Balloon Aortic Valvuloplasty as Bridge-to-Decision in High Risk Patients with Severe Aortic Valve Stenosis

Background. A sizable group of patients with symptomatic aortic stenosis (AS) can undergo neither surgical aortic valve replacement (AVR) nor transcatheter aortic valve implantation (TAVI) because of clinical contraindications. The aim of this study was to assess the potential role of balloon aortic valvuloplasty (BAV) as a “bridge-to-decision” in selected patients with severe AS and potentially reversible contraindications to definitive treatment. Methods. We retrospectively enrolled 645 patients who underwent first BAV at our Institution between July 2007 and December 2012. Of these, the 202 patients (31.2%) who underwent BAV as bridge-to-decision (BTD) requiring clinical re-evaluation represented our study population. BTD patients were further subdivided in 5 groups: low left ventricular ejection fraction; mitral regurgitation grade ≥3; frailty; hemodynamic instability; comorbidity. The main objective of the study was to evaluate how BAV influenced the final treatment strategy in the whole BTD group and in its single specific subgroups. Results. Mean logistic EuroSCORE was 23.5±15.3%, mean age was 81±7 years. Mean transaortic gradient decreased from 47±17 mmHg to 33±14 mmHg. Of the 193 patients with BTD-BAV who received a second heart team evaluation, 72.5% were finally deemed eligible for definitive treatment (25.4%for AVR; 47.2% for TAVI): respectively, 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented relevant comorbidities. 27.5% of the study population was deemed ineligible for definitive treatment and treated with standard therapy/repeated BAV. In-hospital mortality was 4.5%, cerebrovascular accident occurred in 1% and overall vascular complications were 4% (0.5% major; 3.5% minor). Conclusions. Balloon aortic valvuloplasty should be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive percutaneous or surgical treatment.

Life cycle assessment in construction field: A life cycle cost analysis of reinforcement concrete bridge

The present work is included in the context of the assessment of sustainability in the construction field and is aimed at estimating and analyzing life cycle cost of the existing reinforced concrete bridge “Viadotto delle Capre” during its entire life. This was accomplished by a comprehensive data collection and results evaluation. In detail, the economic analysis of the project is performed. The work has investigated possible design alternatives for maintenance/rehabilitation and end-of-life operations, when structural, functional, economic and also environmental requirements have to be fulfilled. In detail, the economic impact of different design options for the given reinforced concrete bridge have been assessed, whereupon the most economically, structurally and environmentally efficient scenario was chosen. The Integrated Life-Cycle Analysis procedure and Environmental Impact Assessment were also discussed in this work. The scope of this thesis is to illustrate that Life Cycle Cost analysis as part of Life Cycle Assessment approach could be effectively used to drive the design and management strategy of new and existing structures. The final objective of this contribution is to show how an economic analysis can influence decision-making in the definition of the most sustainable design alternatives. The designers can monitor the economic impact of different design strategies in order to identify the most appropriate option.

I giochi di strategia nell'educazione matematica - il caso del bridge

La tesi evidenzia quanto importante sia l'uso dei giochi di strategia per la didattica della Matematica con particolare attenzione per il gioco del Bridge. Fornisce qualche strumento in più per appassionare lo studente alla matematica. I temi affrontati sono i seguenti: La probabilità con l'uso delle carte, la Matematica che occorre ad un giocatore di bridge per migliorare le proprie prestazioni, i problemi di bridge che offrono stimoli per lo studio della matematica e il Bridge come sport della mente.

Boundary condition identification of a bridge pier using experimental data and FEM modal updating

Over the past twenty years, new technologies have required an increasing use of mathematical models in order to understand better the structural behavior: finite element method is the one mostly used. However, the reliability of this method applied to different situations has to be tried each time. Since it is not possible to completely model the reality, different hypothesis must be done: these are the main problems of FE modeling. The following work deals with this problem and tries to figure out a way to identify some of the unknown main parameters of a structure. This main research focuses on a particular path of study and development, but the same concepts can be applied to other objects of research. The main purpose of this work is the identification of unknown boundary conditions of a bridge pier using the data acquired experimentally with field tests and a FEM modal updating process. This work doesn’t want to be new, neither innovative. A lot of work has been done during the past years on this main problem and many solutions have been shown and published. This thesis just want to rework some of the main aspects of the structural optimization process, using a real structure as fitting model.

Immunoglobulin A: a bridge between innate and adaptive immunity

The review summarizes the recent progress that has been made in understanding the function of immunoglobulin A (IgA) in promoting a healthy mutualism with the commensal microbiota and protecting against pathogens. Although IgA is by far the most abundant antibody produced by mammals, direct experimental evidence for its function is still lacking.

Eugene Onegin As A Bridge Between Worlds: Aleksandr Pushkin As Translator Of The 19Th-Century Russian Experience

In my thesis, I use literary criticism, knowledge of Russian, and elements of translation theory to study the seminal poet of the Russian literary tradition ¿ Aleksandr Pushkin. In his most famous work, Eugene Onegin, Pushkin explores the cultural and linguistic divide in place at the turn of the 19th century in Russia. Pushkin stands on the peripheries of several colliding worlds; never fully committing to any of them, he acts as a translator between various realms of the 19th-century Russian experience. Through his narrator, he adeptly occupies the voices, styles, and modes of expression of various characters, displaying competency in all realms of Russian life. In examining Tatiana, his heroine, the reader witnesses her development as analogous to the author¿s. At the center of the text stands the act of translation itself: as the narrator ¿translates¿ Tatiana¿s love letter from French to Russian, the author-narrator declares his function as a mediator, not only between languages, but also between cultures, literary canons, social classes, and identities. Tatiana, as both main character and the narrator¿s muse, emerges as the most complex figure in the novel, and her language manifests itself as the most direct and capable of sincerity in the novel. The elements of Russian folklore that are incorporated into her language speak to Pushkin¿s appreciation for the rich Russian folklore tradition. In his exaltation of language considered to be ¿common¿, ¿low¿ speech is juxtaposed with its lofty counterpart; along the way, he incorporates myriad foreign borrowings. An active creator of Russia¿s new literary language, Pushkin traverses linguistic boundaries to synthesize a fragmented Russia. In the process, he creates a work so thoroughly tied to language and entrenched in complex cultural traditions that many scholars have argued for its untranslatability.

Monitoring and Modeling of the Hydraulic and Sediment Processes at In-Stream Restoration Structures in the Vicinity of a Bridge Crossing

The long-term performance of infrastructure depends on reliable and sustainable designs. Many of Pennsylvania’s streams experience sediment transport problems that increase maintenance costs and lower structural integrity of bridge crossings. A stream restoration project is one common mitigation measure used to correct such problems at bridge crossings. Specifically, in an attempt to alleviate aggradation problems with the Old Route 15 Bridge crossing on White Deer Creek, in White Deer, PA, two in-stream structures (rock cross vanes) and several bank stabilization features were installed along with a complete channel redevelopment. The objectives of this research were to characterize the hydraulic and sediment transport processes occurring at the White Deer Creek site, and to investigate, through physical and mathematical modeling, the use of instream restoration structures. The goal is to be able to use the results of this study to prevent aggradation or other sediment related problems in the vicinity of bridges through improved design considerations. Monitoring and modeling indicate that the study site on White Deer Creek is currently unstable, experiencing general channel down-cutting, bank erosion, and several local areas of increased aggradation and degradation of the channel bed. An in-stream structure installed upstream of the Old Route 15 Bridge failed by sediment burial caused by the high sediment load that White Deer Creek is transporting as well as the backwater effects caused by the bridge crossing. The in-stream structure installed downstream of the Old Route 15 Bridge is beginning to fail because of the alignment of the structure with the approach direction of flow from upstream of the restoration structure.

Extracorporeal membrane oxygenation as a bridge to diagnosis in a 20-month old girl with pulmonary hypertension and right ventricular failure

A 20-month old girl with severe pulmonary hypertension and cardiomegaly was admitted to the paediatric intensive care unit with right ventricular failure of unknown origin. Only after decompression of the heart chambers under extracorporeal membrane oxygenation (ECMO), did the pathognomonic membrane of Cor triatriatum become visible on echocardiography. The patient underwent successful surgical correction and subsequently cardiac function recovered completely. Cor triatriatum remains a rare congenital cardiac disorder with a variable presentation, often including recurrent respiratory infections before right-sided heart failure occurs. This case illustrates that ECMO can serve not only as a bridge to diagnosis, but can also facilitate correct diagnosis. Given the excellent outcome after surgical treatment, it is crucial that cardiologists rule out the possibility of cor triatriatum when assessing a child with unexplained pulmonary hypertension.

Mechanical circulatory support as a bridge to heart transplantation: what remains? Long-term emotional sequelae in patients and spouses

Implantation of a ventricular assist device (VAD) reduces short-term mortality and morbidity and provides patients with reasonable quality of life even though it may also be a long-lasting emotional burden. This study was conducted to analyze the long-time emotional consequences of VAD implantation, followed by heart transplantation in patients and spouses.