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Plaque rupture (PR) is the main cause of coronary thrombosis in non-ST segment elevation myocardial infarction (NSTEMI), but can be found in stable coronary artery disease (CAD). Our study compared the morphology and local inflammatory activity of ruptured plaques between stable CAD and NSTEMI patients using frequency-domain optical coherence tomography (FD-OCT).We retrospectively evaluated 70 plaques with PR at the FD-OCT (25 in stable CAD patients and 45 in NSTEMI patients). Main clinical, angiographic, and morphological features were compared.Besides an overall equivalence in clinical and angiographic features (except for more smokers among NSTEMI patients), some important FD-OCT differences in plaque morphology emerged: PR in NSTEMI was characterized by more macrophage infiltrates (78% in NSTEMI patients vs 20% in stable CAD patients; P.001) and intraluminal thrombosis (84% in NSTEMI patients vs 48% in stable CAD patients; P.01). Quantitative analysis showed a higher density of macrophages in NSTEMI than in stable CAD patients: median max normalized standard deviation (NSD) was 0.0934 (IQR, 0.0796-0.1022) vs 0.0689 (IQR, 0.0598-0.0787); P.01 and mean NSD was 0.062 (IQR, 0.060-0.065) vs 0.053 (IQR, 0.051-0.060); P.001. Other morphological features did not differ between stable CAD and NSTEMI patients. Main FD-OCT quantitative parameters like minimal lumen area and plaque length were also equivalent between the 2 groups.Differences in morphological features of PR between stable CAD and NSTEMI patients suggest that local inflammation contributes to the unstable fate of the atherosclerotic plaque.

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Palaeoclimate records are important tools for understanding climate modifications and contextualizing recent anthropogenic perturbations in climate change relative to natural variability in the Earthclimate system. Moreover, time-series proxy records of the main physical and chemical parameters in marine and continental environments are increasingly used for testing climate models in order to ascertain the reliability of projections for future scenarios in our greenhouse modified Earth. In order to account for the limited number of continuous instrumental measurements of climatic variables in the past, such as sea surface temperature (SST), salinity (SSS), sea-level fluctuations and water chemistry, a complementary approach is the examination of geochemical tracers (i.e. trace elements and stable isotopes) in well-dated natural marine archives. Recently, the Mediterranean Sea has been the focus of a number of studies where new high resolution climate archives have been investigated utilizing proxies for sea surface temperature, salinity,marine chemistry, and ocean circulation, different to those available for tropical regions. In particular, vermetids (Dendropoma petraeum), non-tropical zooxanthellate corals (Cladocora caespitosa) and cold-water corals (Desmophyllum dianthus, Lophelia pertusa and Madrepora oculata) have been studied by conventional and advanced analytical techniques (e.g., laser ablation ICP-MS, MC-ICP-MS, synchrotron X-ray fluorescence) and have been successfully used as high-resolution palaeoenvironmental proxies. Vermetid reefs have the potential to yield valuable information on past sea-level changes and SST, through the combination of stable isotopes and radiocarbon dating. The trace element concentration, in combination with U-series and radiocarbon dating, of the skeletal aragonite of the Mediterranean zooxanthellate coral Cladocora caespitosa, and of the coldwater corals Desmophyllum dianthus and Lophelia pertusa, has been successfully demonstrated to be a valid high-resolution SST archive, and a seawater chemistry and ocean circulation proxy, respectively. Here we present a review of our research over the last few years, aiming for the establishment of new natural marine archives collected from various sites of the Mediterranean Sea, reporting on our methodological approaches and main results.

The Mediterranean Sea (MS), is extremely sensitive to rising sea-levels (SL) as attested by drowned archeological remains from the Roman Period [2]. Due to the absence of coral reefs, evidence for recent and Holocene SL change has so far mainly been restricted to coastal cores [1] archeological remains [2] and submerged speleothem deposits. Vermetid reefs are an extremely sensitive high resolution carbonate archive [3,4] and they are mainly formed in the lower intertidal zone by gregarious and sessile gastropods belonging to the genus Dendropoma (family Vermetidae). Since their interval of growth is restricted to the tidal zone, they can be used as precise SL proxies (about ±0.1 m in low range tidal areas).Here, we report new SL data covering two time-windows: between 2,380 and 1,520 years cal BP and during the last 300 yrs. These data have been obtained from two quasi-stable areas of the Western MS: S. Vito Lo Capo (N Sicily, Italy) and Cabo de Gata (SE Spain), opening new perspectives to understand the response of the global changes on this semienclosed basin

The response to a beach face nourishment of the Terracina barred beach (Tyrrhenian sea, Italy) is analyzed based on a bi-weekly data set of timex video-images collected during a 34-month period (January 2008 - October 2010). Proxies for shoreline and sandbar crest positions were extracted from video-images and compared with topo-bathymetric surveys. During the first 17 months part of the nourished sediments were moved seaward and a shore-parallel linear single-bar system was restored. Bar dynamic was mainly influenced by on/offshore movements in relation to storms occurrence. A cluster of southerly extreme storms with maximum wave height of 4m sharply reshaped the nearshore morphology and a new double-barred system developed. A new inner bar generated close to the shoreline and the pre-existing one migrated 50m offshore. After this morphological reset the outer bar remained inactive and preserved a linear morphology for the whole analyzed period. On the contrary, the new inner bar dynamic was characterized by limited cross-shore displacements and high alongshore morphologic variability. During the last 5 months of observations a single barred-system was restored since the outer bar crest lost its morphologic evidence. As a consequence the inner bar moved 20m offshore and straightened.

The endemic Mediterranean reef building vermetid gastropods Dendropoma petraeum complex (Dendropoma spp) and Vermetus triquetrus develop bio-constructions (rims) on rocky shorelines at about Mean Sea Level (MSL) and are therefore commonly used as relative sea-level (RSL) markers. In this study, we use elevations and age data of vermetid reefs to (1) re-assess the vertical uncertainties of these biological RSL indicators, and (2) evaluate the vertical growth rates along a Mediterranean east-west transect, in attempt to explain the differences found in both growth rates and uncertainties. In Israel, Differential Global Positioning System (DGPS) and laser measurements relative to the local datum show that the reef surfaces mainly occupy the upper intertidal zone with variations in elevation from +0.51 ± 0.07 m to +0.13 ± 0.05 m along the coast. However, in specific sites the vertical uncertainty exceeds the tidal range. In some places the local vermetid species D. anguliferum and V. triquetrus appear to alternate along the vertical rim profiles. This study documents a spatial variability of vertical growth rates, ranging from ~1 mm yr−1 in Israel and Crete, to ~0.1–0.2 mm yr−1 in NW Sicily and Spain. The order of magnitude of the difference in growth rates correlates with the east-west spatial thermal gradient of Sea-Surface Temperature (SST). Preferential skeleton deposition of D. petraeum and V. triquetrus measured by growth axis δ18O analysis shows that most calcification occurs at SST above the mean annual value. These findings indicate that vermetid reefs are a site-specific RSL indicator, displaying various vertical uncertainties and inner-structure complexities. Local data on the indicative range of vermetids are required when reconstructing relative sea-level changes using fossil vermetids.

Aims Treatment delay is a powerful predictor of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated effectiveness of pre-hospital diagnosis of STEMI with direct referral to PCI, alongside more conventional referral strategies. Methods and results From January 2003 to December 2004, 658 STEMI patients were referred for primary PCI at our intervention laboratory. Three predefined referral routes were compared: (1) for patients within 90 min drive of the PCI centre, pre-hospital diagnosis and direct transportation ( n =166), (2) diagnosis at the interventional hospital emergency department ( n =316), (3) diagnosis at local hospitals before transportation ( n =176). Pre-hospital diagnosis was associated with more than 45 min reduction in treatment delay ( P =0.001). No significant difference in in-hospital mortality was apparent in the overall study population. In the cardiogenic shock subgroup ( n =80), pre-hospital diagnosis was associated with a two-thirds reduction in in-hospital mortality ( P =0.019); mortality was only 6.2% in shock patients who underwent PCI in

The presence of Vermetid reefs in temperate waters, their diffusion in the Mediterranean Sea, and the possibility of performing 14 C ages allowed the use of Vermetids as an indicator of sea level changes. We present new data on sea climate trend fluctuations that could be interpreted as Sea Surface Temperature (SST) variations, recorded on Vermetid (Dendropoma petraeum) reefs, by means of isotopic analysis. The isotopic records show positive values of the d 18 O relative to present-day values in the period between 1600 and 1850 AD; this deviation occurs in association with the climatic cooling event known as Little Ice Age (LIA). Subsequently, we can observe the warming trend that characterized the last century. These preliminary results indicate that Vermetids could be considered a new SST proxy-data for the Mediterranean Sea and, more generally, for temperate areas. D 2003 Elsevier B.V. All rights reserved.

We investigated the impact of ambulance-based prehospital triage on treatment delay and all-cause mortality (in hospital and long term) in patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock referred for primary percutaneous coronary intervention in a prospectively collected registry. During the study period (January 2003 to December 2005), a total of 121 patients was referred for primary percutaneous coronary intervention at our intervention laboratory through 2 main triage groups: (1) after prehospital, ambulance-telemedicine-based triage (42 patients) and (2) by more conventional routes (79 patients) represented by the institutional S. Orsola-Malpighi hospital emergency department triage (44 patients) and spoke hospital triage (35 patients). Total ischemic time was shorter in the prehospital triage (142 minutes, range 106 to 187, vs 212 minutes, range 150 to 366, p = 0.003). Patients with prehospital triage showed a lower rate (29% vs 54%, p = 0.01) of severely depressed (