7 research outputs found
The Forte San Procolo: Recovering the Historic Topography and and Rediscovering the Site
No full textLAUREA MAGISTRALELa protezione e la conservazione delle strutture fortificate isolate è un argomento un po’ trascurato rispetto ad altre tipologie di edifici storici. La loro funzione è diventata obsoleta. A Verona, un tempo la più grande, pensata per i tempi di guerra, roccaforte d’Italia, un intero sistema di forti austriaci circondava la città in due anelli distinti, attorno alle mura comunali. Oggi tredici di questi forti sono stati demoliti e molti altri sono in cattive condizioni.
È chiaro che la vicinanza e la scala delle nuove costruzioni hanno avuto un impatto sul Forte San Procolo e l’urbanizzazione ha interrotto il suo rapporto con le mura comunali. Il Forte è completamente isolato dalla rete urbana e manca l’accesso al sito. Gli insediamenti residenziali hanno lentamente intaccato il paesaggio del forte e gli strati di vegetazione e gli edifici altri hanno nascosto l’architettura del Forte San Procolo.
La proposta mira a recuperare la topografia storica e a riscoprire il sito. Utilizza un sistema di regole di ri-costruzione del luogo che possono essere ritrovate; le costruzioni sono inserite nel paesaggio perduto e stabiliscono nuove relazioni tra gli antichi manufatti e il loro contesto.
Poiché il forte è attualmente in un buono stato di conservazione, è più rilevante ristabilire il suo ruolo all’interno del sistema urbano come luogo pubblico accessibile. Viene creato un percorso che collega direttamente le mura comunali e il forte, con un sottopassaggio per le zone urbane divise. La proposta comprende un intervento architettonico collocato all’interno di un “taglio” praticato nel terrapieno storico. Ospita un centro di conoscenza delle fortificazioni veronesi; una collaborazione tra l’Associazione Verona Città Fortezza e l’Università, che comprende un’aula magna, sale studio/laboratori, un caffè immersivo, uffici e servizi pubblici. La massiccia struttura in calcestruzzo a moduli ripetitivi costituisce lo scheletro del terrapieno perduto.
La riscoperta delle fortificazioni richiede sistemi architettonici non invasivi che riflettano le nuove esigenze di una città in crescita. La mancanza di responsabilità nella pianificazione urbana ha permesso di dimenticare la storia della città come fortezza; questa tesi considera la natura in evoluzione delle città e utilizza modi per progettare la soglia tra vecchio e nuovo a partire proprio dalla conoscenza di questa storia.The protection and preservation of isolated fortified structures is a somewhat neglected topic when compared with other typologies of historic buildings. Their function has become obsolete, designed for times of war. In Verona, once the greatest stronghold in Italy, an entire system of Austrian forts surrounded the city in two distinct rings, alongside the municipal wall. Now thirteen of these forts have been demolished and many others in poor condition.
It is clear that the proximity and scale of new constructions have impacted the Forte San Procolo, and urbanisation has severed its relationship with the municipal wall. There is a complete isolation of the fort from the urban network and lack of access to the site. Residential developments have slowly eaten away at the forts landscape, and layers of vegetation and high-rise buildings have hidden the fort.
The proposal aims to recover the historic topography and rediscover the site. It uses a system of re-constructive rules that can be replicated; constructions are inserted into lost landscape and establish new relationships between the ancient artefacts and their context.
As the fort is currently in a well-conserved state, it is more relevant to re-establish its role within the urban system as an accessible public place. A pathway is created directly connecting the municipal wall and the fort, with an underpass for divided urban zones. The proposal includes an architectural intervention placed within a ‘cut’ that was made in the historic embankment. It houses a centre of knowledge for the forts; a collaboration between the Verona Citta Fortezza Associazione and the university, including a lecture theatre, study rooms/workshops, an immersive cafe, offices and public services. The massive concrete structure with repetitive modules forms the skeleton construction of the lost embankment.
Rediscovering fortifications requires non-invasive architectural systems that reflect the new needs of a growing city. A lack accountability in urban planning has allowed the cities history as a stronghold to be forgotten; this thesis considers the evolving nature of cities and utilises ways to design for the threshold between old and new
REducing INFectiOns thRough Cardiac device Envelope: insight from real world data. The REINFORCE Project
No full textBackground: Infections resulting from cardiac implantable electronic device (CIED) implantation are severely impacting on patients' and on health care systems. The use of TYRXTM absorbable antibiotic-eluting envelope has proven to decrease major CIED infections within 12 months of CIED surgery. Aims: to evaluate the impact of the envelope use on infection-related clinical events in a real-world contemporary patient population. Methods: Data on patients undergoing CIED surgery were collected prospectively by participating centers of the One Hospital ClinicalService project. Patients were divided into two groups according to whether TYRXTM absorbable antibiotic-eluting envelope was used or not. Results: Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and included in the Envelope group and 947 (52.1%) patients who did not receive an envelope were included in the Control group. Compared to control, patients in the Envelope group had higher thrombo-embolic or hemorrhagic risk, higher BMI, lower LVEF and more comorbidities. During a mean follow-up of 1.4 years, the incidence of infection-related events was significantly higher in the control compared to the Envelope group (2.4% vs 0.8%, p = 0.007). The 5-year cumulative incidence of infection-related events was 8.1% in the control and 2.1% in the Envelope group (HR: 0.34, 95%CI: 0.14-0.80, p = 0.010). Conclusions: In our analysis, the use of an absorbable antibiotic-eluting envelope in the general CIED population was associated with a lower risk of systemic and pocket infection
Critical appraisal of cardiac implantable electronic devices: complications and management
No full textLuigi Padeletti1, Giosuè Mascioli2, Alessandro Paoletti Perini1, Gino Grifoni1, Laura Perrotta1, Procolo Marchese3, Luca Bontempi3, Antonio Curnis31Istituto di Clinica Medica e Cardiologia, Università degli Studi di Firenze, Italia; 2Elettrofisiologia, Istituto Humanitas Gavazzeni, Bergamo, Italia; 3Elettrofisiologia, Spedali Civili, Brescia, ItaliaAbstract: Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.Keywords: pacemaker, cardiac cardioverter-defibrillator, cardiac implantable electronic devices, infection, recall, quality of life&nbsp
Novel Medical Treatments and Devices for the Management of Heart Failure with Reduced Ejection Fraction
No full textHeart failure (HF) is a growing issue in developed countries; it is often the result of underlying processes such as ischemia, hypertension, infiltrative diseases or even genetic abnormalities. The great majority of the affected patients present a reduced ejection fraction (≤40%), thereby falling under the name of “heart failure with reduced ejection fraction” (HFrEF). This condition represents a major threat for patients: it significantly affects life quality and carries an enormous burden on the whole healthcare system due to its high management costs. In the last decade, new medical treatments and devices have been developed in order to reduce HF hospitalizations and improve prognosis while reducing the overall mortality rate. Pharmacological therapy has significantly changed our perspective of this disease thanks to its ability of restoring ventricular function and reducing symptom severity, even in some dramatic contexts with an extensively diseased myocardium. Notably, medical therapy can sometimes be ineffective, and a tailored integration with device technologies is of pivotal importance. Not by chance, in recent years, cardiac implantable devices witnessed a significant improvement, thereby providing an irreplaceable resource for the management of HF. Some devices have the ability of assessing (CardioMEMS) or treating (ultrafiltration) fluid retention, while others recognize and treat life-threatening arrhythmias, even for a limited time frame (wearable cardioverter defibrillator). The present review article gives a comprehensive overview of the most recent and important findings that need to be considered in patients affected by HFrEF. Both novel medical treatments and devices are presented and discussed
Predictive value of Shanghai score system in patients with drug-induced type 1 Brugada electrocardiographic pattern
No full textBackground The Shanghai score system was developed to enhance the risk stratification in Brugada Syndrome (BrS); however, its prognostic value in drug-induced type 1 BrS remains unclear. Methods This study involved 698 patients with drug-induced type 1 BrS, confirmed via pharmacologic challenge (flecainide or ajmaline), from 21 centers in Italy and Switzerland. Patients were classified according to the Shanghai score system: probable/definite BrS (score >= 3.5) and possible BrS (score < 3.5). The primary outcome was appropriate ICD therapy or sudden cardiac death (SCD)/sustained ventricular arrhythmias; the secondary outcome includes the identification of clinical predictors of primary outcome events. Kaplan-Meier and Cox regression analyses were used. Results Our study population included 239 patients (34.2%) with probable/definite BrS and 459 (65.8%) patients with possible BrS. During a median follow-up of 57.4 months, 20 patients (2.9%) experienced the primary outcome. Kaplan-Meier analysis revealed a significantly lower event rate in possible BrS (0.11% over 10 years) compared to probable/definite BrS (0.42%). SCN5A pathogenic variants were a significant predictor of primary endpoint in the possible BrS group (OR: 12.5). Conclusions Shanghai score system for BrS diagnosis may be useful as a tool for risk stratification of life-threatening arrhythmias among patients with drug-induced type I BrS ECG. Identifying the SCN5A mutations is of pivotal importance for refining the risk stratification
Long-Term Clinical Outcomes of Patients with Drug-Induced Type 1 Brugada Electrocardiographic Pattern: A Nationwide Cohort Registry Study
No full textBackground: There are limited real-world data about the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). Objective: We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. Materials and methods: This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death (SCD), was assessed along with the clinical predictors of these events. Results: A total of 606 patients (mean age 49.7±14.7 years; 69.8% men) were followed up for a median of 60.3 [23.0-122.4] months. Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of primary outcome (HR: 4.54, p= 0.002); whereas a trend was observed for unexplained syncope (HR: 3.85; p= 0.05). Among patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation (VF) during programmed ventricular stimulation (PVS). Conclusion: In drug-induced type 1 Brugada ECG patients, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. The unexplained syncope correlated with worse clinical outcomes. The VF inducibility at PVS significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years
Cardiac Contractility Modulation Therapy in Patients with Amyloid Cardiomyopathy and Heart Failure, Case Report, Review of the Biophysics of CCM Function, and AMY-CCM Registry Presentation
No full textCardiac amyloidosis may result in an aggressive form of heart failure (HF). Cardiac contractility modulation (CCM) has been shown to be a concrete therapeutic option in patients with symptomatic HF, but there is no evidence of its application in patients with cardiac amyloidosis. We present the case of TTR amyloidosis, where CCM therapy proved to be effective. The patient had a history of multiple HF hospitalizations due to an established diagnosis of wild type TTR-Amyloidosis with significant cardiac involvement. Since he was highly symptomatic, except during continuous dobutamine and diuretic infusion, it was opted to pursue CCM therapy device implantation. At follow up, a significant improvement in clinical status was reported with an increase of EF, functional status (6 min walk test improved from zero meters at baseline, to 270 m at 1 month and to 460 m at 12 months), and a reduction in pulmonary pressures. One year after device implantation, no other HF hospital admission was needed. CCM therapy may be effective in this difficult clinical setting. The AMY-CCM Registry, which has just begun, will evaluate the efficacy of CCM in patients with HF and diagnosed TTR amyloidosis to bring new evidence on its potential impact as a therapeutic option
