bluuebunny/crossref_metadata_2025_split huggingface dataset:
RF13 CONGENITAL CORONARY ARTERY ANOMALIES: 10-YEARS EXPERIENCE IN A SINGLE CENTER
Authors: Viganò G. , Colaneri M. , Capestro A. , Marzullo R. , Iezzi F. , Pozzi M. 
Published: November 2018

Background and Aim:
Congenital coronary artery anomalies (CCAA) represent a relatively rare heterogeneous group of congenital disorder. They are increasingly recognized due to the improvement of non-invasive imaging techniques. Continuous and profound changes are taking place regarding prevalence, definition, classification, risk of SCD, diagnostic and treatment of those anomalies.

Methods:
We retrospective reviewed our experience (from 2008 to 2017) in 21 patients with CCAA, which were classified as coronary artery arising from the contralateral sinus of Valsalva with intramural or interarterial course (9), coronary artery arising from the pulmonary artery (6), single ostium (1), coronary arteriovenous fistula (2), and myocardial bridges (3). 76% of patients were younger than 30 years of age with a M:F ratio of 1.6:1. The anatomic features, diagnostic and operative techniques for each defect were evaluated.

Results:
Anomalous origins from the wrong sinus (AOWS) was the most common anomaly (42,8%). No operative procedures were associated with early or late mortality in all the categories. During follow-up most patients were asymptomatic with good results at follow-up imaging.

Conclusions:
Spectrum of CCAA subtypes has changed, among our patients AOWS was the most common anomaly. Based on our experience, early diagnosis and surgical intervention can yield satisfactory results in patients with CCAA, with most experiencing relief of symptoms.
RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS
Authors: Lucarelli C. , Biagio L. San , Francica A. , Benfari G. , Noni M. , Abbasciano R.G. , Rossi A. , Zamboni M. , Onorati F. , Ribichini F. , Faggian G. 
Published: November 2018

Background:
Severe aortic stenosis (AS) exposes the left ventricle (LV) to an increased afterload, leading to concentric remodelling and subsequent diastolic dysfunction (DD). Fibrosis is the histological key feature. However, none of the conventional echocardiographic parameters is able to reveal the extent of LV remodelling.

Aim:
to evaluate the ability of speckle tracking echocardiography in detecting LV remodelling in AS patients.

Methods:
patients undergoing aortic valve replacement (AVR) for severe symptomatic AS were prospectively enrolled. Standard transthoracic echocardiography was performed before surgery. Global LV longitudinal and circumferential strain (GLS, GCS), peak atrial longitudinal and contraction strain (PALS, PACS) were measured. LV septal biopsies to assess fibrosis were performed during surgery.

Results:
Forty-three consecutive patients were enrolled, with a mean age 73 ± 6years, 58% female. Ejection fraction (EF) 61 ± 7%, aortic valve area (AVA) 0.72 ± 18 cm2, mean gradient (MG) 51 ± 14 mmHg. LV fibrosis was 22 ± 11%. Global longitudinal strain (GLS) 15 ± 4%, peak atrial longitudinal strain (PALS) 24 ± 6%, peak atrial contraction strain (PACS) 12 ± 4%. The only parameters associated with LV fibrosis were MG (r = 0.45, p = 0.004), GLS (r = 0.37, p = 0.02), PALS (r = 0.43, p = 0.004) and PACS (r = 0.35, p = 0.02). After adjusting for GLS and MG, PALS (p = 0.01) and PACS (p = 0.02) were independent predictors of LV fibrosis. The combination of PALS and GLS was the strongest predictor of LV fibrosis.

Conclusions:
speckle tracking echocardiography provides additional information to characterise the LV remodelling over conventional parameters. Our findings suggest that consequences of pressure overload in AS impact both on ventricular and atrial function, possibly acting through different pathophysiological mechanisms.
RF22 EXTRA-ANATOMIC BYPASS IN AN INFANT WITH SEVERE AORTIC ARCH AND THORACIC DESCENDING AORTA THROMBOSIS
Authors: Hoxha S. , Poretti G. , sandrini C. , barozzi L. , murari A. , prioli A. , pilati M. , rossetti L. , faggian G. , Luciani G.B. 
Published: November 2018

Background:
Aortic arch thrombosis in neonates and infants is a rare and potentially life threatening condition. The initial management usually entails anticoagulation or thrombolysis, but in some cases surgery is needed.

Objective:
The aim of this report is to describe a rare case of an infant with aortic arch and thoracic descending aortic thrombosis.

Clinical Presentation:
A 2 month-old and 4.1 kg infant was admitted to our department with clinical signs of heart failure and feeble femoral pulse. Echo examination showed severe ventricular dysfunction and signs of aortic arch thrombosis. Due to hemodynamic instability, the patient was intubated and inotropes were started. A CT-Scan was performed, which confirmed the diagnosis.

Management:
Medical therapy failed to resolve the problem. Therefore, rescue surgical operation was indicated. The infant underwent extra-anatomic bypass via a postero-lateral thoracotomy with a 4 mm Goretex graft placed between the left caroted artery and the descending aorta. The post-operative course was uneventful and the infant was discharged after 2 months with appropriate anticoagulation therapy. At 14 months after surgery, the patient had severe hypertension (165 mmHg). A CT-Scan was performed and showed patency of the by-pass. Cardiac Cath study demonstated a DP of 50 mmHg. Echo showed a good cardiac function with persistent hypertrophy. The patent was scheduled for surgery and underwent total aortic arch replacement with aortic arch homograft.

Conclusions:
The present anecdotal experience suggests that various types of extra-anatomic bypass may be used as rescue and potentially definitive therapy to manage aortic arch thrombosis in infancy.
RF45 LOW BIRTH WEIGHT NEONATES AND CHD: IS CARDIAC SURGERY ASSOCIATED WITH WORSE OUTCOME?
Authors: Cadonati C. , Seddio F. , Ferrero P. , Uricchio N. , Marcora S. , Sadou Y. , Marrone C. , Bonanomi E. , Mangili G. , Galletti L. 
Published: November 2018

Background and Aim:
Congenital heart diseases often occur in low birth weight and preterm neonates. The aim of our study was to investigate the relationship between different strata of low weight at surgery and outcomes, and between gestational age and outcomes of cardiac surgery in low weight neonates treated at our institution.

Methods:
We retrospectively reviewed hospital records of neonates treated from January 2007 to November 2017. Inclusion criteria were body weight ≤ 2500 g at time of surgery for congenital heart disease, excluding isolated ductus arteriosus closure and pacemaker implantation. The outcomes investigated were 30-days and late mortality, major complications and need for reintervention. 84 patients met our criteria.

Results:
There were 10 early deaths; overall survival was 73% (23 pts died). 35 patients (42%) had major complications. 19 (23%) patients needed a reintervention. Weight at surgery, gestational age, type of operation and single or biventricular physiology did not influence neither mortality (early or late) nor morbidity (reintervention or complication). Mortality was significantly higher when extra-corporeal circulation was used (P < 0,01); this can be related with more severe diagnosis and type of surgery.

Conclusions:
Despite the common thought that low weight and prematurity are associated with increased mortality, according to our results surgery for congenital heart diseases can be performed on low weight and preterm neonates with acceptable outcomes.
RF61 PREDICTING THE PRESSURE OF THE TOTAL CAVO-PULMONARY CONNECTION: CLINICAL TESTING OF A MATHEMATICAL EQUATION
Authors: Di Molfetta A. , Rotella S. , Gagliardi M.G. , Carotti A. , Massetti M. , Amodeo A. , Guccione P. 
Published: November 2018

Introduction:
Among the factors which determine Fontan outcome, the total cavo-pulmonary pressure plays a fundamental role. Some authors advocate the use of a dedicated formula to predict the Fontan pressure. The aim of this work is to test the predictive and the clinical value of the mentioned formula through a retrospective clinical study.

Methods:
Data of all patients undergoing pre-Fontan catheterization and Fontan completion at our institution were collected. Pre-Fontan catheterization data were used to calculate the predicted Fontan pressure. Predicted values were compared to the pressure measured in the acute phase after the Fontan completion and correlated to patients’ clinical outcomes.

Results:
124 Fontan patients were retrospectively enrolled with a median age at the Fontan of 35.00 [31.00- 41.25] months, median weight of 13.00 [11.68-14.10] Kg. Fontan conduct was fenestrated in 78 patients. Fontan failure (composite of death, need for transplant, takedown) was observed in 11. A statistically significant correlation between measured and predicted data for the overall population (p = 0.0114) but with a poor correlation coefficient (r2 = 0.014). In the case of Fontan predicted pressure lower than 17.59 mmHg, the formula was able to identify a good clinical outcome in the acute phase with a sensitivity of 92% and specificity of 31%.

Conclusion:
The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. However, a cut-off value lower than 17.59 mmHg showed a fair sensitivity to identify patients with a good acute clinical outcome.
RF24 HETEROTAXY SYNDROME WITH SIGNLE VENTRICLE PHYSIOLOGY: SINGLE CENTER EXPERIENCE
Authors: Careddu L. , Angeli E. , Petridis F.D. , Romano G. , Tonelli F. , Assenza G. Egidy , Donti A. , Gargiulo G.D. 
Published: November 2018

Objective:
Treatment of infants with functional single-ventricle and heterotaxy syndrome is challenging due to multistage palliation with high operative mortality and morbidity. We report our experience.

Methods:
Between 1996 and 2017, 20 patients with heterotaxy syndrome underwent their first palliative surgery and form the study population. All relevant preoperative, operative and follow-up data were analyzed retrospectively.

Results:
Fourteen (70%) patients required neonatal palliation including a modified Blalock-Taussig shunt (n = 11; 55%), Norwood procedure (n = 1; 5%) or pulmonary artery banding (n = 2; 10%); two patients underwent TAPVC repair during first-stage palliative operation. In the remaining 6 patients (30%), primary bidirectional cavopulmonary anastomosis (BCPA) was the initial palliative surgery. 13 patients underwent BCPA operation as second-stage palliation, whereas one died in the interstage period. Nowadays, 12 of these patients have already undergone total cavopulmonary connection (TCPC) as a third-stage operation after BCPA. In case of Kawashima operation, median time interval before TCPC was 7 years (min 4 years; max 8 years).
Mean follow-up time was 9,6 ± 7,9 years. One patient died during long-term follow-up after TCPC. Overall survival for the entire cohort following first surgery were 94,4% at 1 and 5 years and 82,6% at 10 years.

Conclusions:
Despite recent advances, the management of infants with heterotaxy syndrome with single-ventricle physiology is still a challenge for pediatric cardiac surgeons with high described morbidity and mortality. Conversely, in our experience overall mortality is inferior compared to other single-center reports and these patients may expect satisfying mid-to-long term survival. Further studies are needed to assess long-term morbidity.
RF78 SUCCESFULL MANAGMENT OF PACEMAKER POCKET INFECTION IN A NEONATE COMBINING VACUUM-ASSISTED THERAPY WITH PLASTIC SURGERY WITHOUT DEVICE REMOVAL
Authors: Grimaldi A.M. , Cassano V. , Troise D. , Catucci S. , Vairo U. , Maggio G. , Scalzo G. 
Published: November 2018

Background:
Infection is a serious complication of pacemaker implantation,even more in neonates. Optimal treatment of infections related to pacemaker is poorly defined. We describe a succesfull pacemaker's pocket infection treatment,without device removal, in a neonate.

Methods:
In October 2017 a 2 weeks old,2,5 kg neonate,underwent epicardial double chamber pacemaker implantation for a congenital complete atrio-ventricular block. Via median sternotomy 2 bipolar steroid eluting leads were sutured to the right atrium and right ventricular surfaces. The generator was placed in a subrectal pocket at midepigastric level. After 6 days skin dehiscence with purulent collection presented. From the pocket were isolated Enterobacter cloacae & S. Aureus. Amikacin and Meropenem were started as well as Vacuum-Assisted Therapy (VAC-T). The VAC dressing was changed every 4 days. Until demonstrated absence of infection (after 40 days treatment) we were confident with the chanche to avoid generator's removal. After 50 days of treatment,because of the big dimension of the bicameral generator we were not keen on resuture the pocket and we asked for a plastic surgery advise. The plastic surgeon performed a skin transfer flap from the right flank region.

Results:
The baby was discharged after 2 weeks from the pocket closure with no sign of inflammation nor skin erosion. After 6 months follow up the pocket is free of infection.

Conclusions:
To our knowledge this is the first description of succesfull treatment of a pacemaker pocket infection in a neonate,by means of VAC-T & a skin transfer without device removal.
RF70 RESULTS FROM AN IN VIVO COMPARISON OF THE OPTIFLOW AND EZ GLIDE AORTIC DISPERSION CANNULAE
Authors: Gennari M. , Rossi F. , Bertera A. , Polvavni G. , Fave A. Delle , Rassiga C. , Arlati F. , Penza E. , Agrifoglio M. 
Published: November 2018

Background:
Morbidity associated with embolization during cannulation in coronary artery bypass grafts (CABG) is strongly related to patient characteristics/comorbidities, the arterial cannulation site and the shape of the arterial cannula tip.. The desired features of an arterial cannula should be to prevent those morbid effects and focus on achieving higher flows with lower cannula pressures.

Methods:
To evaluate the in vivo performance of two aortic dispersion flow cannulas: Optiflow (Sorin Group, Italy) and EZ Glide (Edwards Lifesciences, USA) in relation to cannula pressures, pump flow rates and plasma free hemoglobin. Over a 12 month period we collected data on a prospective, randomized (1:1), non-blinded, monocentric study with a cohort of 30 patients (Optiflow group N = 15; EZ Glide group N = 15).

Results:
The Optiflow cannula was found to have decreasing cannula pressures as pump flow rates increased (112.3 ± 10.9 mmHg vs 131.1 ± 11.4 mmHg, p < 0.0001). Results also indicated no significant differences between groups in plasma free hemoglobin increases (p = 0.41) or total microembolic signals counts during cardiac surgery (p = 0.63).

Conclusions:
Both Optiflow and EZ Glide dispersion flow arterial cannulas performed well, but the Optiflow cannula demonstrated an ability to increase pump flow rates with lower arterial line and cannula pressures than the EZ Glide cannula. This implies an ability to improve peripheral perfusion while reducing cannula shear stress and reducing the risk of endothelial damage in an area where the cannula jet hits the intraluminal aortic wall, thereby having the potential to reduce the risk of atherosclerotic plaque dislodgement.
RF92 USEFULNESS OF PATIENT-SPECIFIC NEAR-INFRARED SPECTROSCOPY-BASED ALGORITHMS FOR THE INTRAOPERATIVE MANAGEMENT DURING CARDIAC SURGERY
Authors: Serraino G.F. , Jiritano F. , Garrasi C. , Musolino G. , di Virgilio A. , Malta E. , Mastroroberto P. 
Published: November 2018

Background:
After a systematic review showing poor and conflicting results about the clinical effectiveness of near-infrared spectroscopy (NIRS)-based patient-specific goal-directed algorithms for the prevention of organ failure, sepsis and death in cardiac surgery patients, the proposal of this study was to evaluate if a NIRS-based specific algorithm could improve the intraoperative management, achieving an optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive blood red cell transfusion threshold.

Methods:
168 patients were randomized into two groups: the NIRS-based algorithm Group, that included a restrictive red cell transfusion threshold (haematocrit 18%), and the control group, that had not a based algorithm. The primary outcome for the trial was cognitive function measured up to 3 months post-surgery. Secondary outcomes, including kidney and myocardial injury markers, adverse clinical events, blood transfusion and cost-effectiveness were compared between groups.

Results:
Of the 168 patients, 136 with complete follow-up data for the primary end point formed the analysis cohort. There was no difference between the groups with respect to neurocognitive impairment and for the secondary outcomes. Conversely, a subgroup analysis showed that in aortic arch surgery, for NIRS-based algorithm patients cognitive testing scores were higher in the verbal fluency domain (p < 0.01), whereas transfusion rates are similar in both groups (p > 0.05).

Conclusions:
Near-infrared spectroscopy-based algorithms for the management of CPB do not show clinical advantages except for aortic arch surgery patients.
EPIDEMIOLOGY AND OUTCOMES OF ACUTE RESPIRATORY FAILURE AT THE STAGE OF EMERGENCY MEDICAL CARE IN ST. PETERSBURG
Authors: Ershov A. L. , Miroshnichenko A. G. , Bojkov A. A. , Schurov A. Yu. 
Published: November 2018

This research is devoted to a retrospective analysis of the number of missions of the emergency medical service to adult patients that suffer from acute respiratory failure (ARF) of various severity in St. Petersburg during 2017. Gender and age characteristics of the groups of patients with ARF are presented. Nosologic forms of diseases that tend to be the most common reason of ARF are also identified. The analysis of immediate results of missions to the patients is presented.
FIRST EXPERIENCE OF ECMO-CPR IN EMERGENCY DEPARTMENT
Authors: Teplov V. M. , Komedev S. S. , Skvorcov A. E. , Kolachev I. I. , Shurov A. Yu. , Merkulov A. L. , Filatov V. P. , Mamontov M. N. , Boikov A. A. , Reznik O. N. , Polushin Yu. S. , Bagnenko S. F. 
Published: November 2018

There are a few cases of applying of extracorporeal membrane oxygenation in emergency situations in Russian Federation. This article is about of first experience of using VA-ECMO for the treating patients, which were admitted with cardiac arrest in our ED. We are faced with the problem of long transportation from out-of-hospital to hospital treatment. There is necessity for harmonization algorithms of CPR for amblulances while creating ECMO-centers for the patients with cardiac arrest in Russia.
CVS Health and the Imaginary Worlds of the Institute for Clinical and Economic Review (ICER)
Authors: Langley Paul 
Published: November 2018

In August 2018, CVS Health released a position paper detailing policies in place and those being implemented to help reduce the costs of drugs. This paper introduced three new strategies for reducing costs. These are (i) zero out of pocket costs for chronic disease through a preventive drug list; (ii) reducing the launch price through adoption of modeled cost-per-QALY outcomes by the Institute for Clinical and Economic Review (ICER) to guide clients to exclude drugs launched at a price of greater than $100,000 per QALY; and (iii) introducing tools to be used by doctors, pharmacists and consumers to create greater transparency in understanding the real cost of drugs. The purpose of this commentary is to consider the second of these strategies, the application of a willingness to pay threshold as a viable strategy for impacting launch costs. The arguments presented here are that while modeled cost-per-QALY claims are a staple of formulary committee deliberations in many single payer health systems, their adoption by CVS Health fails to take into account not only the imaginary nature of the modeled construct utilized to generate the cost-per-QALY estimate and its shortcomings but the fact that alternative model structures may render invalid the application of willingness-to-pay thresholds. The case is made that CVS Health could adopt a more rigorous process of formulary assessment to support both preliminary assessments of new products and also an ongoing process of formulary review that challenge manufacturers to justify pricing over product patent life. This process should capitalize on the development of formulary evaluation platforms, potentially involving blockchain technology and smart contracting, for therapy interventions in targeted patient populations. Introducing a more rigorous formulary process, in particular the requirement for claims evaluation protocols, will not only assist CVS Health in restraining price increases over the life of the product but, for the first time in the US, put manufacturers on notice that patently unreasonable pricing policies and claims for product performance can be systematically and effectively challenged.

Article Type: Commentary
Inovação em turismo e eventos:
Authors: Ernesto Filho Isaias , Chiarelli Milito Marcelo , Ferreira de Farias Mayara 
Published: November 2018

Para um entendimento do desenvolvimento do conhecimento de determinado fenômeno, se recorre a investigações sobre a comunicação científica que versam sobre os avanços na área de interesse. Assim, o presente artigo tem como objetivo analisar as pesquisas desenvolvidas sobre Inovação em Turismo e Eventos, realizando um estudo bibliométrico das publicações acerca do tema. A metodologia utilizada foi predominantemente descritiva atuando simultaneamente nos campos qualitativo e quantitativo. Os resultados apresentam que se discute sobre o tema Inovação em Turismo e Eventos a quase duas décadas, porém, apenas nos últimos anos ele é analisado mais afinco. Alguns periódicos demonstram-se mais comprometidos com o tema, sendo a minoria com publicações mais recentes e ainda poucos tratam especificamente da inovação em um determinado evento. Conclui-se que, dada à relevância do tema, sugere-se à comunidade científica realizar estudos mais complexos e com maior frequência abordando o tema Inovação em Turismo e Eventos.
VALIDITAS DAN PRAKTIKALITAS LEMBAR KERJA SISWA BERBASIS PENDEKATAN KONTEKSTUAL MATERI BANGUN RUANG SISI DATAR PADA SISWA SMP
Authors: Rahayu Puji , Kholillah Kholilullah 
Published: November 2018

Penelitian ini bertujuan untuk menghasilkan Lembar Kerja Siswa (LKS) berbasis pendekatan kontekstual materi bangun ruang sisi datar pada siswa SMP yang memiliki kualifikasi valid dan praktis. Jenis penelitian yang dilakukan adalah penelitian pengembangan dengan model 4-D (four-D models) dari Thiagarajan dan Semmel yang terdiri atas 4 tahap, yaitu Define, Design, Develop, Disseminate, namun penelitian ini dibatasi hanya sampai tahap Develop. Instrument penelitian yang digunakan diantaranya lembar validasi perangkat (LKS, RPP, soal tes) untuk mengukur kevalidan, angket respon guru (terhadap LKS, RPP), angket respon siswa, dan lembar keterlaksanaan pembelajaran untuk mengukur kepraktisan. Penelitian ini menghasilkan perangkat (RPP, LKS) Matematika materi bangun ruang sisi datar dengan pendekatan kontekstual. Berdasarkan hasil penilaian kevalidan LKS diperoleh skor rata-rata 4,55 pada skala 5 dengan kategori sangat baik, hasil validasi RPP memperoleh nilai rata-rata 4,23 pada skala 5 dengan kategori sangat baik. Berdasarkan hasil penilaian kepraktisan menurut angket respon guru terhadap RPP diperoleh rata-rata 4,76 pada skala 5 dengan kategori sangat baik, nilai rata-rata angket respon guru terhadap LKS .diperoleh skor 4,57 pada skala 5 dengan kategori sangat baik, angket respon siswa memperoleh skor rata-rata 4,21 pada skala 5 dengan kategori sangat baik, serta rata-rat presentase keterlaksanaan pembelajaran diperoleh skor 85,71% dengan kategori sangat baik. Dengan demikian hasil penelitian pengembangan ini menunjukkan bahwa LKM berbasis pendekatan kontekstual materi bangun ruang sisi datar memenuhi kualifikasi valid dan praktis