The Shockwave Medical device (S-IVL; Shockwave Medical Inc, Santa Clara, CA, USA) emits sound waves that act selectively on the calcific component, breaking it up and making the vessel more compliant.Device loss or entrapment during percutaneous coronary interventions (PCI) is a rare circumstance whose incidence has decreased over time mainly because of device improvements. Nevertheless, they still represent fearful complications also and above all because the operators may be unfamiliar with rescue and retrieval techniques. The devices that most frequently experience loss or entrapment are stents, followed by angioplasty balloons, burrs for rotational atherectomy, guidewires and microcatheters. In this review we will illustrate the risk factors for device loss and the main retrieval techniques, as described in the literature or stemmed from our experience as high-volume PCI center.Primary percutaneous coronary intervention (PCI) represents the reperfusion strategy of choice for patients presenting with ST-segment elevation myocardial infarction. However, despite the restoration of epicardial flow, primary PCI may not determine an effective reperfusion of myocardial tissue due to the occurrence of microvascular obstruction. This phenomenon also known as "no-reflow" may occur in 30-60% of patients treated with primary PCI. Of importance, no-reflow attenuates the benefit of reperfusion therapy and is associated with a poor clinical outcome in terms of adverse ventricular remodeling, heart failure and mortality. The pathophysiology of no-reflow is complex and multiple players may be involved. Indeed, distal embolization, ischemia-reperfusion injury and an individual predisposition to microvascular dysfunction synergically interact to determine the occurrence of no-reflow. In this review, we will analyze the pathophysiological mechanisms, the diagnostic tools and the main therapeutic targets of no-reflow, with particular attention to the most recent acquisitions in this field.Background The causative role played by intra-abdominal pressure (IAP) in the syringogenesis of the Chiari 1 malformation syringomyelia has been still not adequately studied. The aim of this study is to validate the transmedullary theory about the hindbrain-related syrinx, also discussing the implications for safety of these patients related to the use of high-pressure CO2 pneumoperitoneum during laparoscopic and robotic surgery. Methods Fourteen patients with a hindbrain-related syrinx were candidate for a posterior fossa decompression. Preoperative and follow-up protocol involved conventional T1/T2 and cardiac-gated Cine phase-contrast MRI sequences. Peak systolic and diastolic velocities were acquired at four Regions Of Interests (ROI), namely syrinx, ventral and dorsal cervical subarachnoid space, and foramen magnum region. Data were reported as mean ± SD. Patients were followed for three years. One-way ANOVA with Bonferroni post hoc test of multiple comparisons were performed, where p-value was less then 0.001. Results A systolic-diastolic pulsatile pattern of CSF was found in all cases inside the syrinx. Syrinx and premedullary cistern velocities decreased within the first month after surgery ( less then 0.001). All symptoms apart from atrophy and spasticity improved. These data lead to validate the Oldfield and Heiss transmedullary theory about syringogenesis, within which an increased IAP play a key role. Conclusion Raised IAP plays a paramount role in the formation and maintenance of the hindbrain-related syrinx. High-pressure CO2 surgical pneumoperitoneum is strongly discouraged in these patients because at risk of rapid neurological worsening. A low-pressure insufflation technique has a rationale in those patients having smaller or incidental syrinxes. Key words Hindbrain-Related Syringomyelia, Intra-Abdominal Pressure, Laparoscopic Robotic Surgery.Introduction Tacrolimus is routinely used to prevent rejection after organs' transplantation. Neurotoxicity is underrated side effect, where no typical clinical, radiological, or histopathological patterns have yet been found. The present study is targeted to a review of the literature on tacrolimus-induced neurotoxicity secondary to organs' transplantation, aimed to its prompt diagnosis. Materials and methods Multiple PubMed searches were performed to review relevant articles regarding tacrolimusinduced neurotoxicity. selleck An illustrative case is also presented. Results Twenty articles published between 1997 and 2019 were identified and reviewed. Clinical manifestations of tacrolimus-induced neurotoxicity varied. MRI showed subcortical white matter involvement in most cases. Symptoms and radiological signs occurred at various drug dosages and blood tacrolimus levels. Tacrolimus discontinuation resulted in disappearance or marked reduction of neurological symptoms and imaging lesions in every case. Conclusion Neurotoxicity is an underrated reversible side effect of chronic tacrolimus administration after organs' transplantation. Its prompt diagnosis, based on T2 and FLAIR MRI sequences neuroimaging combined with stereotactic biopsy, allows the discontinuation of the drug and a recovery of the patient in most of the cases. Key words Stereotactic Biopsy, Neurotoxicity, Tacrolimus, Transplant Complications, Transplantation, Tumorlike Lesion.Chemical composition and anticholinesterase activity of the essential oil of Pavetta graciliflora Wall. ex Ridl. (Rubiaceae) was examined for the first time. The essential oil was obtained by hydrodistillation and was fully characterized by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). A total of 20 components were identified in the essential oil, which made up 92.85% of the total oil. The essential oil is composed mainly of β-caryophyllene (42.52%), caryophyllene oxide (25.33%), β-pinene (8.67%), and α-pinene (6.52%). The essential oil showed weak inhibitory activity against acetylcholinesterase (AChE) (I% 62.5%) and butyrylcholinesterase (BChE) (I% 65.4%) assays. Our findings were shown to be very useful for the characterization, pharmaceutical, and therapeutic applications of the essential oil from P. graciliflora.