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duration of intravenous diuretictreatment(2 studies, WMD=0.17 days; 95% CI -1.26 to 1.6 days; p =0.81), the serum creatinine levels(5 studies, WMD=0.05 mg/dl; 95% CI -0.16 to 0.26 mg/dl; p=0.12), and serum sodium levels(5 studies, WMD= -0.86 mmol/L;95% CI-2.92 to 1.2 mmol/L; p=0.41). By contrast, serum BNP levels were significantly higher in the group with free water intake(4 studies, WMD=223.76 pg/ml ; 95% CI 158.8 to 288.72 pg/ml; p less then 0.001). CONCLUSIONS In patients with heart failure, liberal fluid consumption does not seem to exert an unfavorable impact on heart failure rehospitalizations or all-cause mortality. Considering the heterogeneity of the included studies and their quite exiguous sample sizes, larger randomized controlled trials would be warranted in the future in order to achieve definitive confirmation of the present findings. These findings substantially disavow any useful role of water intake restriction as a non-pharmacological measure to be adopted in heart failure management.Patients with coronary microvascular dysfunction (CMVD) represent a widespread population and despite the good prognosis, many of them have a poor quality of life with strong limitations in their daily activities because of the angina symptoms. This work summarizes the most frequent clinical presentation pictures like stable and unstable microvascular angina. Main risk factors are discussed, followed by the last updates on the subject about different pathogenic hypotheses, diagnosis and treatment. Not very well understood microvascular alterations, like slow flow phenomenon and no reflow are discussed and both prognosis and the impact of the disease in the quality of life are analized.BACKGROUND Cardiac patients are managed medically or with an intervention. This review aims to explore the survival benefit of each approach in the management of cardiac patients. METHODS We reviewed updated evidence of survival benefit from the most recent trials and guidelines. RESULTS Patients with ST-segment-elevation myocardial infarction (STEMI) have a mortality benefit when a Primary Cardiac Intervention is implemented. No similar benefit has been shown in chronic stable coronary artery disease. Heart failure patients show a mortality benefit using medication and similarly, mild or moderate valve disease patients do not require an intervention. In atrial fibrillation, the CABANA trial using ablation therapy, had no mortality benefit. Hypertension drug therapy showed a significant mortality benefit, a similar benefit was noted with drug therapy for the treatment of dyslipidemia, when achieving the target lipid goal. CONCLUSIONS Not all interventional procedures result in a mortality benefit. Medical therapy alone increases survival in many cardiac diseases.BACKGROUND Ischemic mitral regurgitation (IMR) is a frequent valvular heart disease and is related to worse prognosis. The aim of this study was to investigate the dynamics in the degree of IMR from the acute phase of inferoposterior myocardial infarction (MI) to 5-years follow-up and to identify the predictors of change in the degree of mitral regurgitation (MR). METHODS We included patients with first ever acute inferoposterior MI and examined them in two phases at the time of acute MI then 5-years later. Based on two-dimensional transthoracic echocardiography, the patients were divided into the non-significant MR (NMR) group and IMR group. The parameters of left ventricle (LV), mitral apparatus and clinical data were assessed in both phases. The predictors of a decrease or an increase in the degree of mitral regurgitation after 5-years were identified. RESULTS The values of the parameters of mitral apparatus and LV chambers increased with higher degrees of IMR. The tenting height, systolic blood pressure and posteromedial papillary muscle (PMPM) displacement during the acute phase were the most important in predicting the change in the degree of MR after 5-years. CONCLUSIONS The assessment of mitral apparatus in acute phase of MI can be most useful to determine the change of the degree of MR long-term post MI. Although LV remodelling itself contributes to IMR, this influence is directly dependent on alterations in mitral geometry.BACKGROUND The recent advances in technology and miniaturization of endoscopic devices have permitted the use of RIRS to treat large and complicated kidney stones as first line therapy in alternative to PCNL. OBJECTIVE Systematically review the efficacy and safety of RIRS for large renal stones over 2 cm versus the current gold standard, the percutaneous nephrolithotomy. METHODS A large search was effected in PubMed, Cochrane Library, Embase, Ovid and Scopus regarding the treatment of renal stones over 2cm with RIRS versus PCNL. Articles not in English and not regarding adult population were excluded. The retrieval time included a time span from 2000 to 2019. All clinical trials were further evaluated about quality and references. The eligible studies were included and analyzed with RevMan 5.2 Software. RESULTS Two randomized and nine non-randomized studies were included for a total of 1618 patients involved. Our meta-analysis showed no difference in SFR (RR = 0.92, 95% CI 0.86- 0.99, p = 0.03) and in mean operation time (WMD = 6.34 min, 95% CI -4.98 – 17.65, p = 0.27) while shorter hospital stay was reported for RIRS (WMD = -2.15 days,95% CI -3.04 – -1.25, = less then 0.00001). We reported moreover lower Hb drop (WMD = -0.83 g/dl, 95% CI -1.20 – -0.45, p= less then 0.00001) and complications rate in favours of RIRS (RR = 0.88, 95% CI 0.71 – 1.09, p=0.23). CONCLUSIONS RIRS is challenging PCNL for the treatment of large renal stones over 2cm, becoming a safe and effective alternative with a comparable stone free rate, lower complication rate and lower hospitalization time. It is, however, of the uttermost importance to share the treatment decision with the patient due to the possibility of requiring multiple RIRS session to completely clear larger stone burdens.BACKGROUND To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. METHODS Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson comorbidity index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence- free survival (RFS) rates, complication rates and global renal function. RESULTS A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0- 79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. selleck kinase inhibitor Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.