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ABSTRACT Background and objective: The coexistence of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increases with age. The occurrence, prognosis and therapeutic implications of concurrent COPD in elderly patients with CHF were investigated. Methods: One hundred and eighteen consecutive patients, ≥65 years old with ≥10 pack/years of smoking and with a verified diagnosis of CHF in stable condition, were enrolled. They were followed for a mean of 1029 (range 758-1064) days. All patients had spirometry and the diagnosis and classification of COPD were made according to Global Initiative for Chronic Obstructive Lung Disease guidelines. Results: The mean occurrence of COPD was 30% (90% confidence interval: 24-37%). At baseline in patients with CHF and COPD, there was a shorter 6-min walk distance, lower arterial oxygen tension, glomerular filtration rate and higher N-terminal pro-B-type natriuretic peptide (all P < 0.05). The prescription of CHF therapies, including β-blockers, was similar in the two groups. After follow up, the presence of COPD in patients with CHF did not appear to influence survival. Conclusions: COPD is relatively frequent in elderly patients with CHF. COPD did not alter survival. [ABSTRACT FROM AUTHOR]

After almost a decade of stagnation in clinical research for HF treatment, five large randomized trials recently published have supported the use of four new classes of drugs, namely: angiotensin receptor/neprilysin inhibitor, sodium–glucose co-transporters 2 inhibitors, soluble guanylate cyclase modulators, and myosin activators. Each treatment has proved to be beneficial for both long-term outcomes and quality of life. Beside their clinical relevance, all these novel treatments have a different mechanism of action beyond the usual neuro-hormonal blockage. These different pathways, together with the unquestionable clinical evidence, advocate a re-thinking of HF treatment and of the appropriate drug to integrate with the existing standard therapy, according to different characteristics of HFrEF patients. This study aimed to offer a synthetic overview of the mechanisms of action of the new drugs and to propose a more personalized approach, considering patients' characteristics and safety profiles. To this end, we have identified seven profiles for patients with chronic heart failure with reduced ejection fraction and two for pre-discharge patients. [ABSTRACT FROM AUTHOR]

Background: Phase II and observational studies support the use of rituximab in multiple sclerosis. Standard protocols are lacking, but studies suggest comparable efficacy between low- and high-dose regimens. Objective: To evaluate effectiveness and safety of de-escalating rituximab dose from 1000 to 500 mg/6 months in multiple sclerosis. Methods: Patients were switched from rituximab 1000 to 500 mg/6 months and prospectively followed for 12 months. Relapses, disability, occurrence of brain/spinal magnetic resonance imaging (MRI) lesions, serum neurofilament light chain (NfL), CD19+ B cell, and IgG concentrations were analyzed. Results: Fifty-nine patients were included (37 relapsing-remitting, 22 secondary progressive). No relapses occurred, with no difference in expanded disability status scale (EDSS) between baseline (4 (2.5–4.5) and 12 months (3.5 (2.5–5.5) p = 0.284). Overall, three new T2 lesions appeared during follow-up. NfL concentration was stable between baseline (7.9 (5.9–45.2) pg/mL) and 12 months (9.1 (5.9–21.3) pg/mL, p = 0.120). IgG concentrations decreased with greater rituximab load (coefficient = −0.439, p = 0.041). IgG deficient patients had greater risk of infections (OR = 6.27, 95% CI = 1.71–22.9, p = 0.005). Conclusion: De-escalating rituximab dose from 1000 to 500 mg/6 months is safe, results in clinical and radiological stability, and does not affect serum NfL over 12 months. Rituximab load negatively influences IgG concentrations, and IgG deficient patients are at higher risk of infections. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac pressures. Several studies reported a crucial role of immune activation and inflammation in the chronic heart failure (HF) pathogenesis, suggesting that pro-inflammatory and anti-inflammatory mediators could be predictive markers of the HF development and/or progression. Human Leukocyte Antigen-G (HLA-G), a tolerogenic and anti-inflammatory class I non-classical major histocompatibility complex molecule, was reported to be upregulated in patients diagnosed with HF, suggesting a tentative to regulate the inflammatory condition. We evaluated soluble (s)HLA-G plasmatic levels in patients with stable chronic heart failure at baseline visit and after 6 and 12 months. The 14 bp Insertion/Deletion polymorphisms of the HLA-G gene was also analyzed. We showed that in HF subjects, sHLA-G levels were higher in NYHA class II and III subjects (mild-severe symptoms) (6.11 ± 1.15 ng/ml; 8.25 ± 2.27 ng/ml, respectively) in comparison with NYHA class I subjects (no symptoms) (2.35 ± 0.43 ng/ml) (I vs II: p = 0.0156; I vs III: p = 0.0122). Moreover, the exposure to chemicals seems to affect sHLA-G levels, with higher sHLA-G levels in exposed patients (3.36 ± 5.12 ng/ml) in comparison with unexposed subjects (2.01 ± 2.84 ng/ml). The HLA-G 3′UTR 14 bp INS/DEL polymorphism correlated with sHLA-G, with the 14 bp INS/INS genotype associated with higher sHLA-G levels during the 12 months follow-up in unexposed subjects (p = 0.008). In conclusion, these results support a correlation between sHLA-G levels, genetics and HF disease in presence of work chemical exposition. [ABSTRACT FROM AUTHOR]

Background: In elderly smokers, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) usually present with dyspnoea. COPD and CHF are associated -almost invariably with concomitant chronic diseases, which contribute to severity and prognosis. Objectives: We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for -mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers. Methods: We examined 144 patients with COPD and 96 with CHF, ≥65 years, ≥20 pack/years, and measured COPD Assessment Test (CAT) score, modified Medical Research Council, NYHA, and Charlson Index, routine blood test, estimated glomerular filtration rate, HRCT scan, 6-min walk test. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome. Results: COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT, and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 months hospitalizations, renal disease, and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score, and lower FEV1/FVC ratio were associated with hospitalization in COPD, while age, lower FEV1% predicted, and peripheral vascular disease were in CHF. Conclusions: There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units. [ABSTRACT FROM AUTHOR]

Objectives: Return to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty. Participants: We studied 102 patients, in employment at the time of AMI (88.24% of men), admitted to the Department of Cardiology of the University-Hospital of Ferrara between March 2015 to December 2016. Demographical and clinical characteristics were obtained from the cardiological records. After completing an interview on social and occupational variables and the Hospital Anxiety and Depression (HADS) questionnaire, patients underwent exercise capacity measurement and spirometry. Results: Of the 102 patients, only 12 (12.76%) held a university degree, 68.63% were employees and 31.37% self-employed. The median number of sick-leave days was 44 (IQR 33–88). At day 30, 78.5% of all subjects had not returned to work, at day 60, 40.8% and at day 365 only 7.3% had not resumed working. At univariate analyses, educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and HADS depression score were significant for earlier return to work. The multivariate analysis confirms that having a university degree, being self-employed and presenting a lower value of HADS depression score increase the probability of a quicker return to work. Conclusions: These findings suggest that the strongest predictors of returning to work within 1 year after discharge for an acute myocardial infarction are related more to socio-occupational than to clinical parameters. [ABSTRACT FROM AUTHOR]

It is unknown whether components present in heart failure (HF) patients' serum provide an angiogenic stimulus. We sought to determine whether serum from HF patients affects angiogenesis and its major modulator, the Notch pathway, in human umbilical vein endothelial cells (HUVECs). In cells treated with serum from healthy subjects or from patients at different HF stage we determined: (1) Sprouting angiogenesis, by measuring cells network (closed tubes) in collagen gel. (2) Protein levels of Notch receptors 1, 2, 4, and ligands Jagged1, Delta-like4. We found a higher number of closed tubes in HUVECs treated with advanced HF patients serum in comparison with cells treated with serum from mild HF patients or controls. Furthermore, as indicated by the reduction of the active form of Notch4 (N4IC) and of Jagged1, advanced HF patients serum inhibited Notch signalling in HUVECs in comparison with mild HF patients' serum and controls. The circulating levels of NT-proBNP (N-terminal of the pro-hormone brain natriuretic peptide), a marker for the detection and evalutation of HF, were positively correlated with the number of closed tubes (r = 0.485) and negatively with Notch4IC and Jagged1 levels in sera-treated cells (r = −0.526 and r = −0.604, respectively). In conclusion, we found that sera from advanced HF patients promote sprouting angiogenesis and dysregulate Notch signaling in HUVECs. Our study provides in vitro evidence of an angiogenic stimulus arising during HF progression and suggests a role for the Notch pathway in it. J. Cell. Physiol. 231: 2700-2710, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims Up to 30-45% of implanted patients are non-responders to CRT.We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing. Methods and results A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT. Conclusions Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate. [ABSTRACT FROM AUTHOR]

Aims: Up to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing.Methods and Results: A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT.Conclusions: Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate. [ABSTRACT FROM AUTHOR]

In this article, the author discusses cardiac remodelling after an infarct. Topics discussed include remodelling applicable to cardiac structure occurring to the left ventricle (LV) after myocardial infarction, remodelling reflecting myocyte proliferation and increasing in volume, and effect of exercise on remodelling of the heart.

The objective of this study was to determine the effect of the length of the suckling period and the dietary energy level on the duration of postpartum anestrus in Creole goats. Twenty-eight multiparous pregnant goats (bodyweight BW 39.9 ± 6.4 kg; mean ± SEM) each bearing a single fetus were used in a 2 suckling period (30 vs. 60 d) × 2 levels of energy intake (low (L) vs. high (H)) factorial design. Kids were separated from their dams 3 d after birth and then suckled twice per day until weaned at 30 or 60 d postpartum. Dams weaned at 30 d postpartum were hand milked for the next 30 d. Goats were individually fed chopped alfalfa hay + balanced concentrates (45:55 DM basis) at 3% of BW in the last month of pregnancy and at the same level to the L goats in the postpartum period when the H goats were fed at 4% of BW. Energy balance was estimated by difference between energy intake and calculated energy requirements. Duration of postpartum anestrus was estimated by determining the occurrence of ovulation from changes in blood progesterone concentrations. There were no significant lengths of suckling x energy intake level interactions. Goats on all treatments lost weight until 45 d postpartum with more weight loss on the low than the high energy intake level (L 4.06 ± 0.43 vs. H 1.99 ± 0.64 kg; P < 0.05). The daily 4% FCM production was similar for all treatments (overall mean 1.10 ± 0.01 kg). The difference between the postpartum anestrus period between low (129 d) and high (128 d) dietary energy levels was not significant but no goat ovulated while in negative energy balance. The effect of suckling on the resumption of ovarian activity was highly significant (P < 0.001) with goats weaned 30 d postpartum resuming ovulation 102 d after parturition compared to 155 d for those weaned 60 d postpartum. This study illustrates the importance of the bond between the doe and its kid in the prolongation of the anestrus period in goats. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the benefit of diet mixing for Creole goats grazing native forage species in the central Monte desert of Argentina and the drivers of preference in the mixed diet. To achieve this goal, cafeteria-style experiments were conducted with thirty female Creole goats (2 years old; 44 ± 1.4 kg) and forage species that are typically ingested by goats in this region: Two tanniniferous ( Tricomaria usillo , Mimosa ephedroides ) and three non-tanniniferous shrubs ( Prosopis flexuosa , Capparis atamisquea, Atriplex lampa ). In Experiment 1, goats were assigned to three groups ( n = 10); two groups were offered single tannin-containing shrubs as their basal diet ( T. usillo ; SDTU or M. ephedroides , SDME), whereas the third group received a combination of all five forages (Mixed diet of forages, MD). After a fifteen-day adaptation period, half the animals in each group ( n = 5) were dosed with polyethylene glycol (PEG), a polymer that neutralizes the negative effects of tannins, whereas the other half (Control) were not dosed (CG). Daily dry matter intake (DMI), in vivo apparent digestibility of the diet (ADD) and nitrogen (ADN) were determined. For goats fed MD, preference was estimated based on the DMI of each of the forages offered. Jugular blood samples were collected on the first and last days of the experiment to determine concentrations of blood urea nitrogen (BUN) and serum metabolites indicative of liver damage. In experiment 2, intake rates (IR) of the five forage species were estimated. No significant differences in DMI were detected among treatments. However, goats offered a choice of forages (MD) in the CG treatment had greater diet digestibility and lower BUN than animals fed the single shrubs, showing evidence of a nutritional benefit with dietary diversity. Goats changed their foraging preferences in response to PEG supplementation. Animals in the CG treatment preferred M. ephedroides whereas animals in the PEGG treatment preferred A. lampa. There was a positive correlation between forage preference and IR of crude protein ( r = 0.65; P < 0.001) in PEGG goats, and between forage preference and IR of total tannins ( r = 0.77, P < 0.001) in CG goats. When PEG attenuated biological effects of condensed tannins, goats switched their preference from forages that offered the greatest IR of total tannins (i.e., M. ephedroides ) to those that led to the greatest IR of crude protein (i.e., A. lampa ). In summary, a mixed diet led to greater nutritional benefits than single diets, which contribute to explain the diverse array of food items goats typically show when browsing in the central Monte desert of Argentina. Our results also show that CP, tannins and plant structure (which offer variable intake rates) play significant roles in goats’ foraging preferences in this environment. [ABSTRACT FROM AUTHOR]

Background: To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (ISS-HIV symptoms scale). Methods: The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. Results: The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. Conclusions: The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results. [ABSTRACT FROM AUTHOR]

Introduction: Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. Methods: We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. Results: The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition. Conclusions: Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population. [ABSTRACT FROM AUTHOR]

This study was aimed to determine the effect of the rearing system on the establishment and development of different functional groups of microorganisms in the rumen of kid goats. Fifty kids were fed on goat milk until weaning at 45 (TR, traditional rearing system, n = 25) and 30 days of age (alternative rearing system, AR, n = 25). In addition, only AR group was offered with rumen starter from birth. Both groups consumed alfalfa hay and ground corn between 30 and 90 days of age. Five kids from each group were slaughtered at 21, 30, 45, 70 and 90 days old. It was determined the total number of protozoa, anaerobic, amylolytic and cellulolytic bacteria present in the rumen. Kids of AR were lighter in weight than TR kids between 42 and 56 days old. In both rearing systems, anaerobic and amylolytic bacteria were found at 21 days of age, while cellulolytic and protozoa were not found until 45 days of age. Kids of AR had higher quantities of anaerobic and amylolytic bacteria until 30 and 45 days of age, respectively. These results demonstrate the rearing system does not affect the sequence and time in which the functional groups of microorganisms are established in the rumen. However, the alternative rearing system with early intake of solid food allowed the establishment of greater amount of bacteria and protozoa. Nevertheless, the effect of weaning on growth rate was more marked in kids from alternative rearing system, despite its greater microbiological rumen development. [ABSTRACT FROM AUTHOR]

This study compared rumen development and blood metabolite concentrations of Criollo kids under two different rearing systems. Forty goat kids were reared by their dams, suckling goat milk from birth until weaning at 45 (TR, traditional rearing system, n=20) or 30 days of age (AR, alternative rearing system, n=20). Goat kids in the AR group were offered a solid starter diet ad libitum from birth until 45 days of age and a growing diet (80% alfalfa hay and 20% ground corn) from 30 to 90 days of age. The TR group was fed a growing diet (without starter diet) between 30 and 90 days of age. Blood samples were analyzed for serum concentration of glucose, total protein, blood urea nitrogen (BUN), -hydroxybutyrate (HB), and non-esterified fatty acids (NEFA). Five kids from each group were slaughtered at 21, 45, 70 and 90 days of age to determine rumen variables. AR kids consumed 32.7 % less goat milk than TR kids throughout the trial. Body weight of AR kids at 45-60 days of age was lower than the traditional market weight. Rumen weight (as % of body weight) was higher (P<0.01) in AR kids than in TR kids at 21 and 45 days of age. Furthermore, rumen weight (as % of weight of all compartments) was higher in AR kids compared to TR kids at 21, 45 and 70 days of age. Rumen papillae of AR kids tended (P<0.10) to be longer than those of TR kids at 21 and 45 days of age. Blood glucose concentration decreased with increasing age of kids, indicating a shift from glucose to short-chain fatty acids as primary energy source. Serum HB and BUN concentrations at 30 and 45 days of age were higher (P<0.05) in AR kids than in TR kids. The higher serum concentrations of BUN and HB were attributed to early development of rumen microbial fermentation activity and to greater metabolic development of the rumen epithelium of AR kids compared to TR kids. In conclusion, the alternative rearing system improves the physical and metabolic development of the rumen and promotes the transition of kids from pre-ruminant to ruminant. In dry periods with shortage of forage, the alternative rearing system could be used, but these goat kids should be reared above the traditional age to enable them to achieve an appropriate weight for marketing. [ABSTRACT FROM AUTHOR]

Abstract: The changes in forage availability and the physicochemical variability of plants influence the diet selection by herbivores. In this study, the foraging behavior of Creole goats was studied in terms of botanical composition of the diet, food availability and physicochemical properties of vegetation. The study was performed in a desert rangeland in the northeast (NE) Mendoza region in Argentina. Experiments with grazing goats were made in dry (winter) and wet (summer) seasons and cafeteria experiments (feeding trial) were performed during the summer. Food availability was estimated from forage species cover. Botanical composition of the goat's diet was determined by microhistological analysis of fecal samples. Morphological parts of forage species consumed by goats were sampled and analyzed to determine chemical traits (plant nutrients and secondary metabolites) in both seasons. Also, during summer, the two morphological traits of browse species stem specific density (SSD) and specific leaf area (SLA) were evaluated. In the experiments with grazing goats, diet selection was evaluated based on Ivlev's electivity index ( ) and, in cafeteria experiments, preference was estimated based on the number of bites. Diet selection varied between the two seasons. Grazing goats showed differences in the patterns of diet selection related to changes in forage availability. The botanical composition of the diet had a greater (p <0.001) participation of woody species in relation to grass species in both seasons, but the herbaceous stratum was more utilized by goats during the summer according to their higher availability. Correlations between diet and availability were positive in both seasons, but not significant in summer. The models including crude protein (CP), neutral detergent fiber (NDF) and total phenols (TP) had substantial support for predicting variation in diet selection in summer and winter. In both seasons the preference increased as the concentrations of CP, NDF and TP increased, but the effect of CP was significant only in winter. Thus, goats selected supplementary food mixtures (mixed diet) and tannins were not considered dissuasive but, rather, were maintained below a certain threshold. In summer, SSD was negatively and significantly related to diet selection by grazing goats. This morphological trait allowed explaining a greater percentage of the variation in (36%) with regard to the variation explained by the chemical variables (16%). In cafeteria experiments, in summer, the optimization of nutrient intake rate through consumption of species with low SSD values represented a best explanation for the preferences observed, whereas the hypotheses of minimization of secondary metabolites and maximization of nutrients were not able to fully explain the preferences observed in cafeteria experiments. To conclude, dietary decisions by goats in desert rangelands could be interpreted in terms of intake rate optimization and complementation of nutrients and secondary compounds, rather than by explanations involving the isolated effects of nutrient intake maximization or tannin intake minimization. [Copyright &y& Elsevier]

Aim: Circulating mesenchymal cells increase in heart failure (HF) patients and could be used therapeutically. Our aim was to investigate whether HF affects adipose tissue derived mesenchymal cell (adMSC) isolation, functional characteristics and Notch pathway. Methods and results: We compared 25 patients with different degrees of HF (11 NYHA classes I and II and 14 NYHA III and IV) with 10 age and gender matched controls. 100% adMSC cultures were obtained from controls, while only 72.7% and 35.7% from patients with mild or severe HF (p<0.0001). adMSC from HF patients showed higher markers of senescence (p16 positive cells: 14±2.3% in controls and 35.6±5.6% (p<0.05) and 69±14.7% (p<0.01) in mild or severe HF; γ-H2AX positive cells: 3.7±1.2%, 19.4±4.1% (p<0.05) and 23.7±3.4% (p<0.05) respectively), lower proliferation index (Ki67 positive cells: 21.5±4.9%, 13.2±2.8% and 13.7±3.2%, respectively), reduced pluripotency-associated genes (Oct4 positive cells: 86.7±4.9%, 55±12% (p<0.05) and 43.3±8.7% (p<0.05), respectively; NANOG positive cells: 89.8±3.7%, 39.6±14.4% (p<0.01) and 47±8.1%, respectively), and decreased differentiation markers (α-sarcomeric actin positive cells: 79.8±4.6%, 49±18.1% and 47±12.1% (p<0.05) and CD31-positive endothelial cells: 24.5±2.9%, 0.5±0.5% (p<0.001) and 2.3±2.3% (p<0.001), respectively). AdMSC from HF patients also showed reduced Notch transcriptional activity (lowered expression of Hey 1 and Hey 2 mRNAs). Stimulation with TNF-α of adMSC isolated from controls affected the transcription of several components of the Notch pathway (reduction of Notch 4 and Hes 1 mRNAs and increase of Notch 2 and Hey 1 mRNAs). Conclusions: In HF yield and functionality of adMSC are impaired and their Notch signaling is downregulated. [ABSTRACT FROM AUTHOR]

Although myocardial angiogenesis is thought to play an important role in heart failure (HF), the involvement of circulating proinflammatory and proangiogenic cytokines in the pathogenesis and/or prognosis of HF has not been deeply investigated. By using a highly standardized proliferation assay with human endothelial cells, we first demonstrated that sera from older (mean age 52 ± 7.6 years; n = 46) healthy donors promoted endothelial cell proliferation to a significantly higher extent compared to sera obtained from younger healthy donors (mean age 29 ± 8.6 years; n = 20). The promotion of endothelial cell proliferation was accompanied by high serum levels of several proangiogenic cytokines. When we assessed endothelial cell proliferation in response to HF patients' sera, we observed that a subset of sera (n = 11) promoted cell proliferation to a significantly lesser extent compared to the majority of sera (n = 18). Also, in this case, the difference between the patient groups in the ability to induce endothelial cell proliferation correlated to significant (P < 0.05) differences in serum proangiogenic cytokine levels. Unexpectedly, HF patients associated to the highest endothelial proliferation index showed theworst prognosis as evaluated in terms of subsequent cardiovascular events in the follow-up, suggesting that high levels of circulating proangiogenic cytokines might be related to a worse prognosis. [ABSTRACT FROM AUTHOR]

Aims Chronic heart failure (HF) is in part characterized by immune activation and inflammation, and factors that regulate lymphocyte trafficking and inflammation may contribute to the progression of this disorder. The homeostatic chemokine CCL21 is a potent regulator of T-cell migration into non-lymphoid tissue and may exert inflammatory properties and influence tissue remodelling. We therefore investigated CCL21 levels and association with fatal outcomes in patients with chronic HF. Methods and results Plasma CCL21 was measured at randomization in 1456 patients enrolled in the Controlled Rosuvastatin Multinational Trial in HF (CORONA) and in 1145 from the GISSI-HF trial. Association between CCL21 levels [given below as hazard ratio (HR) with 95% confidence interval (CI) for 1 SD increase] with all-cause (n = 741) or cardiovascular (CV) mortality (n = 576) was evaluated with multivariable Cox proportional hazard models, adjusting for clinical risk factors, C-reactive protein, and NT-proBNP. In multivariable Cox models, CCL21 was associated with higher risk of all-cause mortality (HR 1.16, 95% CI 1.02–1.32; P = 0.020) and CV mortality (HR 1.20, 95% CI 1.08–1.33; P < 0.001). When the two trials were analysed separately, CCL21 had a similar influence on risk prediction. Finally, CCL21 had a modest but significant impact on the discriminatory properties of the model (all-cause mortality, change in Harrell's C-statistic 0.004, P = 0.001; CV mortality, change in C-statistic 0.002, P = 0.002). Conclusion Circulating CCL21 was associated with all-cause and CV mortality in two large populations of contemporary patients with chronic HF. [ABSTRACT FROM PUBLISHER]

Background Knowledge of the role of the receptor for advanced glycation end products ( RAGE), particularly its soluble form (s RAGE), and of its advanced glycation end product ( AGE) ligand, N-(carboxymethyl)lysine adducts ( CML), is limited in chronic heart failure ( CHF) and in chronic obstructive pulmonary disease ( COPD). We evaluated whether the AGE/ RAGE system is activated in stable CHF and COPD, and whether plasma s RAGE and CML levels are affected by clinical and functional parameters. Materials and methods We measured plasma levels of s RAGE and CML using a sandwich enzyme-linked immunosorbent assay ( ELISA) in 143 subjects, aged ≥ 65 years, divided into five groups: 58 with CHF, 23 with COPD, 27 with CHF+ COPD and 35 controls (17 healthy smokers and 18 healthy nonsmokers). Individuals with diabetes were excluded from the study. Results Plasma levels of s RAGE and CML were higher in CHF patients than in controls [s RAGE: 0·48 (0·37-0·83) vs. 0·42 (0·29-0·52) ng/mL, P = 0·01; CML: 1·95 (1·58-2·38) vs. 1·68 (1·43-2·00) ng/mL, P = 0·01]. By contrast, s RAGE and CML were not different between both COPD and CHF+ COPD patients and controls ( P > 0·05). N-terminal pro-brain natriuretic peptide ( Nt-pro BNP) correlated with s RAGE, but not with CML, in the patient groups: CHF ( r = 0·43, P < 0·001), COPD ( r = 0·77, P < 0·0001) and CHF/ COPD ( r = 0·43, P = 0·003). Conclusions Plasma levels of s RAGE and CML are increased in CHF, but not in COPD patients. The robust association between NT-pro BNP, a diagnostic and prognostic marker in CHF, and sRAGE concentrations might suggest a possible BNP pathway of amplification of inflammation via the AGE/ RAGE system. [ABSTRACT FROM AUTHOR]

Abstract: This paper evaluated the growth performance of Criollo kids under three different rearing systems and determine the economic profit of each rearing systems with slaughter at two different ages. Forty-eight kids were distributed randomly into three groups (n =16). Two groups of kids were naturally reared with their mothers, suckling goat milk until weaning at 30 and 45days of age (groups N30 and N45, respectively). In the remaining group, kids were artificially reared on milk replacer until 45days of age (group A45). Between 30 and 90days, all groups were ad libitum offered with a ration of alfalfa hay and ground corn. Kids from each group were slaughtered at 60 (n =8) and 90 (n =8) days old. The growth performance of kids was acceptable achieving average daily gain (ADG) values ranging between 115.9 and 129.5gd−1, with no major differences between rearing systems at the end of the study. The natural rearing systems showed low values of gross return, which ranged from −0.60 to 5.67US$kid−1, while the artificial rearing system was not economically viable due to the high cost of milk replacer and high demand of labor. The price of milk replacer should not exceed 20% of meat value so that artificial rearing becomes economically feasible. The average gross return of the two natural rearing groups slaughtered at 90days (3.96±1.46US$kid−1) was three times higher than the animals slaughtered at 60days (1.25±0.93US$kid−1). On the basis of the economic results it would be advisable to raise the kids naturally with goat milk and increase the age of slaugther, as long as consumers accept these older animals without decreasing the selling price of meat. [Copyright &y& Elsevier]

Abstract: The botanical composition of the diet and species preference of grazing goats in different physiological states were evaluated in the autumn and winter seasons. The study was performed in a desert rangeland in the northeast (NE) Mendoza region in Argentina. Food availability was estimated from forage species cover. Rectal grab faecal samples were collected from goats, and the botanical composition of the goat diet was determined using a microhistological technique. Goat preferences for each species consumed were calculated based on Ivlev''s index. Nutritional composition and secondary compounds of forage species were determined. Correlations between diet and availability; and between goat preference and nutritional composition of forage species were also estimated. The habitat consisted of a dominant woody stratum associated with an herb stratum primarily composed of grasses. Goats in different physiological states utilised a significantly higher proportion of woody vegetation compared to grass (p <0.01). When grass availability was high (autumn), the herb stratum was more utilised by pregnant and lactating goats than by dry goats (p <0.05). In the winter, the diet of lactating goats consisted of more Atriplex lampa compared to the diet of dry goats (p <0.05), probably due to the high crude protein content of the plant. Goats consumed forage species with highly variable total phenol and tannin contents, which did not negatively affect selection. Correlations between diet and availability were high in the winter for dry (r s =0.88, p <0.02), pregnant (r s =0.93, p <0.01) and lactating goats (r s =0.97, p <0.01) but were not significant in the autumn. A significant correlation between preference and crude protein was shown during the autumn season for pregnant and lactating goats (r s =0.6, p <0.05). Forage availability was the main factor influencing diet selection in this arid environment. When food availability was not a limiting factor, goats selected a diet that most closely matched their nutritional requirements. Physiological state modified nutrient requirements and affected diet selection in that pregnant and lactating goats selected forage species with high protein contents. [Copyright &y& Elsevier]

The infrastructures that are built and used for astronomical research are financed by -- and therefore must be justified to -- our society. Astronomy has an innate appeal for people of all ages, partly because it concerns the fascinating, great questions "of life, the Universe and everything" and partly because much of the data obtained with telescopes can be presented as objects of stunning beauty. These are key facts when considering communicating astronomy with the public. This native advantage that astronomy has over many other sciences does not, however, relieve us of the obligation to explain what we are doing to the public at large. There are many reasons for doing this. They range from attracting bright young people into the subject to fuel future research endeavours to convincing decision-takers to allocate large sums of money to finance increasingly expensive and ambitious projects. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether time-related changes of pulmonary hypertension (PH) have prognostic relevance in severe chronic heart failure (CHF). Methods: All CHF patients referred for follow-up from 1996 through 2003 were screened for this study. Eligibility depended on availability of a concomitant clinical, laboratory, electrocardiographic (ECG), echocardiographic and right-heart catheterization (RHC) assessment at index evaluation, as well as absence of pre-capillary PH. Results: One hundred ninety-six patients (age 54 ± 9 years; 27% women, 73% men; 50% in New York Heart Association [NYHA] Class III or IV) were included. PH at index evaluation was an independent predictor of acute heart failure or cardiovascular death (AHF/CD), with adjusted risk ratio (RR) = 2.30, 95% confidence interval (CI) 1.42 to 3.73 and p < 0.001. A pre-study (≥6 months) RHC was available for 174 of the 196 patients. Worsening of mean pulmonary artery pressure (mPAP) of ≥30% (a pre-specified cut-off corresponding to the 75th percentile of ΔmPAP%) provided prognostic information independent of all index-evaluation parameters (adjusted RR = 2.60, 95% CI 1.45 to 4.67, p = 0.001), and from time-related changes in the other hemodynamic parameters (p ≤ 0.033). Conclusions: PH retains independent prognostic significance even after adjusting for a large set of clinical/laboratory/instrumental parameters. Furthermore, serial measurements of mPAP seem to provide additional prognostic information as compared with a single assessment. These findings indicate that serial evaluations of PAP may help identify a sub-set of high-risk CHF patients deserving a particularly close follow-up to facilitate timely indications for non-pharmacologic strategies, including (when appropriate) heart transplantation. [Copyright &y& Elsevier]

Chronic obstructive pulmonary disease (COPD) is a common comorbidity of heart failure (HF), but remains often undiagnosed, and we aimed to identify symptoms predicting COPD in HF. As part of an observational, prospective study, we investigated stable smokers with a confirmed diagnosis of HF, using the 8-item COPD-Assessment-Test (CAT) questionnaire to assess symptoms. All the items were correlated with the presence of COPD, and logistic regression models were used to identify independent predictors. 96 HF patients were included, aged 74, 33% with COPD. Patients with HF and COPD were more symptomatic, but only breathlessness when walking up a hill was an independent predictor of COPD (odds ratio = 1.33, p = 0.0484). Interestingly, COPD-specific symptoms such as cough and phlegm were not significant. Thus, in elderly smokers with stable HF, significant breathlessness when walking up a hill is most indicative of associated COPD, and may indicate the need for further lung function evaluation. [ABSTRACT FROM AUTHOR]

On May 2012 the city of Ferrara and the surrounding region were hit by several earthquakes. We had the chance to observe the behavior of one thalassemic heart during the shocks, because of a 24-h electrocardiogram recording had been put in place a few hours before the shocks. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) may coexist in elderly patients with a history of smoking. Low-grade systemic inflammation induced by smoking may represent the link between these 2 conditions. In this study, we investigated left ventricular dysfunction in patients primarily diagnosed with COPD, and nonreversible airflow limitation in patients primarily diagnosed with CHF. The levels of circulating high-sensitive C-reactive protein (Hs-CRP), pentraxin 3 (PTX3), interleukin-1β (IL-1 β), and soluble type II receptor of IL-1 (sIL-1RII) were also measured as markers of systemic inflammation in these 2 cohorts. Patients aged ≥50 years and with ≥10 pack years of cigarette smoking who presented with a diagnosis of stable COPD (n=70) or stable CHF (n=124) were recruited. All patients underwent echocardiography, N-terminal pro-hormone of brain natriuretic peptide measurements, and post-bronchodilator spirometry. Plasma levels of Hs-CRP, PTX3, IL-1 β, and sIL-1RII were determined by using a sandwich enzyme-linked immuno-sorbent assay in all patients and in 24 healthy smokers (control subjects). Although we were unable to find a single COPD patient with left ventricular dysfunction, we found nonreversible airflow limitation in 34% of patients with CHF. On the other hand, COPD patients had higher plasma levels of Hs-CRP, IL1 β, and sIL-1RII compared with CHF patients and control subjects (p < 0.05). None of the inflammatory biomarkers was different between CHF patients and control subjects. In conclusion, although the COPD patients had no evidence of CHF, up to one third of patients with CHF had airflow limitation, suggesting that routine spirometry is warranted in patients with CHF, whereas echocardiography is not required in well characterized patients with COPD. Only smokers with COPD seem to have evidence of systemic inflammation. [ABSTRACT FROM AUTHOR]

An abstract of the article "Secondary cardiomyopathy in patients with Beta-thalassemia major: a model of reverse cardiomyopathy," by S. Gaitani and colleagues is presented.