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Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

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World Journal of Clinical Cases 2017年第2期5卷 27-34页

作者： Elia De Maria ambra borghi Lorenzo Bonetti Pier Luigi Fontana Stefano Cappelli Cardiology Unit Ramazzini Hospital

Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.

关键词： Implantable cardioverter defibrillator Biotronik implantable cardioverter defibrillator lead Externalized conductors Insulation failure

Antitachycardia pacing programming in implantable cardioverter defibrillator:A systematic review

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World Journal of Cardiology 2017年第5期9卷 429-436页

作者： Elia De Maria Daniele Giacopelli ambra borghi Letizia Modonesi Stefano Cappelli Cardiology Unit Ramazzini Hospital Biotronik Italia Dipartimento Clinico

Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.

关键词： Implantable cardioverter defibrillator programming Antitachycardia pacing Ventricular tachycardia Electrical antitachycardia therapy

Cardiac magnetic resonance imaging:Which information is useful for the arrhythmologist?

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World Journal of Cardiology 2017年第10期9卷 773-786页

作者： Elia De Maria Annachiara Aldrovandi ambra borghi Letizia Modonesi Stefano Cappelli Cardiology Unit Ramazzini Hospital41012 Carpi(Modena)Italy

Cardiac magnetic resonance(CMR) is a non-invasive,nonionizing,diagnostic technique that uses magnetic fields,radio waves and field gradients to generate images with high spatial and temporal *** administration of contrast media(e.g.,gadolinium chelate),it is also possible to acquire late images,which make possible the identification and quantification of myocardial areas with scar/fibrosis(late gadolinium enhancement,LGE).CMR is currently a useful instrument in clinical cardiovascular practice for the assessment of several pathological conditions,including ischemic and nonischemic cardiomyopathies and congenital heart *** recent years,its field of application has also extended to arrhythmology,both in diagnostic and prognostic evaluation of arrhythmic risk and in therapeutic *** this review,we discuss the possible useful applications of CMR for the *** is possible to identify three main fields of application of CMR in this context:(1) arrhythmic and sudden cardiac death risk stratification in different heart diseases;(2) decisionmaking in cardiac resynchronization therapy device implantation,presence and extent of myocardial fibrosis for left ventricular lead placement and cardiac venous anatomy; and(3) substrate identification for guiding ablation of complex arrhythmias(atrial fibrillation and ventricular tachycardias).

关键词： Cardiac magnetic resonance Ablation Sudden cardiac death Cardiac resynchronization therapy Arrhythmic risk stratification

Riata silicone defibrillation lead with normal electrical measures at routine ambulatory check:The role of highvoltage shock testing

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World Journal of Cardiology 2016年第11期8卷 657-666页

作者： Elia De Maria ambra borghi Lorenzo Bonetti Pier Luigi Fontana Stefano Cappelli Cardiology Unit Ramazzini Hospital

AIM To describe our experience with shock testing for the evaluation of patients with Riata? *** Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt *** In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.

关键词： Implantable cardioverter defibrillator Lead failure Defibrillation testing Riata™ lead Externalized conductors

The role of structural inheritance in continental break-up and exhumation of Alpine Tethyan mantle(Canavese Zone,Western Alps)

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Geoscience Frontiers 2020年第1期11卷 167-188页

作者： Andrea Festa Gianni Balestro Alessandro borghi Sara De Caroli Andrea Succo Dipartimento di Scienze della Terra Universitàdi TorinoTorinoItaly Dipartimento di Scienze Chimiche della Vita e della SostenibilitàAmbientaleUniversitàdi ParmaParmaItaly

The Canavese Zone(CZ)in the Western Alps represents the remnant of the distal passive margin of the Adria microplate,which was stretched and thinned during the Jurassic opening of the Alpine *** detailed geological mapping,stratigraphic and structural analyses,we document that the continental break-up of Pangea and tectonic dismemberment of the Adria distal margin,up to mantle rocks exhumation and oceanization,did not simply result from the syn-rift Jurassic extension but was strongly favored by older structu ral inheritances(the Proto-Canavese Shear Zone),which controlled earlier lithospheric *** findings allowed to redefine in detail(i)the tectono-stratigraphic setting of the Variscan metamorphic basement and the Late Carbonife rous to Early Cretaceous CZ succession,(ii)the role played by inherited Late Carboniferous to Early Triassic structures and(iii)the significance of the CZ in the geodynamic evolution of the Alpine *** large amount of extensional displacement and crustal thinning occurred during different pulses of Late Carbonife rous-Early Triassic strike-slip tectonics is wellconsistent with the role played by long-lived regional-scale wrench faults(e.g.,the East-Variscan Shear Zone),suggesting a re-discussion of models of mantle exhumation driven by low-angle detachment faults as unique efficient mechanism in stretching and thinning continental crust.

关键词： Alpine Tethys Western Alps Jurassic ophiolite Structural inheritance Continental break-up Mantle exhumation

Multistage tectono-stratigraphic evolution of the Canavese Intracontinental Suture Zone:New constraints on the tectonics of the Inner Western Alps

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Geoscience Frontiers 2022年第6期13卷 91-110页

作者： Gianni Balestro Andrea Festa Sara De Caroli Edoardo Barbero Alessandro borghi Franco Gianotti Department of Earth Sciences University of TorinoTorinoItaly National Research Council of Italy Institute of Geosciences and Earth ResourcesTorinoItaly School of Earth and Environmental Sciences Cardiff UniversityCardiffWalesUK

The Canavese Intracontinental Suture Zone(CISZ) within the Inner Western Alps represents the remnant of a long-lived minor subduction zone involving a narrow, thinned continental crust/oceanic lithosphere seaway between two continental domains of the Adria microplate(i.e., the Sesia Zone and the IvreaVerbano Zone). As opposed to many suture zones, the CISZ mostly escaped pervasive tectonic deformation and metamorphism, thus preserving the original stratigraphy and allowing the relationships between tectonics and sedimentation to be defined. Through detailed geological mapping(1:5000 scale),structural analysis, stratigraphic and petrographic observations, we document evidences for the late Paleozoic to late Cenozoic tectonic evolution of the CISZ, showing that it played a significant role in the context of the tectonic evolution of the Inner Western Alps region from the early to late Permian Pangea segmentation, to the Jurassic Tethyan rifting, and up to the subduction and collisional stages,forming the Western Alps. The site of localization/formation of the CISZ was not accidental but associated with the re-use of structures inherited from regional-scale wrench tectonics related to the segmentation of Pangea, and from the subsequent extensional tectonics related to the Mesozoic rifting, as documented by crosscutting relationships between stratigraphic unconformities and tectonic features. Our findings document that evidences derived from stratigraphy, facies indicators, and relationships between tectonics and sedimentation in the shallow crustal portions of suture zones, such in the CISZ, are important to better constrain the tectonic history of those metamorphic orogenic belts around the world in which evolutionary details are commonly complicated by high-strain deformation and metamorphic transformations.

关键词： Suture zone Western Alps Structural inheritance Tectonics and sedimentation Multistage tectonic evolution

Political economy analysis of the performance‐based financing programme in Afghanistan

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Global Health Research and Policy 2021年第1期6卷 414-428页

作者： Ahmad Shah Salehi Karl Blanchet Anna Vassall Josephine borghi London School of Hygiene and Tropical Medicine Faculty of Public Health and PolicyDepartment of Global Health and DevelopmentLondonUK CERAH University of GenevaGenevaSwitzerland

Background:Performance-based financing(PBF)has attracted considerable attention in recent years in low and middle-income ***’s Ministry of Public Health(MoPH)implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health *** study aimed to examine the political economy factors influencing the adoption,design and implementation of the PBF programme in ***:Retrospective qualitative research methods were employed using semi structured interviews as well as a desk review of programme and policy *** informants were selected purposively from the national level(n=9),from the province level(n=6)and the facility level(n=15).Data analysis was inductive as well as deductive and guided by a political economy analysis framework to explore the factors that influenced the adoption and design of the PBF *** content analysis was used to analyse the ***:The global policy context,and implementation experience in other LMIC,shaped PBF and its introduction in *** MoPH saw PBF as a promise of additional resources needed to rebuild the country’s health system after a period of *** MoPH support for PBF was also linked to their past positive experience of performance-based *** dynamics and interactions between PBF programme actors also shaped the policy *** PBF programme established a centralised management structure which strengthened MoPH and donor ability to manage the programme,but overlooked key stakeholders,such as provincial health offices and non-state ***,MoPH had limited input in policy design,resulting in a design which was not well tailored to the national ***:This study shows that PBF programmes need to be designed and adapted according to the local context,involving all relevant actors in the policy *** studies should focus on conducting empirica

关键词： income policy analysis

Global paleobiogeography of Albian—Cenomanian(mid-Cretaceous)marine ostracods

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Journal of Palaeogeography 2024年第2期13卷 212-236页

作者： Bernardo Vázquez-García Jorge Villegas-Martín Gerson Fauth Leonardo borghi Aristóteles De Moraes Rios Netto Post-Graduate Program in Geology Unisinos UniversitySao LeopoldoRSBrazil Technological Institute of Paleoceanography and Climate Change-Itt Oceaneon Unisinos UniversitySao LeopoldoRSBrazil Laboratory of Sedimentary Geology(Lagesed) Department of GeologyInstitute of GeosciencesUFRJ-Federal Universityof Riode JaneiroBrazil Labmicro Department of GeologyInstitute of GeosciencesUFRJ-Federal University of Rio de JaneiroBrazil

Despite their potential for providing important information for paleobiogeography,studies using ostracod assemblages compiled from global datasets have been scarce so *** this study,the paleogeographic implications of the relationship between different ostracod assemblages are analyzed and discussed for the Albian and *** compiled an ostracod dataset at the genus level,with 168 genera for the Albian and 174 for the Cenomanian,to which different multivariate statistical methods of grouping were *** affinity between different ostracod assemblages from different regions allowed for the delineation of 30 operational geographic units(OGUs)for the Albian,and 32 OGUs for the Cenomanian,grouped in three paleobiogeographic units(PBUs;Megatethys,Persia,and Austral)and one sub-unit(PBSU;Maghreb associated to the Megatethys).The Maghreb PBSU showed minor changes between the Albian and *** relationship among the OGUs grouped in each PBU is related to different factors,such as eustatic sea level events,similar climatic zones,and marine current circulation patterns.A relationship was observed between the Gabon and Nigeria OGUs with the Persia PBU,which suggests a direct east—west connection between them during the *** affinity observed in the Austral PBU between the South American,South African,and Australian regions during the Albian can be explained by their relative geographic isolation due to the Walvis Ridge *** eventual flooding of this barrier led to the relationship observed between the SE Brazilian and Bolivian regions with the Austral ***,the data also suggested that the separation of the Indian subcontinent from the Austral PBU took place during the Cenomanian.

关键词： Operational geographic units Paleobiogeographic units Albian Cenomanian Marine ostracods

The Industrial Heritage and the New Architecture： Teaching, Researching, Designing the Place Identity

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Journal of Civil Engineering and Architecture 2013年第10期7卷 1295-1300页

作者： Monica Bruzzone Roberta borghi Department of Civil Engineering and Architecture (DICATEA) University of Parma Genoa 16142 Italy

The new architecture may provide unusual opportunities for the abandoned areas involved by former industrial processes, both in the city centers and in the landscape. In fact, it may create new centralities and give new collective function for deprived areas. The case study of the architectural and educational project for a new museum park devoted to the technique and the science in the Apennine＇ s landscape near Parma （Italy） may give an interesting point of view about the role of the teaching and the research of the architecture in the former industrial heritage, and to avoid the abandonment and the pauperization of the territory around.

关键词： Identity industrial heritage architecture architecture design studio teaching research.