Rescue Procedures Research Articles

SAVAGE: Simulation of Virtual Reality-Based for Building Fire Victim Rescue Learning Media

Airports are very dynamic and complex environments, making them high-risk places for incidents and accidents, both due to the aircraft's movement and to the building facilities or structures at the airport. Emergency service personnel must have high skills in emergency response, quick decision-making abilities, and a deep understanding of the various dangerous situations that may be encountered in the field. Continuous education and training are essential to ensure their readiness and ability to deal with emergencies. This study aims to develop Virtual Reality-based Search and Rescue learning media to improve the skills and understanding of training participants in search and rescue operations. This learning media is designed to provide a realistic and interactive simulation experience, allowing participants to practice rescue procedures in various dangerous scenarios without real risk. The development methods used in this study include the stages of needs analysis, design, development, implementation, and evaluation (ADDIE). At the analysis stage, the identification of training needs and competencies that must be achieved is carried out. The design stage involves designing Virtual Reality scenarios that cover various field conditions and rescue techniques. Effectiveness is evaluated by measuring the increase in skills and understanding of participants before and after using Virtual Reality media. The study results indicate that this learning media effectively improves the operational and decision-making skills of training participants in emergency situations. The feasibility assessment by media experts obtained an average score of 88.72%. Then, the feasibility assessment by material experts obtained an average score of 88.90%. After conducting a product trial on students, the evaluation results were 81.30%. Based on the results of the validation and trial of this product, Virtual Reality-based learning media can be recommended as an innovative and efficient training tool for Search and Rescue learning media.

Proposal of an Effective Way of Rescuing People from a Cable Car

This study presents a proposal for procedures and recommendations for the evacuation of people from cable cars. The proposals and procedures were carried out in a specific facility located in the east of Slovakia. Cable cars represent a certain risk of endangering the lives and health of people. This threat can be caused by technical failures, meteorological conditions, or human factors. Despite the existing safety measures, which are at a high level today, extraordinary events occur on cable cars that require the intervention of the integrated rescue system. The rescue services themselves have their own specific rescue procedures and equipment for rescuing people from heights, and in this paper the most frequently used rescue procedures and methods performed by members of the Fire and Rescue Service will be presented. This paper summarizes individual rescue actions, activities, and technical equipment used in rescuing people from cable cars, as well as an analysis of individual rescue and evacuation techniques from the Skipark Erika cable car. The result of the contribution is a proposal for coordination and an evaluation of the best and most suitable method of rescue in terms of time and safety.

An Extended Follow-up of Spinal Instrumentation Rescue with Cement Augmentation.

Percutaneous cement augmentation has been reported as an effective salvage procedure for frail patients with spinal instrumentation failure, such as screw loosening, hardware breakage, cage subsidence, and fractures within or adjacent to stabilized segments. Favorable results were reported during a median follow-up period of 16 months in a retrospective analysis of 31 consecutive procedures performed in 29 patients. In the present study, the long-term effectiveness of this treatment in avoiding or postponing revision surgery is reported. Clinical and radiologic data of our original cohort of patients were retrospectively collected and reviewed to provide an extended follow-up assessment. The need for revision spinal surgery was assessed as the primary outcome, and the radiologic stability of the augmented spinal implants was considered as the secondary outcome. An extended radiologic follow-up was available in 27/29 patients with an average of 50.9 months. Overall, 18 of 27 (66.7%) patients, originally candidates for revision surgery, avoided a surgical intervention after a cement augmentation rescue procedure. In the remaining patients, the average interval between the rescue cement augmentation and the revision surgery was 22.5 months. Implant mobilization occurred in 2/27 (7.4%) patients; rod breakage, in 1/27 (3.7%); a new fracture within or adjacent to the instrumented segment occurred in 4/27 (14.8%) patients; and screw loosening at rescued levels occurred in 5/27 (18.5%) patients. In this cohort, cement augmentation rescue procedures were found to be effective in avoiding or postponing revision surgery during long-term follow-up.

An enhanced bio‐inspired energy‐efficient localization routing for mobile wireless sensor network

SummaryEnvironmental disasters such as earthquakes, tsunamis, floods, and landslides disrupt natural resources, human casualties, and so on. Early warning and alert of such events will help for preparedness to avoid human and economic causalities. Managing a disaster or emergency scenario is a difficult endeavor. These episodes of mass devastation, whether caused by natural disasters or man‐made disasters, result in massive losses of money, property, and lives as a result of inadequate response by the government and management authorities. As a result, actions must be taken to avoid these circumstances from occurring by discovering the causes of these catastrophes in advance and providing swift rescue procedures once the crisis happens. In a disaster situation, communication plays a vital role, and a lot of people turn towards it as a source of information conveyance/delivery for controlling the situation. Even these communication networks are damaged and incur tremendous losses during disasters. All the communication networks, including mobile wireless sensor networks (WSNs) deployed for communication, also suffer huge damage and face many challenges during disasters. Nature appears to deal with these issues well. WSN is inspired by several biological systems and processes that have intrinsically attractive properties such as adaptation, self‐organization, and self‐healing. In this paper, we proposed an enhanced bio‐inspired energy‐efficient localization (EBEEL) routing for Mobile WSN. The main focus of the proposed EBEEL algorithm is to overcome the challenges faced by peer‐existing routing protocols such as data aggregation, limited bandwidth, scalability, data redundancy, energy consumption, packet drops, load balancing, and Quality of Service (QoS).

Multi-attempt missions with multiple rescue options

In spite of intensive works on modeling and optimizing diverse mission aborting systems from the reliability community, none of the existing models have considered multiple rescue options. This paper pioneers the study of a multi-attempt mission system with different types of rescue procedures characterized by dissimilar system performance, shock rates, and costs. A new optimization problem is formulated, which determines the aborting rule and rescue option choice for each attempt to minimize the expected mission losses (EML) encompassing the mission failure penalty, system loss cost and rescue cost. A new numerical algorithm is then put forward to assess the EML of the considered multi-attempt mission system under any given mission abort and rescue policy (MARP). The genetic algorithm is further implemented to solve the MARP optimization problem. The proposed model is demonstrated through an unmanned aerial vehicle (UAV) performing a payload delivery mission with four possible rescue options. The UAV case study also investigates the accuracy and efficiency of the proposed numerical EML evaluation algorithm and reveals the impacts of several key parameters (mission failure penalty, system loss cost, the allowed number of attempts, shock resistance deterioration factor) on the EML and the optimal MARP solutions.

Second harvest of Congenital Heart Surgery Database in Türkiye: Current outcomes.

This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases. This retrospective study examined a total of 4007 congenital heart surgery procedures from 15 centers in the Congenital Heart Surgery Database between January 2018 and January 2023. International diagnostic and procedural codes were used for data entry. STAT (Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery) mortality scores and categories were used for comparison of the data. Surgical priority status was modified from American Society of Anesthesiologist guidelines. Centers that sent more than 5 cases to the database were included to the study. Cardiopulmonary bypass and cardioplegic arrest were performed in 2,983 (74.4%) procedures. General risk factors were present in 22.6% of the patients, such as genetic anomaly, syndrome, or prematurity. Overall, 18.9% of the patients had preoperative risk factors (e.g., mechanical ventilation, renal failure, and sepsis). Of the procedures, 610 (15.2%) were performed on neonates, 1,450 (36.2%) on infants, 1,803 (45%) on children, and 144 (3.6%) on adults. The operative timing was elective in 56.5% of the patients, 34.4% were urgent, 8% were emergent, and 1.1% were rescue procedures. Extracorporeal membrane oxygenation support was used in 163 (4%) patients, with a 34.3% survival rate. Overall mortality in this series was 6.7% (n=271). Risk for mortality was higher in patients with general risk factors, such as prematurity, low birth weight neonates, and heterotaxy syndrome. Mortality for patients with preoperative mechanical ventilation was 17.5%. Pulmonary hypertension and preoperative circulatory shock had 11.6% and 10% mortality rates, respectively. Mortality for patients who had no preoperative risk factor was 3.9%. Neonates had the highest mortality rate (20.5%). Intensive care unit and hospital stay time for neonates (median of 17.8 days and 24.8 days, respectively) were also higher than the other age groups. Infants had 6.2% mortality. Hospital mortality was 2.8% for children and 3.5% for adults. Mortality rate was 2.8% for elective cases. Observed mortality rates were higher than expected in the fourth and fifth categories of the STAT system (observed, 14.8% and 51.9%; expected, 9.9% and 23.1%; respectively). For the first time, outcomes of congenital heart surgery in Türkiye could be compared to the current world experience with this multicenter database study. Increased mortality rate of neonatal and complex heart operations could be delineated as areas that need improvement. The Congenital Heart Surgery Database has great potential for quality improvement of congenital heart surgery in Türkiye. In the long term, participation of more centers in the database may allow more accurate risk adjustment.

Missed Monteggia Injuries in Children and Adolescents: A Treatment Algorithm.

Monteggia injuries are rare childhood injuries. In 25-50% of cases, however, they continue to be overlooked, leading to a chronic Monteggia injury. Initially, the chronic Monteggia injury is only characterized by a moderate motion deficit, which is often masked by compensatory movements. Later, however, there is a progressive valgus deformity, neuropathy of the ulnar nerve and a progressive deformity of the radial head ("mushroom deformity") with ultimately painful radiocapitellar arthrosis. In the early stages, when the radial head is not yet deformed and there is no osteoarthritis in the humeroradial joint, these injuries can be treated with reconstruction procedures. This can be achieved either by an osteotomy of the proximal ulna with or without gradual lengthening. If there is already a severe deformity of the radial head and painful osteoarthritis, only rescue procedures such as functional radial head resection or radial head resection with or without hemi-interposition arthroplasty can be used to improve mobility and, above all, to eliminate pain. In this review article, we provide an overview of the current treatment options of chronic Monteggia injury in children and adolescents and present a structured treatment algorithm depending on the chronicity and dysplastic changes.

Implementing health and safety standards in Offshore Wind Farms

Offshore wind farms represent a significant source of renewable energy, but their operation poses unique health and safety challenges due to the harsh marine environment and remote locations. This review explores the implementation of health and safety standards in offshore wind farms, highlighting key challenges and proposing solutions to mitigate risks. The offshore environment presents numerous hazards to workers, including adverse weather conditions, rough seas, and complex machinery. Ensuring the health and safety of personnel working in such environments requires comprehensive risk assessments, stringent safety protocols, and robust emergency response plans. However, the remote nature of offshore wind farms complicates rescue and evacuation procedures, necessitating specialized training and equipment for personnel. One of the primary challenges in implementing health and safety standards is the dynamic nature of offshore operations, which demand continuous monitoring and adaptation to changing conditions. Furthermore, the integration of multiple stakeholders, including project developers, contractors, and regulatory bodies, requires effective communication and collaboration to ensure compliance with safety regulations. To address these challenges, innovative technologies such as remote monitoring systems and predictive analytics can enhance safety performance by providing real-time data on environmental conditions and equipment status. Additionally, the development of standardized safety protocols and training programs tailored to the offshore wind industry can improve the competence and readiness of personnel in emergency situations. Implementing health and safety standards in offshore wind farms is crucial for safeguarding the well-being of workers and minimizing operational risks. By addressing the unique challenges of the offshore environment and adopting proactive safety measures, the industry can ensure sustainable growth while prioritizing the health and safety of its workforce.

Abstract TP191: National Trends in Rescue Therapy for Failed Thrombectomy 2009-2020

Introduction: For a subset of patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) mechanical thrombectomy with a stent retriever and/or aspiration is insufficient to revascularize the target artery. Rescue therapy with angioplasty alone or with stenting has been utilized. This study assesses the longitudinal trends for adjunctive treatments following failed thrombectomy in the U.S. Methods: We performed a data search from the National Inpatient Sample (NIS) database using ICD9 and ICD10 procedure codes from 2009 through 2020. Data was collected for patients with stroke who underwent thrombectomy for LVO and subsequent angioplasty or angioplasty and stenting. The use of drug eluting stents, patient demographics, regional trends, length of stay, and mortality statistics were also assessed. Results: Between 2009 and 2020, the NIS data shows a significant increase in the use of stenting as adjunctive therapy to thrombectomy for LVO. In 2009, stenting with thrombectomy in LVO represented 5.6% (25/443) of patients stented with stroke from ICAD. In 2020, these cases represented 48.6% (520/1,070) of the patients stented. Over the study period, this increase in stent use during LVO treatment was significant (p<0.001). There has been a mild increase in the use of drug eluting stents in rescue therapy, but not as significant as bare metal stents. Angioplasty as an adjunct to thrombectomy for LVO has steadily increased over the study period, with 87 cases in 2009 and 265 cases in 2020, representing a 205% increase. Conclusion: There has been a progressive, significant increase in the number of rescue procedures for failed thrombectomy over the study period with stent procedures outnumbering angioplasty alone. Referencing published data these cases represent approximately 2-3% of the total number of thrombectomies performed for AIS.

Life-saving Field Amputation During the 2023 Türkiye Earthquake: Ethical, Social, and Legal Implications Beyond the Complex Medical and Rescue Procedures in the Rubble.

Amputation as a life-saving measure for earthquake-trapped patients is supported by WHO and INSARAG guidelines. However, implementing these guidelines in highly stressful contexts can complicate decision-making. This report presents a case of life-saving amputation during the 2023 Turkey earthquake, adhering to recommended guidelines. The 16-year-old patient was trapped for 55 hours in a narrow corridor. Extensive interdisciplinary discussions led to the decision for a field amputation after alternative rescue attempts failed. Consent was obtained from the family, given the patient's delirium. Meticulous planning and anesthesia using midazolam and ketamine ensured successful amputation with minimal blood loss. Challenges encountered during the disaster response were discussed. Delays in administering antibiotics, a lack of cervical protection, ethical dilemmas, psychological concerns, and legal implications were highlighted. Continued improvement and addressing ethical, legal, and psychological aspects are essential for optimal disaster response outcomes.

Opioid Misuse Harm Reduction.

The misuse of opioids by the public is a major health issue. Prescription opioids and nonprescription opioids, such as heroin and opium, are misused in epidemic proportions. When opioids are used incorrectly or illegally, they can lead to drug dependence, addiction, morbidity, and mortality. This program is in collaboration with the Jolt Foundation that provides resources to prevent opioid overdose deaths. This program involves community education on the dangers of opioid use and training on the use of naloxone rescue procedures to prevent overdose deaths. A pretest-posttest design was employed to determine if participants gained knowledge regarding the naloxone administration procedures. The researcher presented 10 community naloxone trainings that included staff from 20 different social service agencies, two schools, and three local churches. Each agency received at least one naloxone kit. The outcomes were met and included educating 137 participants on the risk factors and signs and symptoms of opioid overdose and the proper procedure to administer naloxone. One hundred twenty-eight posttests were returned and showed that the objectives for the project were met. The overall mean score for the pretests was 65.00 ( n = 126) with a standard deviation of 19.01, and the overall mean for the posttests was 86.64 ( n = 128) with a standard deviation of 14.60. Community social service agency staff were successfully educated to respond appropriately to overdose situations in a group training setting as evidenced by significant posttest scores.

Aspiration Thrombectomy Versus Stent-Retriever Thrombectomy for the First-Pass Therapy of Intracranial Atherosclerosis–Related Large Vessel Occlusion: A Post Hoc Analysis of The Endovascular Treatment With Versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke Trial

BackgroundThis study sought to scrutinize the clinical outcomes associated with first-pass mechanical thrombectomy (MT) strategies in the management of intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO). MethodsWithin this post-hoc analysis of the RESCUE BT trial, we compared data pertaining to ICAS-LVO patients situated in the anterior circulation who underwent initial therapeutic interventions utilising either aspiration thrombectomy or stent-retriever thrombectomy. The analysis encompassed the assessment of intraprocedural recanalization, rescue procedures involving balloon angioplasty or stenting, 48-hour reocclusion rates, occurrences of cerebral hemorrhagic complications, and 90-day Modified Rankin Scale (mRS) scores. ResultsAmong the 948 patients encompassed in the RESCUE BT trial, a total of 230 patients with ICAS-LVO in the anterior circulation were enrolled in the study. Of these, 111 underwent aspiration thrombectomy as the first-pass therapy, while 119 patients underwent stent-retriever thrombectomy as the initial intervention. The difference in first pass recanalization rates between aspiration thrombectomy and stent-retriever thrombectomy was not statistically significant (17.1% vs. 14.3%, p=0.555), and mechanical thrombectomy success rates (90.1% vs. 90.8%, p=0.864), the use of balloon angioplasty or stenting for rescue therapy (54.6% vs. 45.9%, p=0.189; 23.4% vs. 25.2%, p=0.752), and favorable 90-day mRS outcomes (53.2% vs. 40.3%, p=0.051) showed no statistically significant differences. ConclusionsBoth aspiration thrombectomy and stent-retriever thrombectomy can be considered as primary therapeutic options for patients presenting with ICAS-LVO in the anterior circulation.

Is insolvency stigmatised?

AbstractIt is a commonly held belief that there exists a sense of stigma around insolvency, which explains the low uptake of rescue procedures in the United Kingdom and around the world. We assess the accuracy of this claim through two qualitative studies. The first is conducted through interviews with corporate directors in the United Kingdom. The second study is a comparative literature review in selected jurisdictions. The literature review reveals a prominent stigma narrative in policy and legal texts, whereas the interview data reveal only moderate levels of stigma. Rather, they indicate that a lack of knowledge and understanding of insolvency (concept, law and procedures) may be a more powerful factor in explaining why corporate directors do not file for rescue procedures.

Abstract 091: Intraventricular milrinone for management of vasospasm following aneurysmal subarachnoid hemorrhage

Introduction Aneurysmal subarachnoid hemorrhage (aSAH) accounts for about 10% of hemorrhagic strokes [1] and holds a high mortality and morbidity rate. [2, 3] Vasospasm is one of the more devastating complications of aSAH. Novel imaging modalities have drastically improved our ability in prompt detection of vasospasm in these patients. However, clinical management of this complication is still debated among experts. [4] Systemic cerebral vasodilators are widely used in aSAH patients, but guidelines for interventional and rescue procedures are not well developed. [5] Methods Here, we report a case of severe vasospasm following aSAH that was successfully treated with intraventricular injection of milrinone through external ventricular drain (EVD) in conjunction to standard therapy. Results A 70‐year‐old man with a history of diabetes, hypertension, and hyperlipidemia was brought to the emergency department after he was found down and unresponsive. He was intubated by EMS on route. Head CT on arrival showed a diffuse subarachnoid hemorrhage, more prominent in the posterior fossa, and grade IV on the modified Fisher scale. An initial DSA showed a ruptured aneurysm in the second segment of the right posterior inferior cerebellar artery, second segment. A right frontal EVD was placed on the second day. Hemodynamic augmentation was achieved with intravenous and intraventricular milrinone. Cerebral arterial patency was evaluated with daily transcranial doppler (TCD). The patient did not show any evidence of vasospasm until day 9 where TCD revealed severe vasospasm in the basilar and bilateral vertebral arteries, as well as mild vasospasm of anterior and middle cerebral arteries. Intraventricular milrinone was injected into the EVD in from day 9 to day 12. Using sterile technique, 4 mL of CSF was removed followed by the injection of 0.87mg (2mL) of milrinone into the EVD via a three way stop cock. EVD was then flushed with 2mL of preservative‐free saline and clamped for 1 hour. This procedure effectively improved vasospasm on serial TCDs and also DSAs (Figure1). The patient underwent several DSA’s on days 10, 14, 19, 20, and 21 with targeted intraarterial milrinone and verapamil injections. His final TCD showed only mild middle cerebral artery and moderate basilar artery vasospasm. At that point, no more intervention was deemed necessary. A ventriculoperitoneal shunt was also placed. CT scan before discharge showed mild improvement in ventricular size and stable SAH blood products. The course of hospitalization was complicated by hyponatremia, atrial fibrillation, and respiratory failure with inability to wean off ventilator, resulting in tracheostomy and gastrostomy tube placement. The patient was discharged in stable condition on day 30 to a rehabilitation center. Conclusion Intraventricular milrinone in addition to standard therapy can be an effective method in treatment of severe vasospasm in aSAH patients.

Development and Validation of a Novel "Luminescent Guidewire“ for more Efficient and Safer Guidance During Endovascular Rescue Procedures

Introduction:Endovascular procedures in emergencies like the implantation of tubes for a life support system are increasing. Guidewires are the essential basis for the regularly used Seldinger Technique. We present a novel concept that may further optimize the safety and efficacy of guidewire handling and navigation during endovascular procedures.Method:Using specifically designed luminescent particles, a novel, clinical-grade coating protocol was created to develop a new luminescent guidewire. Different prototypes were designed and tested for their luminescent capacity following a short exposure to any light-source. Chemical-analysis, hemocompatibility, hemolysis and cytotoxicity testing of the new guidewire was performed. The usability of the new prototype was compared to regular guidewires by application into needles, catheters and tubes which are used during percutaneous procedures.Results:The engineered guidewires demonstrated a luminescent capacity of at least 20 minutes after less than ten seconds of exposure to a light source. Chemical analysis, cytotoxicity, hemolysis, and hemocompatibility indicated a biocompatibility profile of the guidewire. Good usability, safe and rapid handling was demonstrated when simulating endovascular procedures. Under dimmed-light conditions, the luminescent guidewire demonstrated substantially enhanced visibility when compared to the standard-of-care.Conclusion:We present a new, luminescent guidewire that may enhance the safety and efficacy of endovascular procedures, especially where light conditions are suboptimal or for emergency situations when procedures have to be as fast and efficient as possible.

Legal Review of the Performance of Firefighters and Rescue Workers in Deli Serdang

Fire and Rescue or abbreviated as Fire and Rescue are implementing elements of the Government which have the responsibility to assist the community in handling fires and rescue. The research objective was to find out the legal review regarding the performance of firefighters and rescue workers in Deli Serdang Regency. And it is necessary to have a legal study on how to deal with fires in accordance with rescue procedures from the government which can create common perceptions and uniformity of ways of acting for all personnel involved. The type of research in this paper is normative with a statutory and conceptual approach. While the specification of the research is analytical descriptive, namely explaining the problem according to the research title. The data used as primary legal materials include Regulation of the Minister of Home Affairs of the Republic of Indonesia Number 16 of 2020 Concerning Nomenclature Guidelines for Provincial and District/City Fire and Rescue Services, and secondary legal materials in the form of books, journals, writings, media , and documents or other information related to the research title. By carrying out the procedures from the government, efficient suppression efforts can be achieved in deploying personnel to minimize losses and work as optimally as possible in blackout operations and rescue operations. Therefore, it is recommended for Firefighters and Rescue Executors to improve performance and timeliness, quality of facilities and infrastructurein tackling fire disasters and better rescue so that more and more people are saved. Especially to improve the procedures, rules and performance of officers to do more optimal fire prevention and rescue so that they run according to community expectations and regulation from government.

A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta

BackgroundThe Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta.Main bodyThe insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices.Short conclusionTechnical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.

Behaviour of a social unit of sperm whales (Physeter macrocephalus) entangled in a driftnet off Capo Palinuro (Southern Tyrrhenian Sea, Italy)

Driftnet fishing is notorious for being the major source of fatal entanglement of cetaceans and for its devastating impact on some pelagic species of the Mediterranean fauna. Of all the large cetaceans, the sperm whale (Physeter macrocephalus) is most affected by this fishing technique. On 9 August 2004, a group of five sperm whales, two adult females and three juvenile individuals, was found trapped in a driftnet 40 miles southwest off Capo Palinuro (Italy). Their tails were totally immobilised by the net and one animal was completely entangled. All the animals showed numerous lesions on their bodies. The group was freed by the Italian Coast Guard scuba-diving team during a two-day rescue operation. This exceptional case of sperm whale disentanglement was a unique opportunity to study the group’s acoustic and general behaviour during a particularly stressful event. Out of a total video/acoustic recording of 110 minutes, 91 were examined. During the rescue procedures, the whales’ behaviour was described as open mouthed, sideways roll, agitation of fluke and pectoral fins, head rubbing, fluke contact (with head, flippers and back by the liberated animals) and defecation. As expected, the entangled individuals produced different patterns of clicks, identified as ‘usual clicks’, ‘codas’ and ‘creaks’. Each pattern was associated with specific behaviour. Despite international and national regulation banning fishing with driftnets in the Mediterranean Sea, driftnets continue to be used illegally in this sperm whale habitat, posing a constant threat to the species’ survival in the region.

Sex-related differences and chronobiology of ST-elevation myocardial infarction: findings from a single hub center in Italy.

Type I acute myocardial infarction (AMI) is a life-threatening condition. Time of event and rescue procedures, and sex-specific differences may play a crucial role. We aimed to investigate chronobiological patterns and sex-specific differences in a cohort of AMI patients referred to a single hub center in Italy. We considered all patients consecutively admitted for AMI (STEMI) to the Hospital of the Heart, in Massa, Tuscany (a region of Italy), between 2006 to 2018, who underwent interventional procedures. Sex, age, time of hospital admission, outcome (discharged alive/deceased), main comorbidities, and time between symptom onset and emergency medical service (EMS) activation, were analyzed. Chronobiologic analysis was applied according to hour of day, month, and season of the year. Overall 2,522 patients (mean age 64.6±13.1 years, 73% males) were considered. In-hospital death (IHM) occurred in 96 subjects (3.8%). At univariate analysis, deceased subjects were more likely to be female, older, with longer wait for EMS activation and with interventional procedures during night-time. The multivariate analysis identified female sex, age, history of ischemic heart disease, and night-time interventional procedure as independently associated factors to IHM. Chronobiologic analysis showed a pattern with a main morning peak for total sample, males, and females (p=0.00027; p=0.0006); p=0.0121, respectively). Events showed a higher peak in summer, with no differences by sex, but IHM was higher in winter. Females showed a higher delay for EMS activation, compared to males (p<0.001), but with no effects on prognosis. On the contrary, males with a delay showed higher mortality. Great effort should be spent to reduce patient-related delays in interventional procedures, being this issue crucial in both sexes.

Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment.

Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%; P<0.001) or non-IAC (13.4%; P<0.001). Rescue procedures were more frequently performed in symptomatic-IAC (26.9%) than in asymptomatic-IAC (1.3%; P<0.001) and non-IAC (4.1%; P<0.001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11.89 [95% CI, 3.94-35.91]; P<0.001), adoption of rescue procedures (odds ratio, 12.38 [95% CI, 2.22-69.09]; P=0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02-12.00]; P=0.046). The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.