Pubblicazioni recenti - cardiopulmonary

• Is robotic assistance an added value in minimally invasive mitral valve surgery? A meta-analysis from propensity score-matched series.
  Asian Cardiovasc Thorac Ann

  2023 Mar;():2184923231166352. doi: 10.1177/02184923231166352.
  
  Jegaden Olivier, Al Shamry Adel, Ashafy Salah, Mahdi Alhaitham, Eker Armand,
  
  Abstract
  
  OBJECTIVES:
  There is still ongoing debate about the benefits of robotic assistance (R-MVS) in comparison with video assistance (V-MVS) in minimally invasive mitral valve surgery. This study aims to update the current evidence.
  
  METHODS:
  Three propensity score-matched studies published from 2011 to 2021 were included with a total of 1193 patients operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early mortality, postoperative event, and time-related outcomes were extracted and submitted to a meta-analysis using weighted random-effects modeling.
  
  RESULTS:
  The incidence of early mortality, stroke, renal failure, conversion, atrial fibrillation, and prolonged ventilation were similar, all in the absence of heterogeneity. Reoperation for bleeding (odds ratio [OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, ?=?0.01) and the need for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, ?=?0.001) were significantly lower in V-MVS group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in R-MVS: differences in means were 20.7?min for cross-clamp time (95% CI, 9.07-32.3, ?=?0.001), 20.7?min for cardiopulmonary bypass time (95% CI, 2.5-38.9, ?=?0.03) and 40.2?min for total operative time (95% CI, 24.5-55.8, ?0.001). Intensive care unit stay and hospital stay were reported in one study, and longer after R-MVS compared to V-MVS; the differences in means were 0.17 days (?=?0.005) and 0.6 days (?=?0.017), respectively. Total cost of both procedures was reported in an additional dedicated propensity score-matched series including 448 patients; it was 21% higher for R-MVS than for V-MVS.
  
  CONCLUSIONS:
  This meta-analysis showed excellent outcomes of both video and robotic techniques with low incidence of morbidity and mortality. However, there is no evidence for an added value of robotic assistance in comparison with video assistance; the drawbacks of mini access are reported higher regardless the induced over cost.
  
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• Management of Renal Cell Carcinoma With Intra-atrial Tumour Thrombus: A Case Report.
  Cureus

  2023 Feb;15(2):e35380. doi: 10.7759/cureus.35380.
  
  Alam Ahmad S, Yashi Kanica, Elkhawaga Mostafa,
  
  Abstract
  
  Renal cell cancer (RCC) is at times associated with intravascular tumour thrombus (TT), which in rare cases can extend to the right atrium. The management of RCC with intravascular tumour thrombus is complex and requires a multidisciplinary approach involving urologists, vascular surgeons, and cardiologists. The pre-operative workup is extensive and includes imaging studies to determine the extent of the tumour thrombus and assess the patient's overall health status. Here, we present a case report detailing the operative and perioperative management of a patient presenting with renal cell cancer and intravascular TT.
  
  Copyright © 2023, Alam et al.
  
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• Hereditary Congenital Methemoglobinemia Diagnosed at the Age of 79 Years: A Case Report.
  Medicina (Kaunas)

  2023 Mar;59(3):. doi: 615.
  
  Nakata Marohito, Yokota Naoko, Tabata Kazuhiko, Morikawa Takuya, Shibata Hiroki, Kenzaka Tsuneaki,
  
  Abstract
  
  : Cardiopulmonary disorders are the most common cause of central cyanosis, and methemoglobinemia is often overlooked in the differential diagnosis of patients with central cyanosis. In most cases, methemoglobinemia is acquired and hereditary congenital methemoglobinemia is rare. Only a few case reports of congenital methemoglobinemia can be found in PubMed. To date, only four cases of congenital methemoglobinemia diagnosed after the age of 50 years have been reported. : A 79-year-old Japanese woman presented at our hospital with the chief complaints of dyspnea and cyanosis. She exhibited cyanosis of the lips and extremities, and her SpO was 80%, with oxygen administration at 5 L/min. Blood gas analysis revealed a PaO of 325.4 mmHg and methemoglobin level of 36.9%. The SpO and PaO values were dissociated, and methemoglobin levels were markedly elevated. Genetic analysis revealed a nonsynonymous variant in the gene encoding nicotinamide adenine dinucleotide cytochrome (NADH) B5 reductase 3 (), and the patient was diagnosed with congenital methemoglobinemia. : It is important to consider methemoglobinemia in the differential diagnosis of patients with central cyanosis. At 79 years of age, our patient represents the oldest patient with this diagnosis. This report indicates that it is crucial to consider the possibility of methemoglobinemia regardless of the patient's age.
  
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• Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
  Medicina (Kaunas)

  2023 Mar;59(3):. doi: 571.
  
  Moore Geoffrey E, Keller Betsy A, Stevens Jared, Mao Xiangling, Stevens Staci R, Chia John K, Levine Susan M, Franconi Carl J, Hanson Maureen R,
  
  Abstract
  
  : Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scale (SSS) that includes nine common symptoms of ME/CFS, we sought to characterize the duration and severity of PEM symptoms following two cardiopulmonary exercise tests separated by 24 h (2-day CPET). : Eighty persons with ME/CFS and 64 controls (CTL) underwent a 2-day CPET. ME/CFS subjects met the Canadian Clinical Criteria for diagnosis of ME/CFS; controls were healthy but not participating in regular physical activity. All subjects who met maximal effort criteria on both CPETs were included. SSS scores were obtained at baseline, immediately prior to both CPETs, the day after the second CPET, and every two days after the CPET-1 for 10 days. : There was a highly significant difference in judged recovery time (ME/CFS = 12.7 ± 1.2 d; CTL = 2.1 ± 0.2 d, mean ± s.e.m., Chi = 90.1, 22,
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• Extracorporeal Circulation and Optic Nerve Ultrasound: A Pilot Study.
  Medicina (Kaunas)

  2023 Feb;59(3):. doi: 445.
  
  Ta?k?n Öztürk, Demir Ufuk,
  
  Abstract
  
  : Cardiopulmonary bypass (CPB) is an extracorporeal circuit that provides surgical access to an immobile and bloodless area, allowing for technical and procedural advances in cardiothoracic surgery. CBP can alter the integrity of the blood-brain barrier and cause changes in intracranial pressure (ICP) postoperatively. Optical nerve sheath diameter (ONSD) measurement is among the alternative non-invasive methods for ICP monitoring. In this study, we aimed to evaluate the optic nerve sheath diameter measurements under the guidance of ultrasonography for ICP changes during the extracorporeal circulation process. : The study population included 21 patients over 18 years of age who required extracorporeal circulation. Demographic data of the patients, such as age, gender, comorbidity, American Society of Anesthesiologists (ASA) classification and reason for operation (coronary artery disease or mitral or aortic valve disease) were recorded. The ONSD was measured and evaluated before the extracorporeal circulation (first time) and at the 30th minute (second time), 60th minute (third time) and 90th minute (fourth time) of the extracorporeal circulation. Non-invasive ICP (ICP ONSD) values were calculated based on the ONSD values found. : The mean ONSD values measured before the extracorporeal circulation of the patients were found to be 4.13 mm (3.8-4.6) for the right eye and 4.36 mm (4.1-4.7) for the left eye. Calculated nICPONSD values of 11.0 mm Hg (1.0-21.0) for the right eye and 10.89 mm Hg (1.0-21.0) for the left eye were found. It was observed that there was a significant increase in the ONSD and nlCPONSD values recorded during the extracorporeal circulation of all patients compared to the baseline values (
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• Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement.
  Life (Basel)

  2023 Mar;13(3):. doi: 737.
  
  Zubarevich Alina, Szczechowicz Marcin, Arjomandi Rad Arian, Amanov Lukman, Ruhparwar Arjang, Weymann Alexander,
  
  Abstract
  
  BACKGROUND:
  Sutureless aortic valve prostheses have proven to provide a significant decrease in procedural, cardiopulmonary bypass and cross-clamp time, leading to a significant reduction in mortality risk in elderly high-risk cohorts. In this study, we sought to review our institutional experience on the sutureless aortic valve replacement (SU-AVR) and the concomitant mitral valve replacement (SMVR), comparing the combined conventional surgical aortic valve replacement (SAVR) with SMVR.
  
  METHODS AND MATERIAL:
  Between March 2018 and July 2022, 114 consecutive patients underwent a combined aortic and mitral valve replacement at our institution. We stratified the patients according to the operative procedures into two groups and matched them 1:2: Group 1 underwent a combined conventional SAVR and SMVR (n = 46), and Group 2 included combined SU-AVR with Perceval prosthesis and SMVR (n = 23).
  
  RESULTS:
  No significant differences in the preoperative characteristics were present. SU-AVR combined with SMVR demonstrated excellent haemodynamic performance, comparable to that of SAVR plus SMVR, with median postoperative gradients over the aortic valve of 4 mmHg (IQR 3.0-4.0) in Group 1 and 4 mmHg (IQR 3.0-4.0) in Group 2 ( = 0.67). There was no significant difference in the occurrence of postoperative major adverse events such as death, stroke, myocardial infarction and kidney failure between the groups. There was also no significant difference in the permanent pacemaker implantation rate, paravalvular leakage or valve dislocation. We also could not detect any significant difference in postoperative mortality between the groups.
  
  CONCLUSIONS:
  SU-AVR has proven to be a reliable alternative to conventional valve prostheses in patients with multivalve disease undergoing combined aortic and mitral valve replacement, offering shorter procedural time and outstanding hemodynamic performance compared to the conventional surgical method.
  
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• Post-COVID Syndrome and Cardiorespiratory Fitness-26-Month Experience of Single Center.
  Life (Basel)

  2023 Mar;13(3):. doi: 684.
  
  Sova Milan, Sovova Eliska, Ozana Jaromir, Moravcova Katarina, Sovova Marketa, Jelinek Libor, Mizera Jan, Genzor Samuel,
  
  Abstract
  
  INTRODUCTION:
  Persistent post-COVID syndrome, also referred to as long COVID, is a pathologic entity that involves persistent physical, medical, and cognitive sequelae following COVID-19. Decreased fitness has repeatedly been reported in numerous studies dealing with post-COVID syndrome, however, it is still not fully clear which groups of patients may be more susceptible for persisting symptoms.
  
  AIM:
  The aim of our study was to evaluate the number of post-COVID patients with cardiac symptoms, where these patients were evaluated by CPET and the results compared with a control group of patients.
  
  METHODS:
  Follow-up of patients in post-COVID outpatient clinic from 1 March 2020 to 31 May 2022. Inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. The initial examination was performed 4-12 weeks after the disease onset. All patients with possible cardiac symptoms had completed cardiopulmonary exercise testing. The control group was randomly selected from a database of clients in 2019, with the preventive reason for evaluation.
  
  RESULTS:
  From 1 March 2020 to 31 May 2022, 2732 patients (45.7% males) were evaluated with a mean age of 54.6 ± 14.7. CPET was indicated only in 97 patients (3.5%). Seventy-four patients (26 male) achieved the exercise maximum and a comparison were made with a control group (same age ( = 0.801), BMI ( = 0.721), and sex ratio). No significant dependence between the parameter VO max mL/kg/min and post-COVID disability was demonstrated ( = 0.412). Spearman's correlation analysis did not show a significant relationship between the parameter VO max mL/kg/min and the severity of COVID-19 ( = 0.285).
  
  CONCLUSIONS:
  Cardiac symptoms occurred in only a small percentage of patients in our study. There is a need for further studies that would objectively evaluate the effect of COVID-19 disease on the patient's health.
  
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• Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen?
  Life (Basel)

  2023 Feb;13(3):. doi: 621.
  
  Torres-Castro Rodrigo, Núñez-Cortés Rodrigo, Larrateguy Santiago, Alsina-Restoy Xavier, Barberà Joan Albert, Gimeno-Santos Elena, García Agustin Roberto, Sibila Oriol, Blanco Isabel,
  
  Abstract
  
  There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.
  
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• Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology?
  J Clin Med

  2023 Mar;12(6):. doi: 2375.
  
  Gentili Federica, Calcagni Giulio, Cantarutti Nicoletta, Manno Emma Concetta, Cafiero Giulia, Tranchita Eliana, Salvati Annamaria, Palma Paolo, Giordano Ugo, Drago Fabrizio, Turchetta Attilio,
  
  Abstract
  
  Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that imposes a long-term follow-up. The purpose of our pilot study is to evaluate the usefulness of the cardiopulmonary stress test (CPET) in the follow-up after MIS-C. All patients admitted for MIS-C in our hospital in the 12 months preceding the date of observation were considered for inclusion in the study. Pre-existing cardio-respiratory diseases and/or the lack of collaboration were the exclusion criteria. At enrolment, each subject passed a cardiological examination, rest ECG, echocardiogram, 24 h Holter-ECG, blood tests, and a CPET complete of spirometry. A total of 20 patients met the inclusion criteria (11.76 ± 3.29 years, 13 male). In contrast to the normality of all second-level investigations, CPET showed lower-than-expected peakVO and peak-oxygen-pulse values (50% of cases) and higher-than-expected VE/VCOslope values (95% of cases). A statistically significant inverse correlation was observed between P-reactive-protein values at admission and peakVO/kg values ( 0.034), uric acid values at admission, and peakVO ( 0.011) or peak-oxygen-pulse expressed as a percentage of predicted ( = 0.021), NT-proBNP values at admission and peakVO expressed as a percentage of predicted ( = 0.046). After MIS-C (4-12 months) relevant anomalies can be observed at CPET, which can be a valuable tool in the follow-up after this condition.
  
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• One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials.
  J Clin Med

  2023 Mar;12(6):. doi: 2235.
  
  Penna Alessio, Magliocca Aurora, Merigo Giulia, Stirparo Giuseppe, Silvestri Ivan, Fumagalli Francesca, Ristagno Giuseppe,
  
  Abstract
  
  Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
  
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• The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients.
  J Clin Med

  2023 Mar;12(6):. doi: 2233.
  
  Gounaridi Maria Ioanna, Vontetsianos Angelos, Oikonomou Evangelos, Theofilis Panagiotis, Chynkiamis Nikolaos, Lampsas Stamatios, Anastasiou Artemis, Papamikroulis Georgios Angelos, Katsianos Efstratios, Kalogeras Konstantinos, Pesiridis Theodoros, Tsatsaragkou Aikaterini, Vavuranakis Manolis, Koulouris Nikolaos, Siasos Gerasimos,
  
  Abstract
  
  Coronavirus disease (COVID-19) is a respiratory disease, although arterial function involvement has been documented. We assess the impact of a post-acute COVID-19 rehabilitation program on endothelium-dependent vasodilation and arterial wall properties. We enrolled 60 convalescent patients from COVID-19 and one-month post-acute disease, who were randomized at a 1:1 ratio in a 3-month cardiopulmonary rehabilitation program (study group) or not (control group). Endothelium-dependent vasodilation was evaluated by flow-mediated dilation (FMD), and arterial wall properties were evaluated by carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx) at 1 month and at 4 months post-acute disease. FMD was significantly improved in both the study (6.2 ± 1.8% vs. 8.6 ± 2.4%,
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• Feasibility of Seated Stepping and Handshaking as a Cardiopulmonary Exercise Testing: A Pilot Study.
  J Clin Med

  2023 Mar;12(6):. doi: 2140.
  
  Imashiro Kyosuke, Nishioka Yasuko, Teramura Kenzo, Hashimoto Hiromi, Kimura Hiroki, Tanabe Naoya, Taniguchi Yasuhiro, Nakai Koya, Umemoto Yasunori, Ito Tomoyuki, Tajima Fumihiro, Mikami Yasuo,
  
  Abstract
  
  Cardiopulmonary function is usually assessed by cardiopulmonary exercise testing (CPX) using a cycle ergometer (CE-CPX) or a treadmill, which is difficult in patients with lower extremity motor dysfunction. A stepping and handshaking (SHS) exercise has been developed that can be performed safely and easily while sitting on a chair. This study compared peak oxygen uptake (peak V.O2) between CE-CPX and SHS-CPX in healthy adults and investigated the safety and validity of SHS-CPX. Twenty young adults (mean age 27.8 ± 4.4 years) were randomly assigned to perform CE-CPX or SHS-CPX, with the other test to follow 1-2 weeks later. The peak V.O2, respiratory exchange ratio (RER), peak heart rate, blood pressure, and test completion time were compared between CE-CPX and SHS-CPX. All subjects completed the examination and met the criteria for peak V.O2. SHS-CPX and CE-CPX showed a strong correlation with peak V.O2 (r = 0.85,
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• Use of Renal Near-Infrared Spectroscopy and Urinary Neutrophil Gelatinase-Associated Lipocalin Monitoring as Indicators of Acute Kidney Injury in Pediatric Cardiac Surgery.
  J Clin Med

  2023 Mar;12(6):. doi: 2085.
  
  Wakamatsu Yoshihito, Nakanishi Keisuke, Satoh Takanori, Kawasaki Shiori, Amano Atsushi,
  
  Abstract
  
  Acute kidney injury (AKI) is a common complication following cardiac surgery under cardiopulmonary bypass (CPB) in children. A prospective study for examining urinary neutrophil gelatinase-associated lipocalin (NGAL) and renal near-infrared spectroscopy (NIRS) trends during AKI was conducted among pediatric patients undergoing cardiac surgery with CPB. Urinary NGAL showed a significant difference between intensive care unit admission (0 h) and 2 h post-admission (
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• Flat versus Simulated Mountain Trail Running: A Multidisciplinary Comparison in Well-Trained Runners.
  Int J Environ Res Public Health

  2023 Mar;20(6):. doi: 5189.
  
  Skroce Kristina, Bettega Simone, D'Emanuele Samuel, Boccia Gennaro, Schena Federico, Tarperi Cantor,
  
  Abstract
  
  This paper compares cardiopulmonary and neuromuscular parameters across three running aerobic speeds in two conditions that differed from a treadmill's movement: flat condition (FC) and unpredictable roll variations similar to mountain trail running (URV). Twenty well-trained male runners (age 33 ± 8 years, body mass 70.3 ± 6.4 kg, height 1.77 ± 0.06 m, V?Omax 63.8 ± 7.2 mL·kg·min) voluntarily participated in the study. Laboratory sessions consisted of a cardiopulmonary incremental ramp test (IRT) and two experimental protocols. Cardiopulmonary parameters, plasma lactate (BLa), cadence, ground contact time (GT) and RPE values were assessed. We also recorded surface electromyographic (sEMG) signals from eight lower limb muscles, and we calculated, from the sEMG envelope, the amplitude and width of peak muscle activation for each step. Cardiopulmonary parameters were not significantly different between conditions (V?O: = 0.104; BLa: = 0.214; HR: = 0.788). The amplitude ( = 0.271) and width ( = 0.057) of sEMG activation peaks did not change between conditions. The variability of sEMG was significantly affected by conditions; indeed, the coefficient of variation in peak amplitude ( = 0.003) and peak width (
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• Heart Rate Recovery Assessed by Cardiopulmonary Exercise Testing in Patients with Cardiovascular Disease: Relationship with Prognosis.
  Int J Environ Res Public Health

  2023 Mar;20(6):. doi: 4678.
  
  Dewar Amy, Kass Lindsy, Stephens Robert C M, Tetlow Nicholas, Desai Terun,
  
  Abstract
  
  BACKGROUND:
  The use of exercise testing has expanded in recent decades and there is a wealth of information examining the prognostic significance of exercise variables, such as peak oxygen consumption or ventilatory measures whilst exercising. However, a paucity of research has investigated the use of recovery-derived parameters after exercise cessation. Heart rate recovery (HRR) has been considered a measure of the function of the autonomic nervous system and its dysfunction is associated with cardiovascular risk.
  
  OBJECTIVES:
  We aim to provide an overview of the literature surrounding HRR and its prognostic significance in patients with cardiovascular disease undertaking an exercise test.
  
  DATA SOURCES:
  In December 2020, searches of PubMed, Scopus, and ScienceDirect were performed using key search terms and Boolean operators.
  
  STUDY SELECTION:
  Articles were manually screened and selected as per the inclusion criteria.
  
  RESULTS:
  Nineteen articles met inclusion criteria and were reviewed. Disagreement exists in methodologies used for measuring and assessing HRR. However, HRR provides prognostic mortality information for use in clinical practice.
  
  CONCLUSIONS:
  HRR is a simple, non-invasive measure which independently predicts mortality in patients with heart failure and coronary artery disease; HRR should be routinely incorporated into clinical exercise testing.
  
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• Prenatal Detection of a Deletion in a Fetus with ACDMPV and Hydronephrosis.
  Genes (Basel)

  2023 Feb;14(3):. doi: 563.
  
  Bzd?ga Katarzyna, Kutkowska-Ka?mierczak Anna, Deutsch Gail H, Plaskota Izabela, Smyk Marta, Niemiec Magdalena, Barczyk Artur, Obersztyn Ewa, Modzelewski Jan, Lipska Iwona, Stankiewicz Pawe?, Gajecka Marzena, Rydzanicz Ma?gorzata, P?oski Rafa?, Szczapa Tomasz, Karolak Justyna A,
  
  Abstract
  
  Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a lethal lung developmental disorder caused by the arrest of fetal lung formation, resulting in neonatal death due to acute respiratory failure and pulmonary arterial hypertension. Heterozygous single-nucleotide variants or copy-number variant (CNV) deletions involving the gene and/or its lung-specific enhancer are found in the vast majority of ACDMPV patients. ACDMPV is often accompanied by extrapulmonary malformations, including the gastrointestinal, cardiac, or genitourinary systems. Thus far, most of the described ACDMPV patients have been diagnosed post mortem, based on histologic evaluation of the lung tissue and/or genetic testing. Here, we report a case of a prenatally detected de novo CNV deletion (~0.74 Mb) involving the gene in a fetus with ACDMPV and hydronephrosis. Since ACDMPV is challenging to detect by ultrasound examination, the more widespread implementation of prenatal genetic testing can facilitate early diagnosis, improve appropriate genetic counselling, and further management.
  
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• Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside.
  Children (Basel)

  2023 Mar;10(3):. doi: 535.
  
  Tana Milena, Tirone Chiara, Aurilia Claudia, Lio Alessandra, Paladini Angela, Fattore Simona, Esposito Alice, De Tomaso Davide, Vento Giovanni,
  
  Abstract
  
  Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn's first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy.
  
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• Overshoot of the Respiratory Exchange Ratio during Recovery from Maximal Exercise Testing in Young Patients with Congenital Heart Disease.
  Children (Basel)

  2023 Mar;10(3):. doi: 521.
  
  Vecchiato Marco, Ermolao Andrea, Zanardo Emanuele, Battista Francesca, Ruvoletto Giacomo, Palermi Stefano, Quinto Giulia, Degano Gino, Gasperetti Andrea, Padalino Massimo A, Di Salvo Giovanni, Neunhaeuserer Daniel,
  
  Abstract
  
  INTRODUCTION:
  The overshoot of the respiratory exchange ratio (RER) after exercise is reduced in patients with heart failure.
  
  AIM:
  The present study aimed to investigate the presence of this phenomenon in young patients with congenital heart disease (CHD), who generally present reduced cardiorespiratory fitness.
  
  METHODS:
  In this retrospective study, patients with CHD underwent a maximal cardiopulmonary exercise testing (CPET) assessing the RER recovery parameters: the RER at peak exercise, the maximum RER value reached during recovery, the magnitude of the RER overshoot and the linear slope of the RER increase after the end of the exercise.
  
  RESULTS:
  In total, 117 patients were included in this study. Of these, there were 24 healthy age-matched control subjects and 93 young patients with CHD (transposition of great arteries, Fontan procedure, aortic coarctation and tetralogy of Fallot). All patients presented a RER overshoot during recovery. Patients with CHD showed reduced aerobic capacity and cardiorespiratory efficiency during exercise, as well as a lower RER overshoot when compared to controls. RER magnitude was higher in the controls and patients with aortic coarctation when compared to those with transposition of great arteries, previous Fontan procedure, and tetralogy of Fallot. The RER magnitude was found to be correlated with the most relevant cardiorespiratory fitness and efficiency indices.
  
  CONCLUSIONS:
  The present study proposes new recovery indices for functional evaluation in patients with CHD. Thus, the RER recovery overshoots analysis should be part of routine CPET evaluation to further improve prognostic risk stratifications in patients with CHD.
  
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• Effect of 11 Weeks of Physical Exercise on Physical Fitness and Executive Functions in Children.
  Children (Basel)

  2023 Mar;10(3):. doi: 485.
  
  Zhang Mingyang, Garnier Hanna, Qian Guoping, Li Shunchang,
  
  Abstract
  
  OBJECT:
  The aim of our study was to evaluate and compare the effects of physical exercise interventions on physical fitness and executive functions in children.
  
  METHODS:
  Six-year-old children participated in the study and were randomly divided into physical exercise group (PE group, = 43) and control group (C group, = 46). The children in the PE group participated in a physical exercise program for 45 min daily, four days a week for 11 weeks. The children in the C group continued with their usual routines. Then, all the children were tested before and after the experiment for body composition (height, weight, BMI), physical fitness (20-m shuttle run test, standing long jump test, grip strength test, 4 × 10 m shuttle run test and sit and reach tests), and executive functions test (animal go/no-go task, working memory span task, simple reaction test and flexible item selection task) before and after the 11-week period.
  
  RESULTS:
  The 11 weeks of physical exercise did not significantly affect the body composition of the children ( > 0.05). The physical fitness and executive functions test results showed that 11 weeks of physical exercise interventions improves physical fitness (cardiopulmonary fitness, muscle strength, speed sensitivity and flexibility quality) and executive functions parameters (inhibitory control, working memory, the reaction time, and cognitive flexibility) in children (
  CONCLUSION:
  11 weeks of physical exercise can improve the physical fitness and executive functions of six-year-old children.
  
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• Use of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit.
  Children (Basel)

  2023 Feb;10(3):. doi: 462.
  
  Ciarmoli Elena, Storti Enrico, Cangemi Jessica, Leone Arianna, Pierro Maria,
  
  Abstract
  
  Cardiopulmonary ultrasound (CPUS), the combination of lung ultrasound (LUS) and targeted neonatal echocardiography (TnECHO)AA, may offer a more appropriate approach to the challenging neonatal cardiovascular and respiratory disorders. This paper reviews the possible use of CPUS in the neonatal intensive care unit (NICU).
  
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