verbal memory/semantic fluency were younger (mean [SD] age, 36.5 [9.8] years and 38.2 [11.1] years) and had shorter disease duration (mean [SD] 8.0 [7.3] years and 8.3 [7.6] years) compared with patients with mild-multidomain (mean [SD] age, 42.6 [11.2] years; mean [SD] disease duration, 12.8 [9.6] years; P

Background and ObjectivesTo investigate whether age at onset influences brain gray matter volume (GMV) and white matter (WM) microstructural abnormalities in adult patients with multiple sclerosis (MS), given its influence on clinical phenotype and disease course.MethodsIn this hypothesis-driven cross-sectional study, we enrolled 67 patients with pediatric-onset MS (POMS) and 143 sex- and disease duration (DD)–matched randomly selected patients with adult-onset MS (AOMS), together with 208 healthy controls. All participants underwent neurologic evaluation and 3T MRI acquisition. MRI variables were standardized based on healthy controls, to remove effects of age and sex. Associations with DD in patients with POMS and patients with AOMS were studied with linear models. Time to reach clinical and MRI milestones was assessed with product-limit approach.ResultsAt DD 1 year, GMV and WM fractional anisotropy (FA) were abnormal in AOMS but not in POMS. Significant interaction of age at onset (POMS vs AOMS) into the association with DD was found for GMV and WM FA. The crossing point of regression lines in POMS and AOMS was at 20 years of DD for GMV and 14 for WM FA. For POMS and AOMS, median DD was 29 and 19 years to reach Expanded Disability Status Scale score 3 (p < 0.001), 31 and 26 years to reach abnormal Paced Auditory Serial Addition Task, 3-second version (p = 0.01), 24 and 18 years to reach abnormal GMV (p = 0.04), and 19 and 17 years to reach abnormal WM FA (p = 0.36).DiscussionYounger patients are initially resilient to MS-related damage. Then, compensatory mechanisms start failing with loss of WM integrity, followed by GM atrophy and finally disability.

Background We carried out a propensity score-based analysis on early outcomes after coronary artery bypass grafting (CABG) in patients with and without peripheral artery disease (PAD). Materials and Methods A total of 11 311 patients undergoing isolated CABG between 1997 and 2017 were included in the study. Patients were divided into two groups based on whether they were affected (n = 1961) or not affected (n = 9350) by PAD. Inverse probability of treatment weighting was employed to reduce confounding preoperative and operative variables. The main endpoints were death, cardiac death, stroke, and limb ischemia requiring percutaneous or surgical revascularization. Results The excellent balance was obtained, and the groups were very similar. For death and cardiac death, there were no differences between patients with and without PAD (P = .06 and P = .179, respectively). In contrast, PAD patients showed a higher incidence of stroke (P = .04), acute kidney disease (AKD) (P = .003) and limb ischemia requiring intervention (P

Background: Ischemic stroke after coronary artery bypass (CABG) has been often linked to aortic manipulation during surgery. Objectives: The objective of the study was to estimate the rate of postoperative ischemic stroke within 30 days from CABG by surgical risk factors alone or in combination. Methods: The multinomial propensity score for multiple treatments was used to create six models with a total of 16,255 consecutive patients undergoing isolated CABG. For each model, a different classification variable was used to stratify patients. Results: Balance achieved in all models was substantial, enabling unbiased estimation of the treatment estimand. Both off-pump techniques with (0.009; 95% CI 0.006–0.011) or without proximal anastomoses (0.005; 0.005–0.003), and surgery performed on the beating heart using cardiopulmonary bypass with (0.009; 0.006–0.011) or without proximal anastomoses (0.024; 0.021–0.029) showed a mean stroke estimate significantly lower than the other techniques. Off-pump surgery and on-pump surgery without an aortic cross-clamp yielded nearly equal incidences of stroke (0.012; 0.008–0.015 and 0.018; 0.012–0.023, respectively). Using an aortic cross-clamp significantly increased the stroke estimate (0.075; 0.061–0.088), whereas using a side-biting clamp did not (0.039; 0.033–0.044). The number of aortic touches (0.029; 0.026–0.031) and the number of proximal anastomoses (0.044; 0.035–0.047) did not significantly increase the incidence of stroke. Conclusions: Aortic cross-clamping was found to be the primary cause of post-CABG ischemic stroke. Instead, additional aortic manipulation from a side-biting clamp, on-pump surgery, multiple aortic touches, number of proximal anastomoses, and aortic cannulation were found not to increase the estimate of stroke significantly. Further research on this topic is warranted., Graphical Abstract Factors increasing post CABG incidence of ischemic stroke (red) and those which were not significant at the multi-model multifactorial analysis that analyzed all technical factors alone or in different combinations (green).

Background In multiple sclerosis (MS), knowledge about how spinal cord abnormalities translate into clinical manifestations is incomplete. Comprehensive, multiparametric MRI studies are useful in this perspective, but studies for the spinal cord are lacking. Purpose To identify MRI features of cervical spinal cord damage that could help predict disability and disease course in MS by using a comprehensive, multiparametric MRI approach. Materials and Methods In this retrospective hypothesis-driven analysis of longitudinally acquired data between June 2017 and April 2019, 120 patients with MS (58 with relapsing-remitting MS [RRMS] and 62 with progressive MS [PMS]) and 30 age- and sex-matched healthy control participants underwent 3.0-T MRI of the brain and cervical spinal cord. Cervical spinal cord MRI was performed with three-dimensional (3D) T1-weighted, T2-weighted, and diffusion-weighted imaging; sagittal two-dimensional (2D) short inversion time inversion-recovery imaging; and axial 2D phase-sensitive inversion-recovery imaging at the C2-C3 level. Brain MRI was performed with 3D T1-weighted, fluid-attenuated inversion-recovery and T2-weighted sequences. Associations between MRI variables and disability were explored with age-, sex- and phenotype-adjusted linear models. Results In patients with MS, multivariable analysis identified phenotype, cervical spinal cord gray matter (GM) cross-sectional area (CSA), lateral funiculi fractional anisotropy (FA), and brain GM volume as independent predictors of Expanded Disability Status Scale (EDSS) score (R2 = 0.86). The independent predictors of EDSS score in RRMS were lateral funiculi FA, normalized brain volume, and cervical spinal cord GM T2 lesion volume (R2 = 0.51). The independent predictors of EDSS score in PMS were cervical spinal cord GM CSA and brain GM volume (R2 = 0.44). Logistic regression analysis identified cervical spinal cord GM CSA and T2 lesion volume as independent predictors of phenotype (area under the receiver operating characteristic curve = 0.95). An optimal cervical spinal cord GM CSA cut-off value of 11.1 mm2 was found to enable accurate differentiation of patients with PMS, having values below the threshold, from those with RRMS (sensitivity = 90% [56 of 62], specificity = 91% [53 of 58]). Conclusion Cervical spinal cord MRI involvement has a central role in explaining disability in multiple sclerosis (MS): Lesion-induced damage in the lateral funiculi and gray matter (GM) in relapsing-remitting MS and GM atrophy in patients with progressive MS are the most relevant variables. Cervical spinal cord GM atrophy is an accurate predictor of progressive phenotype. Cervical spinal cord GM lesions may subsequently cause GM atrophy, which may contribute to evolution to PMS. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zivadinov and Bergsland in this issue.

Key to curtailing the COVID-19 pandemic are wide-scale testing strategies1,2. An ideal test is one that would not rely on transporting, distributing, and collecting physical specimens. Given the olfactory impairment associated with COVID-193-7, we developed a novel measure of olfactory perception that relies on smelling household odorants and rating them online. We tested the performance of this real-time tool in 12,020 participants from 134 countries who provided 171,500 perceptual ratings of 60 different household odorants. We observed that olfactory ratings were indicative of COVID-19 status in a country, significantly correlating with national infection rates over time. More importantly, we observed remarkable indicative power at the individual level (90% sensitivity and 80% specificity). Critically, olfactory testing remained highly effective in participants with COVID-19 but without symptoms, and in participants with symptoms but without COVID-19. In this, the current odorant-based olfactory test stands apart from symptom-checkers (including olfactory symptom-checkers)3, and even from antigen tests8, to potentially provide a first line of screening that can help halt disease progression at the population level.

Recent neuroscience studies demonstrate that a deeper understanding of brain function requires a deeper understanding of behavior. Detailed behavioral measurements are now often collected using video cameras, resulting in an increased need for computer vision algorithms that extract useful information from video data. Here we introduce a new video analysis tool that combines the output of supervised pose estimation algorithms (e.g. DeepLabCut) with unsupervised dimensionality reduction methods to produce interpretable, low-dimensional representations of behavioral videos that extract more information than pose estimates alone. We demonstrate this tool by extracting interpretable behavioral features from videos of three different head-fixed mouse preparations, as well as a freely moving mouse in an open field arena, and show how these interpretable features can facilitate downstream behavioral and neural analyses. We also show how the behavioral features produced by our model improve the precision and interpretation of these downstream analyses compared to using the outputs of either fully supervised or fully unsupervised methods alone., Author summary The quantification of animal behavior is a crucial step towards understanding how neural activity produces coordinated movements, and how those movements are affected by genes, drugs, and environmental manipulations. In recent years video cameras have become an inexpensive and ubiquitous way to monitor animal behavior across many species and experimental paradigms. Here we propose a new computer vision algorithm that extracts a succinct summary of an animal’s pose on each frame. This summary contains information about a predetermined set of body parts of interest (such as joints on a limb), as well as information about previously unidentified aspects of the animal’s pose. Experimenters can thus track body parts they think are relevant to their experiment, and allow the algorithm to discover new dimensions of behavior that might also be important for downstream analyses. We demonstrate this algorithm on videos from four different experimental setups, and show how these new dimensions of behavior can aid in downstream behavioral and neural analyses.

Introduction: We performed a multinomial multifactor propensity-score based analysis on stroke in patients undergoing CABG. The unique model allowed us to test all the potential technical risk related to aortic manipulation alone or in combination. Methods: The study population included 16,255 consecutive patients undergoing isolated CABG between 1997 and 2017. Patients were divided into 7 groups: 1) No Proximal Anastomoses-Off-pump (NPA-OFF) group, 2) Side Biting Clamp-Off-pump (SBCL-OFF) group, 3) No Proximal Anastomoses-Beating Heart-On-Pump (NPA-BH-ON) group, 4) Side Biting Clamp-Beating Heart-On-Pump (SBCL-BH-ON) group, 5) No Proximal Anastomoses-Aortic Total Clamp-On-pump (NPA-ATC-ON) group, 6) Aortic Total Clamp-On-pump (ATC-ON) group, 7) Aortic Total Clamp-Side Biting Clamp-On-pump (ATC-SBCL-ON) group. The main end-point was the incidence of postoperative stroke within 30 days of the procedure. Statistical significance was set for p-values< 0.05 (*). Results: The optimal balance with the balance table, effect size plot and Q-Q plot, allowed us to conclude that the groups were similar to support causal estimation of the treatment estimand. As shown in Figure 1, there was no difference between a total no-touch (NPA-OFF group) vs. the same technique on pump (NPA-BH-ON group, p>0.05) and or adding a side biting clamp to these two procedures (SBCL-OFF group and SBCL-BH-ON group, both p>0.05). All procedures including the use of a total clamp (NPA-ATC-ON, ATC-ON and ATC-SBCL-ON groups) had a significantly higher incidence of stroke (all p0.05). Conclusions: Aortic total clamp is the main factor increasing the incidence of stroke. In contrast, the use of side biting partial clamping, off-pump techniques or cardiopulmonary bypass without aortic clamp and cardioplegic arrest, does not affect the incidence of stroke.

Background Current understanding of the lifetime mortality of patients with hypertrophic cardiomyopathy (HCM) has been extrapolated from cohorts with 8–10 years follow-up. Real survival rates and long-term burden of HCM are largely unresolved. Objective To describe HCM lifetime mortality over 28-years of observation. Methods We analyzed clinical/instrumental data of the historic cohort of 202 patients diagnosed from 1970s. ECG, echocardiographic, clinical records until last follow-up were recorded. Reasons for death were classified as HCM related (Sudden Death (SD), Heart Failure related (HF)) and non-HCM related deaths. Results Patients were followed-up for 28±6 years (41±17 to 69±14 years), 63% were males. Patients progressively dilated the Left Atrium (40±6 to 50±9mm, p Conclusions HCM-related mortality at 10 years significantly underestimated the lifetime rates of HF death, which doubled in the second/third decade of observation. Conversely, SD rates remained constantly low. Real burden of HCM is time dependent and can be appreciated only after prolonged exposure to the disease. Funding Acknowledgement Type of funding source: None

Aims Ischemic Stroke (IS) is a devastating complication of coronary bypass (CABG) surgery, significantly increasing mortality, morbidity, cost, and the need for long-term care, and reducing the quality of life. With the aim of a learning-machine method, we investigated factors influencing the occurrence of IS after CABG. Methods and results We employed a statistical learning method – random forests – to examine which of various variables had the greatest impact on postoperative IS. A dataset including 16,255 consecutive patients undergoing isolated CABG between 1997 and 2017 In one Institution was examined. Along with demographic and clinical variables technical-related factors were included, encompassing surgical technique, number of touches on the aorta, cardiopulmonary bypass, total aortic clamping, use of the side-biting clamp, or number of proximal anastomoses. A ranking score based on the average percent increase in mean squared error and obtained for all variables was employed to quantify the importance of any variable in predicting IS. A total of 641 strokes occurred (3.9%). Total aortic clamp showed the highest incidence of stroke (n=570, 88.95% of total). Total aortic clamp had the highest score among all variables followed by previous stroke and carotid artery disease >50%. In contrast, other variables related to surgical technique showed low ranking scores in predicting IS. In patients undergoing CABG with the use of total aortic, a previous brain ischemic insult as well as age >75 years increase the risk of IS (fIGURE) Conclusions The use of total aortic clamp is the strongest predictor of stroke. A clamp-less technique is recommended whenever possible especially in older patients and those who experienced preoperative stroke or who had significant carotid stenosis. Importance of variables in predicting IS Funding Acknowledgement Type of funding source: None

Objectives: Extracorporeal Life Support (ECLS) may provide pulmonary and circulatory support for patients with acute heart failure refractory to conventional medical therapy. However, indications and effectiveness of ECLS engagement post-cardiac surgery remains a concern. We sought to analyze indications, modality and outcomes of Post-Cardiac Surgery Extracorporeal Life Support (PS-ECLS), to identify predictors of early and midterm survival after PS-ECLS.Methods: Prospective, multicenter analysis of 209 consecutive PS-ECLS patients between January 2004 and December 2018. Demographic and clinical data before, during and after PS-ECLS were collected and their influence on hospital mortality and outcomes (early and midterm) were analyzed.Results: Mean PS-ECLS duration was 5.3 +/- 9.6 days. Multivariate analysis of pre PS-ECLS implantation factors revealed age >70years, female, insulin-dependent diabetes, severe pulmonary hypertension, STS score >35, type/A aortic dissection, aortic cross-clamp time >150 min and pre-ECLS blood lactate >15 mmol/L as risk factors of in-hospital mortality. Instead coronary artery disease (CAD), intra-aortic balloon pump (IABP) implantation, ECLS start in the operating room, and transapical left ventricular venting, were associated with a better outcome. Weaning from ECLS was possible in 56.8% of cases and survival at discharge was 42.6%. Overall, survival was 37.3%, 32.1% and 25.2%, at 6-months, 1-year and 5-years, respectively. Midterm outcome was influenced positively by younger age and CAD, negatively by diabetes, left ventricular ejection fraction (LVEF) Conclusions: PS-ECLS is a valuable option when conventional medical therapies are insufficient. The outcome predictors identified in the study could be an operative support for PS-ECLS indication and management.

Background Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. Methods We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within 30 days of surgery, stroke and acute kidney disease (AKD). Results The study population consisted of 1961 patients. The LITA procedure was performed in 1768 patients whereas 193 patients underwent a BITA technique. The estimate of ALLI was 14% higher in the BITA compared to the LITA (p Conclusions The use of both ITAs led to a significant increase in ALLI. This result was most likely caused by the complete disruption of the ITA collateral providing additional blood supply to the lower extremities. Based on our data, BITA should be used with extreme caution in PAD patients. Further research on this topic is necessary to confirm our findings.

This article provides the first theoretical treatment of the ontologies and epistemologies of digital heritage research at the time of the interconnected and social web, based on extensive ...

This paper draws upon the experience of several years of running a multi-application crowdsourcing platform, as well as a longitudinal evaluation of participant profiles, motivations and behaviour, to argue that heritage crowdsourcing cannot straightforwardly be considered a democratising form of cultural participation. While we agree that crowdsourcing helps expand public engagement with state-funded activities such as Galleries, Libraries, Archives, and Museums, we also note that both in our own experience and in other projects, the involved public cohort is not radically different in socio-demographic make-up to the one that physically visits such institutions, being for example financially better-off with high levels of formal education. In shedding light on issues of participation and cultural citizenship, through a both theoretically and empirically rich discussion, this paper light casts on the current impact of heritage crowdsourcing, in terms of both its strengths and weaknesses. The study will also be useful for cultural heritage policy and practice, museum management and curatorship, to potentially guide the choices and strategies of funders and organisations alike.

Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.

The hamstring muscle complex is made by a group of posterior biarticular thigh muscles, originating at the ischial tuberosity, which extend the hip and flex the knee joint. Proximal hamstring injuries are frequent among athletes, commonly involving their long myotendinous junction during an eccentric contraction. In this pictorial essay, we describe the ultrasound technique to visualize the normal anatomy of the proximal hamstring muscle-tendon-bone complex and present ultrasound findings in patients with traumatic injuries and tendinopathies.

Background: The incidence and potential factors influencing deep sternal wound infection (DSWI) in a cohort of patients undergoing coronary artery bypass grafting (CABG) using skeletonized bilateral internal thoracic artery (BITA) was explored. Furthermore, we studied influence of DSWI on long-term survival, major adverse cardiac events (MACEs) and repeat coronary revascularization (RCR).Methods: The study cohort consisted of 1,325 consecutive patients who were divided in two groups: patients experiencing DSWI (n=33, group 1) and those who did not have sternal infection (n=1,292, group 2). A logistic regression model was employed to find predictors of DSWI whereas Cox regression and a competing risk models were carried out to test predictors of late death, MACE and RCR, respectively. Follow up was 100% complete and ranged from 1 to 245 months. Median follow-up was 103 months (IQR, 61 to 189 months). Cumulative follow-up was 16,430 patient years.Results: The incidence of DSWI was 2.4%. Multivariable logistic regression analysis found any single independent predictor of DSWI. However, the association of peripheral vascular disease (PVD) and diabetes increased the risk by 1.4 and 1.6 times. When DM was associated with obesity the risk increased by 2.1 and 2.6 times compared to the single factors, respectively. Obese female patients were at a 1.6-fold higher risk when compared to the association of DM with obesity. DSWI was not an independent predictor of long-term survival (HR, 2.31; 95% CI: 0.59–9.12), RCR (SHR, 2.89; 95% CI: 0.65–10.12), or MACE (SHR, 1.98; 95% CI: 0.44–8.56).Conclusions: With an accurate patient selection (i.e., exclusion of obese diabetic females) and strict DM control BITA represents a first choice for most of CABG patients, even at high risk for DSWI. The occurrence of DSWI does not influence long-term survival and late outcomes. Our findings should be confirmed by further larger research.

Background: The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation. Methods: A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016. Results: A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications. Conclusion: Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP.

Background and Objectives The aim of the present study is to report the early and mid-term clinical and haemodynamic results of the St Jude Medical Regent 19-mm aortic mechanical prothesis (SJMR-19). Materials and Methods Between January 2002 and January 2012, 265 patients with aortic valve disease underwent AVR (Aortic Valve Replacement) with a SJMR-19 (St Jude Medical Regent Nr.19). There were 51 males. Mean age was 67.5±12.72years and mean body surface area (BSA) was 1.67±0.14m2. Thirty-six patients required annulus enlargement. The mean follow-up was 34.5±18.8months (range 6–60 months). All patients underwent echocardiographic examination at discharge and within one year after surgery. Results There were 14 (5.3%) hospital deaths. Six of the hospital deaths were identified in patients undergoing reoperation, significantly higher than patients undergoing first time operation (p=0.0001). Also the postoperative mortality was significantly higher in patients undergoing annulus enlargement versus patients not requiring annulus enlargement (p=0.02). The mean transprosthesis gradient at discharge was 19±9mmHg. At six months follow-up the mean NYHA FC class was 1.6±0.5 significantly lower than preoperatively 2.4±0.75 (p i ) were significantly lower than preoperatively The actuarial survival and cumulative freedom from reoperation at one, two and three years follow-up were 99.5%, 97.5%, 96.7% and 99.2%, 96.5%, 94.5% respectively. The cumulative actuarial free-events survival at four years was 92%. The Cox model identified age (p=0.015), LVEF≤35% (p=0.043), reoperation (p=0.031), combined surgery (p=0.00002), and annulus enlargement (p=0.015) as strong predictors for poor actuarial free-major events survival. Conclusions The SJMR-19 offers excellent postoperative clinical, haemodynamic outcome and LVM i reduction in patients with small aortic annulus. These data demonstrate that the modern St Jude small mechanical protheses do not influence the intermediate free-reoperation survival.

A nanosensor with dual-mode fluorescence response to pH and an encoded identification signal, was developed by exploiting excitation energy transfer and tailored control of molecular organization in core–shell nanoparticles. Multiple signals were acquired in a simple single-excitation dual-emission channels set-up.

Introduction and objective The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Materials and methods Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Results Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. Conclusion In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients., Highlights • Objective: Our experience with post-infarction left ventricular pseudoaneurysms (LVP) and surgical techniques in 13 patients. • Various techniques: 1) direct pledgeted sutures; 2) single patch; 3) double-patch; 4) pericardial patch through the left atrium. • Hospital mortality 4 (30.7%). Literature review: 306 patients with LVP undergoing surgery with 21.2% (65 deaths) mortality. • In conclusion, this study revealed that surgical repair of LVP was associated with an acceptable surgical mortality rate. • Cardiac rupture did not occur. Various techniques are available and should be considered according to the case presentation.

Progress in science requires standardized assays whose results can be readily shared, compared, and reproduced across laboratories. Reproducibility, however, has been a concern in neuroscience, particularly for measurements of mouse behavior. Here, we show that a standardized task to probe decision-making in mice produces reproducible results across multiple laboratories. We adopted a task for head-fixed mice that assays perceptual and value-based decision making, and we standardized training protocol and experimental hardware, software, and procedures. We trained 140 mice across seven laboratories in three countries, and we collected 5 million mouse choices into a publicly available database. Learning speed was variable across mice and laboratories, but once training was complete there were no significant differences in behavior across laboratories. Mice in different laboratories adopted similar reliance on visual stimuli, on past successes and failures, and on estimates of stimulus prior probability to guide their choices. These results reveal that a complex mouse behavior can be reproduced across multiple laboratories. They establish a standard for reproducible rodent behavior, and provide an unprecedented dataset and open-access tools to study decision-making in mice. More generally, they indicate a path toward achieving reproducibility in neuroscience through collaborative open-science approaches., eLife digest In science, it is of vital importance that multiple studies corroborate the same result. Researchers therefore need to know all the details of previous experiments in order to implement the procedures as exactly as possible. However, this is becoming a major problem in neuroscience, as animal studies of behavior have proven to be hard to reproduce, and most experiments are never replicated by other laboratories. Mice are increasingly being used to study the neural mechanisms of decision making, taking advantage of the genetic, imaging and physiological tools that are available for mouse brains. Yet, the lack of standardized behavioral assays is leading to inconsistent results between laboratories. This makes it challenging to carry out large-scale collaborations which have led to massive breakthroughs in other fields such as physics and genetics. To help make these studies more reproducible, the International Brain Laboratory (a collaborative research group) et al. developed a standardized approach for investigating decision making in mice that incorporates every step of the process; from the training protocol to the software used to analyze the data. In the experiment, mice were shown images with different contrast and had to indicate, using a steering wheel, whether it appeared on their right or left. The mice then received a drop of sugar water for every correction decision. When the image contrast was high, mice could rely on their vision. However, when the image contrast was very low or zero, they needed to consider the information of previous trials and choose the side that had recently appeared more frequently. This method was used to train 140 mice in seven laboratories from three different countries. The results showed that learning speed was different across mice and laboratories, but once training was complete the mice behaved consistently, relying on visual stimuli or experiences to guide their choices in a similar way. These results show that complex behaviors in mice can be reproduced across multiple laboratories, providing an unprecedented dataset and open-access tools for studying decision making. This work could serve as a foundation for other groups, paving the way to a more collaborative approach in the field of neuroscience that could help to tackle complex research challenges.

Background This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFRCKD-EPI) to modification of diet in renal disease (eGFRMDRD) and the Cockcroft-Gault formulas of Creatinine clearance (CCG) equations in predicting post coronary artery bypass grafting (CABG) mortality. Methods Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. Results The discriminatory power was higher in eGFRCKD-EPI than eGFRMDRD and CCG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFRCKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas CCG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45–59 ml/min/1.73m2 (p = 0.32) or ≥ 60 ml/min/1.73m2 (p = 0.48). Conclusions In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.

Background We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFR CKD-EPI ). We also try to identify cut-off values of eGFR CKD-EPI able to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary. Methods One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFR CKD-EPI : Group 1 (≥60ml/min/1.73m 2 ; n=1199), Group 2 (45–59ml/min/1.73m 2 ; n=358), Group 3 (30–44ml/min/1.73m 2 ; n=171) and Group 4 (≤29ml/min/1.73m 2 ; n=126). Median follow-up was 66months [IQR 46–84]. Results eGFR CKD-EPI ≤30ml/min/1.73m 2 , ≤41ml/min/1.73m 2 , ≤27ml/min/1.73m 2 and ≤29ml/min/1.73m 2 were strong predictors of early mortality (OR 5.88 [95% CI 2.59–11.25]), stroke (2.59 [1.43–3.71]), prolonged length of stay (3.49 [1.24–5.92]) and postoperative dialysis (3.68 [1.34–4.91]), respectively. In addition, eGFR CKD-EPI ≤26ml/min/1.73m 2 , ≤25ml/min/1.73m 2 , ≤35ml/min/1.73m 2 and ≤29ml/min/1.73m 2 predicted all-cause death (hazard ratio 2.74 [95% CI 2.10–3.92] cardiovascular death (sub-hazard ratio 2.11 [95% CI 1.42–3.90]), myocardial infarction (2.01 [1.32–3.70]) and heart failure (2.24 [1.41–3.93]), respectively. Analyses corrected by age and left ventricular ejection fraction confirmed these findings. Conclusions In our experience, the use of the eGFR CKD-EPI equation led to categorization with a significantly lower number of patients at risk for post-CABG complications. This might have important clinical repercussions on allocation of healthcare resources and more targeted prevention and management of CABG complications.

Major trauma is a leading cause of death, particularly amongst young patients. Conventional therapies for post-traumatic cardiovascular shock and acute pulmonary failure may sometimes be insufficient and even dangerous. New approaches to trauma care and novel salvage techniques are necessary to improve outcomes. Extracorporeal life support (ECLS) has proven to be effective in acute cardiopulmonary failure from different etiologies, particularly when conventional therapies fail. Since 2008 we have used ECLS as a rescue therapy in severe poly-trauma patients with refractory clinical setting (cardiogenic shock, cardiac arrest, and/or pulmonary failure). The rationale for using ECLS in trauma patients is to support cardiopulmonary function, providing adequate systemic perfusion and, therefore, avoiding consequent multi-organ failure and permitting organ recovery. From our data ECLS, utilizing heparin-coated support to avoid systemic anticoagulation, is a valuable option to support severely injured patients when conventional therapies are insufficient. It is safe, feasible, and effective in providing hemodynamic support and blood-gas exchange. Moreover, we have identified several pre-ECLS patient characteristics useful in predicting ECLS treatment appropriateness in severe poly-traumatized patients. These might be helpful in deciding whether the ECLS should be initiated in patients who are severely complex and compromised. Future improvements in materials and techniques are expected to make ECLS even easier and safer to manage, leading to a further extension of its use in severely injured patients.

The aim was to create a model of myocardial infarction with a borderline myocardial impairment which would enable evaluation of the retrograde cellular cardiomyoplasty through the venous coronary sinus in a large animal model.Fifteen (study group) and 10 juvenile farm pigs (control group) underwent distal left anterior descending artery ligation. One month later the study group animals underwent sternotomy and a murine myoblastic line C2-C12 was injected at a constant pressure of 30mmHg, into the coronary sinus. Thirty days later all animals that survived from both groups underwent transthoracic echocardiography and 99Tc scintigraphy and were later euthanized and specimens were taken for microscopic evaluation.Cardiac output decreased significantly after ligation (p0.001) and increased significantly after cardiomyoplasty (p0.001). In all animals, the surgical induction of myocardial infarction caused a marked decline in the echocardiographic values of cardiac function; however, the cardiac function and dimensions were significantly improved in the study group after cardiomyoplasty versus the control group. All animals undergoing cardiomyoplasty demonstrated a significant reduction of the perfusion deficit in the left anterior descending artery territory, instead such data remained unchanged in the control group. The histological examination demonstrated the engrafted myoblasts could be distinguished from the activated fibroblasts in the scar tissue because they never showed any signs of collagen secretion and fiber buildup.In conclusion, the venous retrograde delivery route through the coronary sinus is safe and effective, providing a significant improvement in function and viability.

With Higher Education and the Creative Economy: Beyond the Campus, Roberta Comunian and Abigail Gilmore offer a well-coordinated collection of theoretically rich, methodologically solid, data-drive...

Background: Minimally invasive aortic valve replacement (MIAVR) procedures are starting to be accepted as the standard procedures for aortic valve diseases. However, only a limited number of studies have directly compared mini-thoracotomy (MT) to mini-sternotomy (MS). Therefore, the aim of this review was to summarize the available literature for comparison between the procedures to have a better understanding of the risks and benefits to guide future procedures. Methods: A literature search for MT and MS was carried out using two literature databases. Relevant articles were identified and assessed through the inclusion and exclusion criteria. Results: 15 studies were identified for inclusion in this review. Comparable results were identified between MT and MS in terms of 30-day mortality. In addition, there was no difference in the incidence of stroke, reoperation for bleeding, and wound infection. In contrast, MT showed longer cardiopulmonary bypass (CPB) and cross-clamping durations than MS. Conclusion: Both MT and MS surgical approaches are reliable, efficient, and comparable. These findings have to be confirmed by large randomized trials

“In the mirror of the Wonder of Luca Giordano” was a multi-sensorial experience created in the gallery frescoed by Luca Giordano in Palazzo Medici Riccardi, in Florence; the project involved different disciplines and researchers. The entire experience was subjected to an impact analysis, combining principally psycho-physiological, qualitative psychological and neuro-physiological aspects. In most of the visitors who participated in the study the experience evoked a sense of pleasure, enjoyment, relaxation, lightness, space-time suspension, involvement and immersiveness. In many of the visitors, the devices detected changes in heartbeat with a stastically significant decrease in blood pressure and heart rate, demontrating that the impact of artwork in a multi-sensorial experience and in an augmented perception environment is a psycho-somatic impact. Our experience suggests that projects such as "In the mirror of the Wonder of Luca Giordano" could be a very useful tool for cultivating emotional intelligence and could be developed in museums alongside the more classical paths of fruition.

The chapter provides critical evaluation of the literature in accounting that examined the role of customer metrics in internal decision-making and control purposes. We draw on the relationships theorized in the organizational architecture outlined in Chap. 1 to structure our selective review and emphasize key critical gaps in our knowledge, especially vis-a-vis extant developments in the marketing literature. The chapter then presents two empirical studies aimed at generating insights on the adoption of customer metrics for internal decision-making and control purposes. The first study is a qualitative case study conducted within a subscription-based enterprise (SBE). The second study reports a survey about the diffusion of customer metrics in a sample of SBEs. In combination, the empirical evidence highlights relevant take-away points and current challenges about the actual use of customer metrics in performance measurement and management control systems.

Current financial accounting models (e.g. IFRS/US GAAP) cannot capture the principle value creator for customer centric firms: Customer Franchise. Among the intangible assets, Customer Franchise is one of the most important for understanding firm’s value. We argue that companies should disclose in the Management discussion and analysis section of their annual report information about the success of their company’s business model, such as new subscriber acquisitions, revenue per subscriber, customer dropouts, cost of customer acquisition. Additionally, we believe that disclosing customer metrics identifies important value drivers and provides an easy-to-implement algorithm to summarize these drivers into a measure of considerable usefulness to investors. In this chapter, we approach the issue by characterizing the business model of subscription-based enterprises (SBEs) that offer a for-fee-per-period access to products or services. Specifically, we show how to aggregate publicly available data into a measure of a firm’s Customer Equity value, which incorporates the major value drivers of SBEs, and empirically examine its properties. We build on the idea that the acquisition and retention of profitable customers is crucial for SBEs to identify the fundamental elements of their business model (e.g., customer base, revenues and service cost per user, and customer turnover).