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Funding Acknowledgements Type of funding sources: None. Background Training-induced cardiac remodelling is usually accompanied by a harmonic and symmetric adaptation of cardiac chambers. Mild aortic enlargement may be a consequence of intense training, although even the definition of aortic dilatation, particularly in athletes and tall athletes, is sometimes challenging. It is therefore essential to early identify competitive athletes with aortic dilatation to manage this condition appropriately. Purpose This study aimed to test a new parameter for the definition of aortic dilatation in competitive athletes, assessing the balancing cardiac remodelling in athletes through the ratio between the aortic diameter and left ventricular (LV) diameter. Methods Competitive athletes were compared with sedentary subjects and with patients with known aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26±7 years), 410 sedentary (74.1% males, mean age 29±11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56±7 years). Results Patients with aortic dilatation had both an absolute (39.2±2.4 mm) and indexed (19.4±2.2 mm/m2) aortic diameter larger than athletes (30.6±3.2 mm; 16.1±1.5 mm/m2) and sedentary subjects ( 30.5±3.1 mm; 16.5±1.6 mm/m2), with no statistically significant differences between athletes and sedentary subjects. The ratio between the aortic diameter and LV end-diastolic diameter was lower in athletes (0.59 ± 0.06), compared to sedentary subjects (0.65 ± 0.05) and to patients with aortic dilatation (0.81 ± 0.06). The latter had a significantly higher value than the remaining groups (p Conclusions This study tested a new echocardiographic parameter for the definition of an aortic dilatation in competitive athletes. The ratio between aortic diameter and LV end-diastolic diameter, with a cut off of 0.71, demonstrated a good sensitivity and specificity to differentiate between physiological and pathological remodelling of the aorta.

There are 130 described species in the genus Mycodrosophila Oldenberg, 1914, distributed across all biogeographic regions. Most of these species show essential mycophagy. Currently, ten species are known from the Neotropical Region, nine of which are found in the Amazon, Atlantic Forest, Cerrado and Pampa biomes of Brazil. In this study, we describe the adult external morphology and structures of male and/or female terminalia for two new species from the Amazon Biome of Brazil. In addition, we propose a new species group, the Mycodrosophila neoprojectans group, encompassing the two new species described here, together with three previously described species from the Neotropics.

Background Mechanical circulatory support (MCS) systems are increasingly employed in critical hemodynamic states, such as in cardiogenic shock and end-stage heart failure. A thorough understanding of the complex interactions occurring between heart, vasculature and device is essential to optimize patient's management. Purpose This study aimed to explore the hemodynamic profile of patients under MCS using a non-invasive method based on pressure-strain analysis. Methods Consecutive patients admitted to the cardiological intensive care unit (CICU) from August 2021 to January 2022 undergoing different MCS systems positioning/implantation were retrospectively reviewed. Patients without a useful echocardiographic exam and/or arterial blood pressure invasive measurement at the time of echocardiography were excluded. Myocardial work analysis by Speckle Tracking Echocardiography (STE) was performed in these patients. Results 3 patients with intra-aortic balloon pump (IABP), 2 patients with durable left ventricular assist device (dLVAD), 2 patients with temporaneous left ventricle (LV)-to-aortic pump, 1 patient with extracorporeal membrane oxygenation (ECMO) and 1 patient with ECMO and IABP were included. The use of IABP shifted the pressure-strain curve rightward and downward. Global work index (GWI) and global wasted work (GWW) decreased after IABP positioning, whereas global work efficiency (GWE) increased. The use of continuous-flow LV-to-aortic pumps, whether temporaneous or long-term (dLVAD), induced a significant change in the pressure-strain loop, with a shift towards a triangular shape. ECMO positioning alone resulted in a narrowing of the pressure-strain loop, with a decrease in GWI and GWE and an increase in GWW and mean arterial pressure. The combined used of IABP with ECMO widened the pressure-strain loop and improved GWI and GWE. Conclusions Pressure-strain loops unveil hemodynamic variations induced by mechanical circulatory support systems. Thus, myocardial work could be used to monitor ventricular-arterial-device coupling in such patients and therefore guide tailored management. Funding Acknowledgement Type of funding sources: None.

Purpose Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular dysfunction, with an important increase of utilization rates (from 38–59%) in the latest years. In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts. Methods Data collected from 2006 and 2014 of patients who received orthotopic Htx were retrospectively analysed. Clinical, laboratory and instrumental features were evaluated and patients with homogenous baseline characteristics were selected to reduce biases among the two groups. Dipyridamole stress echo was performed on donors >55 years old or Results Twenty-two recipients were included (eleven patients with a marginal donor heart, group 1, and eleven with acceptable donor heart, group 2). Mean donors age was 41±23, 45±29 years for group 1 vs 36±12 for group 2. The average follow-up was 113 months. Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two population (P>0.05) (see Table 1). Left atrial size was significantly higher in marginal hearts (Optimal: p=0.007; Marginal: p=0.003). Optimal donors showed a higher impact of CAV (p=0.019) together with more elevated values of cholesterol and triglycerides (p=0.048 and p=0.012 respectively). No rejection differences were found between the two groups. Four patients deceased, 3 had received a standard donor heart and 1 was from the marginal donor group, with and overall median time to death of 124 months. Conclusions No mortality difference was detected among the two heart donor groups with a lower incidence of CAD in the marginal heart donor population. Our study shows how Htx from selected marginal donor heart can implement shortage of organs without difference in survival with acceptable donor hearts. Funding Acknowledgement Type of funding sources: None.

Introduction Cardiac involvement is described as the most important prognostic factor in light chain amyloidosis. An early diagnosis is mandatory to customize the follow-up timing and the best treatment. The aim of the study was to identify the role of advanced echocardiography in the diagnosis of amyloid light chain cardiac amyloidosis (ALCA). Material and methods Seventy-seven patients were prospectively included in the study: 22 patients with biopsy proven ALCA, 28 patients with multiple mieloma, and 27 with monoclonal gammopathy of undetermined significance. All patients underwent first and second level imaging including Speckle Tracking and complete biochemical profile. Univariate and Multivariate analysis was applied to the best multi-chamber predictor assessed with Receiver Operating Curve analysis. Continuous variables were discretized and compared with different subgroups based on multiparametric imaging assessment using available AL score. Results Biochemical indices have been confirmed as the best predictors of ALCA. More specifically, high sensitivity troponin (hsTn) and N-terminal pro brain natriuretic peptide (NT-pro-BNP) showed an AUC of 0.88 and 0.91 respectively. Among left ventricular systolic function parameters, left ventricular longitudinal strain (AUC: 0.92); apical sparing pattern (AUC: 0.75) and relative wall thickness (RWT) (AUC: 0.88) showed the best diagnostic accuracy. Atrial parameters such as left atrial volume index (LAVI) (AUC: 0.74), left atrial stiffness (LAS) (AUC: 0.82) and inter-atrial septum diameter (AUC: 0.75) showed a good diagnostic accuracy in ALCA (Figure 1). LAS and AL score maintained their diagnostic value in the multivariate model analysis (B=2,16; p=0,01 and B= 0,72; p Conclusion ALCA diagnosis often relies only on the biochemical profile. A comprehensive cardiac evaluation by a multiparametric imaging approach with LAS estimation is mandatory to ensure early diagnosis and a prompt treatment through a multidisciplinary team assessment. Funding Acknowledgement Type of funding sources: None.

Background Cardiogenic shock (CS) is the most severe form of acute heart failure, characterized by life-threatening end-organ hypoperfusion resulting from a low cardiac output state. Data on epidemiology of CS has been mostly drawn from registries focusing on acute myocardial infarction (AMI). However, recent evidence in a contemporary cohort in North America has shown that more than two thirds of all CS cases were related to causes other than AMI and that these patients had outcomes at least as poor as patients with AMICS. Purpose To provide data on profile, management, outcome, and evolution over time of CS patients admitted to ICCU/ICU and to compare them between patients with AMICS and acute decompensated heart failure (ADHF-CS). Methods The Altshock-2 Registry is a multicenter national prospective data collection, part of the Italian Altshock-2 program. Recruitment started on 2 March 2020 with 11 Italian Centers contributing to patients' enrolment. A total of 238 patients were hospitalized with confirmed diagnosis of CS between March 2020 and February 2022 in a multicenter national initiative. The mean age of this patient population was 64 years (interquartile range [IQR] 54–74) and 76% were male. Ninety-seven patients (41%) were admitted for AMICS, whereas 84 patients (35.3%) had ADHF-CS; 57 patients (24%) had other causes. As compared to AMICS patients, those admitted for ADHF-CS were younger, but with a higher burden of comorbidities (renal, liver, thyroid disease, atrial fibrillation, anemia), pre-existing decreased ejection fraction and a higher number of chronic drugs. Patients with ADHF-CS had a prevalent cardio-metabolic phenotype upon admission with prevalent congestion. Mechanical ventilation was more commonly used in patients with AMICS, compared to ADHF-CS, along with an increased inotropic score. Conversely, sodium nitroprusside was used in about sixty percent of patients with ADHF-CS. Sixty percent of the included population received a temporary mechanical circulatory support (MCS) device, which was intra-aortic balloon pump (IABP) in the eighty percent of the supported patients. Pulmonary artery catheter was used for monitoring only in the 18% of the included patients whereas an extensive echocardiographic approach was applied. Twenty-one patients (25%) underwent heart replacement therapy in the ADHF-CS patients versus 2 (2%) in the AMICS. Thirty-day mortality occurred in 32 patients (33%) in the AMICS group versus 23 (27%) in the ADHF-CS group (p=0.41). Conclusions Different diagnostic approaches and uses of mechanical circulatory support devises and inotropes are implemented in transatlantic settings. Uniform definitions and more homogenous protocols tailored on CS etiologies and clinical and biochemical phenotypes are needed in prospective initiatives in order to effectively compared results and outcome. Funding Acknowledgement Type of funding sources: None.

Background Right ventricular failure (RVF) complicates 10 to 40% of left ventricular assist device (LVAD) implants, with necessity of high dose inotropic/vasodilatory drugs and right ventricular assist devices in severe cases. Prevention of RVF starts with appropriate patient selection for LVAD implant through extensive clinical, echocardiographic and hemodynamic evaluation. Purpose This study aimed to evaluate the performance of a novel non-invasive echocardiographic method for estimation of right ventricular myocardial work to predict RVF and death after LVAD implant. Methods Consecutive patients from May 2017 to February 2022 undergoing LVAD implant were retrospectively reviewed. Patients without a useful echocardiographic exam and/or a right heart catheterization prior to LVAD implant were excluded. Myocardial work analysis by Speckle Tracking Echocardiography (STE) was performed in these patients. The primary endpoints were RVF and death. Results The study included 23 patients (mean age 64±8 years, 91% men). Median follow-up time was 304 days (IQR: 23–1017). GWI significantly correlated with invasively-derived right ventricular stroke work index (RVSWI, r=0.538; p=0.008) and pulmonary arterial compliance (PAC, r=−0.522; p=0.013). Patients who experienced RVF (26.1%) had lower GWI (p=0.047) and GWE (p=0.001) and higher GWW (p=0.001). Patients who experienced death at 30 days after LVAD implant (26.1%) had lower GWE (p=0.005) and higher GWW (p=0.006). Performance for prediction of RVF after LVAD implant was greatest for GWE (AUC 0.92), followed by GWW (AUC 0.88) and GWI (AUC 0.78). A cut-off of 77% for GWE have a 100% sensibility and 82% specificity for prediction of RVF. At long term follow-up, death occurred in 4 patients (29%) in the GWE>77% group and in 6 patients (67%) in the GWE Conclusions Right ventricular myocardial work is a strong predictor of RVF after LVAD implant and death at long-term follow up. Its calculation should be implemented in the evaluation for LVAD candidacy. Funding Acknowledgement Type of funding sources: None.

Background In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient's quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. Purpose the aim of our study was to determine the association between NT-proBNP and PALS and their prognostic implications in patients acute and chronic HF. Methods patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. Results the overall study cohort included 388 patients, of which 172 with acute HF and 216 with chronic HF. Mean age was 65±12, 37% were female. The majority of patients had reduced LV systolic function (mean LV ejection fraction = 30±10%; mean LV global longitudinal strain = −8.3±3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF (median [interquartile range] = 6039 [2989; 13535]pg/ml vs. 544[200; 1533] pg/ml) and lower global PALS (10.4 [6.3; 16.45] vs. 15.6 [10.6; 21]%). Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (Fig. 1; all p Conclusions global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF. Funding Acknowledgement Type of funding sources: None.

Background The endothelial nitric oxide synthase (eNOS) gene deficiency is known to cause insulin resistance, hypertension, hypertriglyceridemia and impaired coronary vasodilating capability in animal models. In the general clinical population, the eNOS gene polymorphism (Glu298Asp, G894T), able to reduce eNOS activity, was associated either with features of the metabolic syndrome or prevalence of coronary artery disease (CAD). Purpose To investigate the possible association of Glu298Asp polymorphism with cardiometabolic risk [insulin resistance, increased triglycerides (TG) and low HDL-cholesterol (HDL-C)], obstructive CAD and inducible myocardial ischemia in stable patients with suspected coronary disease. Methods Six cardiology units enrolled a total of 506 consecutive patients (314 males; mean age 62±9 years) referred for suspected CAD within the BIOGEN-CARE Tuscan Region Italian Study. Among these, 325 patients underwent stress ECG or cardiac imaging to assess the presence of inducible ischemia and 436 patients underwent non invasive computerized tomography or invasive coronary angiography to assess the presence of obstructive CAD (>50% stenosis in at least one major coronary vessel). Blood samples were collected from each patient for genotyping and measurements of lipid and glucose parameters. The TG/HDL-C ratio and the TyG-index [ln(TG × Fasting plasma glucose/2)] were used as synthetic markers of atherogenic dyslipidemia and insulin resistance, main components of the cardiometabolic risk. Results In the whole population, 49.6% of patients were homozygous for the G894allele, 40.9% heterozygotes, and 9.5% homozygous for T894. Myocardial ischemia was documented in 160/325 (49.2%) patients undergoing stress testing and obstructive CAD in 178/436 (40.8%) patients undergoing coronary angiography. Patients carrying the T allele (dominant model TT+GT vs GG) had higher TG/HDL ratio (2.7±1.8 vs 2.5±1.9, P=0.03) (Figure) without differences in other lipid and glucose markers. Independent predictors of obstructive CAD were age, gender, obesity, diabetes and TG/HDL-C ratio but not the the T allele (OR 0.80; CI 0.51–1.25; ns). Independent predictors of inducible ischemia were age, gender, obesity and the T allele (OR 1.91; CI 01.19–3.08; P=0.007). Stratifying the population for both obstructive CAD and ischemia, the T allele was associated with increased risk of ischemia (OR 1.96; CI 1.11–3.44; P=0.02) even after adjustment for the presence of obstructive CAD (OR 3.09; CI 1.85–5.78; P Conclusions In stable patients with suspected CAD, the eNOS Glu298Asp gene polymorphism is an independent risk factor for inducible myocardial ischemia and is significantly associated with the specific cardiometabolic risk expressed by high TG and low HDL-C which independently predicts obstructive CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): “BIOhumoral and GENetic predictors of CARdiac Evolving phenotype in Ischemic Heart Disease (BIOGENCARE-IHD)”; funded by Toscan Region-Programma per la ricerca regionale in materia di Salute 2009

Layered double hydroxides (LDHs) act as catalysts in several reactions like in the cyanoethylation of alcohols with acrylonitrile to produce alkoxypropionitriles. Here we report an experimental and theoretical study in which it is shown that the experimental catalytic activity of LDHs in the cyanoethylation of 2-propanol and methanol correlates with the predicted strength of the basicity of the adsorbed surface species. First, it is shown that using activated LDHs containing Mg

Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.La impresión en tres dimensiones (3D) incluye un grupo de tecnologías por medio de las cuales es posible generar objetos tridimensionales a partir de información binaria. La ortopedia y traumatología es uno de los campos de la medicina en los que mayor impacto ha tenido la planificación 3D, en especial en trauma y ortopedia oncológica. Las aplicaciones de esta técnica incluyen el diagnóstico, planificación quirúrgica, creación de guías intraoperatorias, implantes personalizados, entrenamiento quirúrgico, impresión de ortesis y prótesis y la bioimpresión. Se han demostrado ventajas en su uso como la mayor precisión técnica, el acortamiento de tiempos quirúrgicos, disminución de pérdida sanguínea y menor exposición a rayos. Si bien el proceso está cada vez más optimizado y accesible por los avances en software y automatización, es una técnica que requiere un entrenamiento adecuado. El objetivo de esta revisión es ofrecer un acercamiento a esta tecnología y sus principios básicos.

Scheduling jobs in a no-wait flow shop with the objective of minimising total earliness and tardiness is the problem addressed in this paper. Idle time may be needed on the first machine due to the...

Reports of deaths caused by alligators or crocodiles are rare in the literature. These deaths may be related to sharp force trauma caused by the teeth of these animals, with or without mutilation, or even drowning after seizure and submersion of the victim. It is difficult to forensically identify bodies in cases of mutilation of the upper limbs during the attack or when the corpse is in an advanced stage of skeletonization. Smile photographs are an important source of ante-mortem references for comparison. We report a human identification based on a photograph of a victim, with the absence of limbs caused by an alligator attack and the advanced skeletonization stage due to scavenger fish action in the Amazon within only 36 hours after his disappearance. The description of alligator attacks and the marks observed on the victim's body are essential to help medical and forensic professionals diagnose the injuries found and, consequently, define the cause of death.

We describe a case of a 63 year–old man with familiar dilated cardiomyopathy, with severe left ventricle dysfunction (EF 20%) and severe mitral regurgitation.A progressive worsening of functional status was detected (peak VO2 11 ml/kg/min, NYHA III) with some episodes of VT interrupted by bicameral ICD,for which the patient was referred to our center and included in the heart transplant (HT) list. In the following months sustained VT with hemodynamic impact were recorded, with consequent worsening in class INTERMACS 2. The patient underwent to endocardial and epicardial VT ablation, complicated with electrical storm with deterioration towards cardiogenic shock (INTERMACS 1), requiring vaso–inotropic drugs,mechanical ventilation and femoro–femoral VA–ECMO.The patient was centralized in our ICCU, where he maintained a adequate MAP, SvcO2 50% and active diuresis but at echocardiography left ventricle appeared dilated with high filling pressure, X–ray and pulmonary ultrasonography showed congestion, lactate value rapidly increased (5 mmol/mol), renal and hepatic function worsened (creat 2 mg/dl, bil 2.8 mg/dl). After multidisciplinary discussion an escalation of mechanical circulatory support (MCS) was performed, changing ECMO configuration: an arterial cannula was positioned in the right axillary artery and venting cannula positioned in the apex of the left ventricle. The hemodynamic and respiratory parameters quickly improved,the right pulmonary catheterization showed good pulmonary resistence,organ perfusion improved and neurological status was intact, therefore the patient was inserted in emergency list for HT. After few days a de–escalation of MCS was performed,removing venous cannula and oxygenator, changing the circuit in para–corporeal left ventricle mid–term support as bridge to transplantation. The patient maintained conscious, in spontaneous breathing,able to perform physiotherapy and spontaneous nutrition. The de–escalation of MCS allowed to reduce potential complications of MCS and achieve the HT intervention in a better general and functional condition. After 36 days the patient underwent HT with positive outcome. Conclusion MCS are device that require a continuous re–assessment a re–modulation to ensure in the early stages the optimization of haemodynamic support, perfusion of vital organs and unloading of the Vsx and in the following stages an adjustment to long–term strategies (bridge to recovery, bridge to VAD, bridge to heart transplantation).

We reported a case of a 42–year–old man with no major pathologies, symptomatic for a few days for headache, fever and dysuria. For worsening dyspnea and tachycardia the patient was admitted to emergency room. He was markedly hypoxic with severe left ventricular dysfunction, therefore in the suspicion of myocarditis, the patient was centralized in our ICCU. The patient appeared tachycardic (sinus tachycardia 160 bpm), normotensive but hypoperfused (svO2 40%, lac 5 mmol/l, oliguric) and severely hypoxemic despite mechanical ventilation. In the first hours the condition of severe hypoxia persisted (P/F 100. For this reason cultural exams were performed and large spectrum antibiotic therapy started. After about 4 hours the patient was still hypotensive and hypoperfused, despite support with IABP and vasopressors, therefore femoro–femoral VA–ECMO was implanted. There was a rapid improvement of hemodynamic status, peripheral perfusion and reduction of pulmonary congestion but a marked leukocytosis and PCT> 100 persisted with negative cultures. On the 4th day, during ECMO weaning we assisted to wide and rapid pressure fluctuations (SBP from 250 to 60 mmHg in a few minutes). Therefore total body CT was performed in the suspected pheochromocytoma and this showed a necrotized left adrenal mass of about 9 cm and multiple right cerebral hemorrhagic lesions. Therapy with IV alfa–blockers was promptly started and for the marked hemodynamic instability, in the presence of cerebral hemorrhage, left adrenalectomy was performed with removal of the mass approximately 10 hours after diagnosis. In the post–operative phase there was a stabilization of the pressure profile with complete recovery of the biventricular cardiac function, a rapid reduction in inflammation indices and recovery of renal function. The patient gradually recovered to a state of consciousness with residual hemiplegia. Histological examination confirmed the diagnosis of pheochromocytoma. Conclusions The present case represents an example of a catecholaminergic crisis, with fulminant onset and multiorgan dysfunction that initially made diagnosis difficult. Emergency adrenalectomy has conflicting evidence in the literature but in this case it was necessary for pressure instability in the context of cerebral hemorrhage.

We report the clinical case of a 75 year–old man, previous smoker with mild lower extremity arterial disease, that presented a sudden and intensive chest pain. The emergency medical system documented an anterior STEMI quickly complicated by out–of–hospital cardiac arrest from a shockable rhythm, treated with DC–shock with rapid ROSC and recovery of consciousness. The patient was transported to the local hospital where coronary angiography showed extensive intraluminal thrombosis of ostial Cx and ostial LAD treated with thrombus aspiration and balloon angioplasty. During the procedure the patient was supported with inotropic agents, mechanical ventilation and IABP for a cardiogenic shock. After few hours he was transferred to level II hospital, equipped with all mechanical circulatory supports (MCS) and on–site cardiac surgery, where he was assisted with vaso–inotropic drugs, Impella CP and continuous renal replacement (CRRT). After 3 days for a refractory cardiogenic shock (stage D) the patient was referred and then transferred to our hospital, a level III hospital with cardiac transplantation program, for hemodynamic stabilization and eventual long term ventricular assist device (VAD). After 5 days the patient was weaned by Impella support, then weaned by mechanical ventilation, renal replacement therapy, without any neurological damage. The echocardiography showed a severe left ventricular dysfunction (EF 20%) with severe mitral regurgitation with good right ventricle function, confirmed also by strain assessment. In the following weeks were reported repeated episodes of pulmonary congestion treated with high doses of diuretics, NIV and nitroprusside infusion and episodes of low cardiac output treated with inotropes for prolonged periods. Mitraclip implantation was technically feasible but Heart Team decided to implantation an LVAD due to numerous episodes of low cardiac output and reduced cardiac index values. Screening for VAD showed no contraindications, therefore after 72 days from acute event LVAD was implanted with positive outcome. Conclusion the presence of a local network for cardiogenic shock allowed to optimize the clinical pathway of this patient and to manage in an integrated way the complex treatment of cardiogenic shock.

A mixed metal-oxide (NiAlOx) obtained from the annealing of a synthetic takovite clay, [(Ni6Al2(OH)16]CO3·4H2O, was used as a catalyst in the hydrodeoxygenation reaction of vanillin, as a model molecule, to simulate deoxygenation of lignin's moieties. The catalysts were characterized by XRD, TPR, XPS and textural analyses and were tested at between 413 and 573 K and 1.2 MPa H2, using a 300 ml batch reactor. The reaction products were analyzed using a gas-chromatograph coupled to a mass detector (GC–MS). The active site is visualized as a Niδ+–O–Al3+ moieties able to dissociate molecular H2 into highly reactive species (H− and H+) for hydrogenation reactions. Depending on the reaction temperature, decarbonylation, hydrogenation, demethoxylation and dehydroxylation reactions occurred in three stages as clearly indicated by Van-Krevelen O/C* vs. H/C* plots. Our study points out that total deoxygenation can be attained at 553 K with a 100% selectivity to products like methyl-cyclohexane and cyclohexane.

Funding Acknowledgements Type of funding sources: None. BACKGROUND A novel echocardiographic method allows to non-invasively assess myocardial work using pressure-strain loops. Even though left ventricular myocardial work has already emerged as a promising prognostic tool for various pathological conditions, its relationship with invasively-derived corresponding indices has not been assessed in humans yet. PURPOSE This study aimed to explore the correlation between left ventricular myocardial work (LVMW) indices and invasively-derived left ventricular stroke work index (LVSWI) in a cohort of patients with advanced heart failure (HF) considered for heart transplantation. METHODS All consecutive patients with advanced heart failure considered for heart transplantation from 2016 to 2021 that had already performed right heart catheterization (RHC) as part of the workup and with an available echocardiographic exam were included (n = 91). Myocardial work analysis was performed in 44 patients, according to exclusion criteria. Conventional LV functional parameters and LVMW indices, including LV global work index (LVGWI), LV global constructive work (LVGCW), LV global wasted work (LVGWW), LV global work efficiency (LVGWE) and other were calculated and compared with invasively measured LV stroke work index (LVSWI). RESULTS Median time between RHC and echocardiography was 0 months [interquartile range (IQR): 0 – 1]. Median age was 60 years (IQR: 54 – 63). For the most part, etiology of HF was non-ischemic (61.4%) and all patients were either on class NYHA II (61.4%) or III (27.3%). Median left ventricular ejection fraction was 25% (IQR: 22.3 – 32.3), median NT-proBNP 1377 pg/mL (IQR: 646 – 2570). Among conventional parameters of LV function, LV global longitudinal strain (LVGLS) significantly correlated with LVSWI (r = - 0.337; p = 0.031), whereas LVEF did not (r = 0.308; p = 0.050). With regard to LVMW indices, some of them demonstrated correlation with LVSWI, particularly LVGWI (r = 0.425; p = 0.006), LVGCW (r = 0.506; p = 0.001), LV global positive work (LVGPW; r = 0.464; p = 0.003) and LV global systolic constructive work (LVGSCW; r = 0.471; p = 0.002). CONCLUSIONS Among left ventricular myocardial work indices, LVGCW correlated better with invasively-derived stroke work, thus representing a powerful and reliable tool for a more comprehensive evaluation of myocardial function. Abstract Figure. Study flow chart Abstract Figure. Correlation results

Transposable elements are abundant and dynamic part of the genome, influencing organisms in different ways through their presence or mobilization, or by acting directly on pre- and post-transcriptional regulatory regions. We compared and evaluated the presence, structure, and copy number of three hAT superfamily transposons (hobo, BuT2, and mar) in five strains of Drosophila willistoni species. These D. willistoni strains are of different geographical origins, sampled across the north-south occurrence of this species. We used sequenced clones of the hAT elements in fluorescence in-situ hybridizations in the polytene chromosomes of three strains of D. willistoni. We also analyzed the structural characteristics and number of copies of these hAT elements in the 10 currently available sequenced genomes of the willistoni group. We found that hobo, BuT2, and mar were widely distributed in D. willistoni polytene chromosomes and sequenced genomes of the willistoni group, except for mar, which is restricted to the subgroup willistoni. Furthermore, the elements hobo, BuT2, and mar have different evolutionary histories. The transposon differences among D. willistoni strains, such as variation in the number, structure, and chromosomal distribution of hAT transposons, could reflect the genomic and chromosomal plasticity of D. willistoni species in adapting to highly variable environments.

This medium is used for the growth of Erwinia/Pectobacterium species to ensure that virulence genes are turned ON. These bacteria turn on virulence (plant cell-wall degrading enzymes = PCWDEs) in response to various environmental signals. One of these signals is of plant origin, and it is thought to allow the bacterium to determine whether it has located a potential plant host. These plant signals are sensed by the bacterial sensor/regulator KdgR.

Close-in planets undergo strong tidal interactions with the parent star that modify their spins and orbits. In the two-body problem, the final stage for tidal evolution is the synchronisation of the rotation and orbital periods, and the alignment of the planet spin axis with the normal to the orbit (zero planet obliquity). The orbital eccentricity is also damped to zero, but over a much longer timescale, that may exceed the lifetime of the system. For non-zero eccentricities, the rotation rate can be trapped in spin-orbit resonances that delay the evolution towards the synchronous state. Here we show that capture in some spin-orbit resonances may also excite the obliquity to high values rather than damp it to zero. Depending on the system parameters, obliquities of 60 to 80 degrees can be maintained throughout the entire lifetime of the planet. This unexpected behaviour is particularly important for Earth-like planets in the habitable zone of M-dwarf stars, as it may help to sustain temperate environments and thus more favourable conditions for life., 12 pages, 9 figures, 2 tables

The severe acute respiratory syndrome coronavirus 2 responsible for COVID-19 remains a persistent threat to mankind, especially for the immunocompromised and elderly for which the vaccine may have limited effectiveness. Entry of SARS-CoV-2 requires a high affinity interaction of the viral spike protein with the cellular receptor angiotensin-converting enzyme 2. Novel mutations on the spike protein correlate with the high transmissibility of new variants of SARS-CoV-2, highlighting the need for small molecule inhibitors of virus entry into target cells. We report the identification of such inhibitors through a robust high-throughput screen testing 15,000 small molecules from unique libraries. Several leads were validated in a suite of mechanistic assays, including whole cell SARS-CoV-2 infectivity assays. The main lead compound, Calpeptin, was further characterized using SARS-CoV-1 and the novel SARS-CoV-2 variant entry assays, SARS-CoV-2 protease assays and molecular docking. This study reveals Calpeptin as a potent and specific inhibitor of SARS-CoV-2 and some variants.

The aim of this study was to evaluate the relationship between temperament in Nellore bulls with carcass and meat quality traits. In total, 1,400 bulls were studied, and temperament was assessed using two measurements: movement score (MOV) and flight speed test (FS). Both MOV and FS were measured at two time points, with background (MOVb and FSb) temperament measured at yearling age, ~550 d after birth, and the preslaughter (MOVps and FSps) temperament measured at the end of the feedlot period. The change of temperament resulting in an increase or decrease in reactivity was also used to measure meat quality. The traits used to define carcass and meat quality included carcass bruises (BRU), hot carcass weight (HCW, kg), ribeye area (REA, cm2), backfat thickness (BFT, cm), marbling score (MS), meat pH after thawing (pH), presence or absence of dark cutters, color parameters of luminosity (L*), redness (a*) and yellowness (b*), cooking loss (CL, %), and Warner–Bratzler shear force (WBSF, kg). A principal component (PC) analysis was initially applied to the carcass and meat quality traits, followed by logistic regression models and linear mixed models to evaluate the effects of temperament on carcass and meat quality. The risks of carcass bruises and dark cutters did not differ as a function of any temperament trait (P > 0.05). In turn, animals classified as high MOVb (reactive) had lower PC3 values (P = 0.05), CL (P = 0.02), and tended to have lower MS (P = 0.08). In addition, animals classified as high FSb (faster and reactive cattle) produced carcasses with smaller REA (P < 0.01), higher meat pH (P < 0.01), lower color gradients (L*, P = 0.04; b*, P < 0.01), and lower PC1 and PC4 scores (P < 0.01) when compared with the low FSb class. For preslaughter temperament, high MOVps was related to lower color a* (P = 0.04), whereas high FSps was related to lower HCW, MS, and PC2 (P < 0.01) than the calmer ones (low FSps). The reduction in MOV was related to more tender meat, and the reduction in FS to heavier carcass and brighter meat. We conclude that excitable temperament in Nellore cattle may have negative effects in some of the carcass and meat quality attributes assessed, mainly those related to muscle deposition on carcass and color gradients. Measurement of temperament before the cattle entered the feedlot was a better predictor of carcass and meat quality traits, compared with temperament assessment at the end of the feeding period.

The two-machine permutation flow shop scheduling problem with the objective of minimizing total earliness and tardiness is addressed. Unforced idle time can be used to complete jobs closer to their due dates. It is shown that unforced idle time only needs to be considered on the second machine. This result is then used to extend a lower bound and dominance conditions for the single-machine problem to the two-machine permutation flow shop problem. Two branch-and-bound algorithms are developed for the problem utilizing the lower bound and dominance conditions. The algorithms are tested using instances that represent a wide variety of conditions.

This paper addresses a permutation flowshop scheduling problem, with the objective of minimizing total weighted squared tardiness. The focus is on providing efficient procedures that can quickly solve medium or even large instances. Within this context, we first present multiple dispatching heuristics. These include general rules suited to various due date-related environments, heuristics developed for the problem with a linear objective function, and procedures that are suitably adapted to take the squared objective into account. Then, we describe several improvement procedures, which use one or more of three techniques. These procedures are used to improve the solution obtained by the best dispatching rule. Computational results show that the quadratic rules greatly outperform the linear counterparts, and that one of the quadratic rules is the overall best performing dispatching heuristic. The computational tests also show that all procedures significantly improve upon the initial solution. The non-dominated procedures, when considering both solution quality and runtime, are identified. The best dispatching rule, and two of the non-dominated improvement procedures, are quite efficient, and can be applied to even very large-sized problems. The remaining non-dominated improvement method can provide somewhat higher quality solutions, but it may need excessive time for extremely large instances.

The layered double hydroxides (LDHs) containing Mg2+, Al3+, and OH– (MgAl-OH), commonly known as meixnerite, meixnerite-like, or activated LDH, act as catalyst in the cyanoethylation of alcohols, f...

This case report aims to describe the occurrence of negative impacts of wearing nose-flap devices on beef calves subjected to the two-stage weaning method. Forty-one calves, twenty-one pure Nellore and twenty F1 Angus-Nellore, were weaned on average at 236 days of age. Commercial nose-flap devices were fitted in the nostrils of the calves (d0) to prevent suckling and removed five days later (d5). Individual body weights were assessed at d0 and d5, and average daily gain (ADG) was calculated. At d5, during nose-flap device removal, it was noted that 26.8% of the calves lost the nose-flap device; however, all of them had wounds in their nostrils (no injuries in the nostrils had been observed on d0). To assess the severity of these injuries, an impairment score was assigned to each calf, ranging from 1 = no lesions to 5 = injured with purulent discharge. A logistic regression model was fitted to evaluate the effect of sex and genetic group on nose-flap retention (kept or lost). The retention rate did not differ (p > 0.05) between sex and genetic groups. All calves showed at least open wounds of the nasal septum (score 2), including those that lost the nose-flaps before d5. Almost half of the calves showed weight loss during this period. We conclude that there is a considerable risk of the two-stage weaning method compromising the physical integrity of the nostrils of beef calves through the use of these devices, and due to this, it should not be referred to as a low-stress weaning practice for beef calves.

Made available in DSpace on 2022-04-29T08:40:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-06-27 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) The use of resistant melon cultivars is considered the most effective method to control gummy stem blight, caused by Didymella bryoniae. However, the selection of genotypes is influenced by environmental conditions and the inoculation method. This study aimed to assess how different screening conditions influences resistance classification and the occurrence of environmental effects on melon genotypes with monogenic dominant resistance locus to D. bryoniae. Four experiments with a randomized block design were used to evaluate the reaction of seven melon genotypes, namely the resistant accessions PI 140471, PI 420145, and PI 157082, and their respective crosses. These genotypes were inoculated by mycelial-agar disc or spores and submitted to two environmental conditions (greenhouse or controlled environment). The data from the experiments were initially submitted to an analysis of variance. Subsequently, a joint analysis was performed. The combination of controlled environment with the disc inoculation proved to be more aggressive to all genotypes whereas inoculation via spore was less harmful and allowed a better characterization of the resistance level. Regardless of the inoculation method, differences between genotypes were smaller under greenhouse. Selection of melon genotypes must be caried out considering the occurrence of genotype-environment interactions. Although the conditions provided in the greenhouse reflects the natural environment, the evaluation and identification of resistant genotypes to D. bryoniae should be undertaken in a controlled environment with inoculation by spores. UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Programa de Pós-graduação em Agronomia (Genética e Melhoramento de Plantas), SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Departamento de Zootecnia, SP Department of Agricultural Food and Nutritional Science University of Alberta UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Programa de Pós-graduação em Agronomia (Produção Vegetal), SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Departamento de Ciências da Produção Agrícola, SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Programa de Pós-graduação em Agronomia (Genética e Melhoramento de Plantas), SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Departamento de Zootecnia, SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Programa de Pós-graduação em Agronomia (Produção Vegetal), SP UNESP Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinárias Departamento de Ciências da Produção Agrícola, SP CAPES: 88887.468860/2019-00 CAPES: 88887.508250/2020-00

Aging is part of the normal evolution of human beings. However, the knowledge about speech in the older ages is still dispersed and incomplete. Considering conflicting findings reported in prior research, this study aims to contribute to increase our knowledge about age effects on the spontaneous speech of Portuguese adults. In order to analyze the effects of age on rhythmic, intonation and voice quality domains, several parameters were extracted from spontaneous speech produced by 112 adults, aged between 35 and 97. Data were obtained through a picture description task. The results showed that the most consistent age-related effects are an increase in speech pauses, mainly in men, and a Harmonics-to-Noise Ratio (HNR) decrease in women. Speaking fundamental frequency (f0) tends to decrease in women and to slightly increase in men with age. These findings for Portuguese are in line with previous research suggesting that suprasegmental characteristics of speech change with age, with some gender differences., El envejecimiento es parte de la evolución normal del ser humano. Sin embargo, el conocimiento sobre el habla en las edades más avanzadas todavía es disperso e incompleto. Teniendo en cuenta los hallazgos contradictorios referidos en investigaciones anteriores, este estudio tiene como objetivo contribuir a aumentar el conocimiento sobre los efectos de la edad en el habla espontánea de los adultos portugueses. Para analizar los efectos de la edad en los dominios del ritmo, entonación y calidad vocal, se extrajeron varios parámetros del habla espontánea producida por 112 adultos, con edades entre 35 y 97 años. Los datos se obtuvieron mediante una tarea de descripción de imágenes. Los resultados demostraron que los efectos relacionados con la edad más constantes fueron un aumento en las pausas del habla, principalmente en los hombres, y una disminución del ratio armónico-ruido en las mujeres. La frecuencia fundamental del habla (f0) tiende a disminuir en las mujeres y a aumentar ligeramente en los hombres con la edad. Estos hallazgos para el portugués están de acuerdo con investigaciones previas que sugieren que las características suprasegmentales del habla cambian con la edad, con algunas diferencias de género. &nbsp

Additional file 1. Read number information. Read number throughout filtering process. Data showing the decrease number of reads according to filtering steps performed.