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OBJECTIVE: To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR). METHODS: We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure. RESULTS: No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase. CONCLUSION: The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.

OBJECTIVE: To identify the left inferior pulmonary vein as an indirect marker of increased pulmonary flow in congenital heart diseases.METHODS: We carried out a prospective consecutive study on 40 patients divided into 2 groups as follows: G1 - 20 patients diagnosed with congenital heart disease and increased pulmonary flow; G2 (control group) - 20 patients who were either healthy or had congenital heart disease with decreased or normal pulmonary flow. We obtained the velocity-time integral of the left inferior pulmonary vein flow, excluding the "reverse A" wave, with pulsed Doppler echocardiography.RESULTS: In G1, 19 out of the 20 patients had well-identified dilation of the left inferior pulmonary vein. No G2 patient had dilation of the left inferior pulmonary vein. Dilation of the left inferior pulmonary vein in conditions of increased pulmonary flow had sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 95% (1 false-negative case). The integral of time and velocity of the pulmonary venous flow obtained with pulsed Doppler echocardiography was greater in the G1 patients (G1=25.0±4.6 cm versus G2=14.8±2.1 cm, p=0.0001).CONCLUSION: The identification of dilation of the left inferior pulmonary vein suggests the presence of congenital heart disease with increased pulmonary flow. This may be used as an indirect sign of increased flow, mainly in malformations of difficult diagnosis, such as atrial septal defects of the venous sinus or coronary sinus type.

OBJETIVO: Avaliar as possibilidades diagnósticas e terapêuticas, através de microcateteres introduzidos nas veias do coração, em estudo angiográfico da circulação venosa coronária. MÉTODOS: Foram realizadas venografias superseletivas do coração em 30 portadores de taquicardia ventricular sustentada, utilizando-se cateter específico que providenciava a oclusão temporária do óstio do seio coronário. A idade média foi de 52,7 (variação de 24 a 76) anos, sendo 25 do sexo masculino e cinco do feminino. As veias foram analisadas de acordo com o número, calibre e distribuição nas paredes anterior e posterior do ventrículo esquerdo (VE). RESULTADOS: O seio coronário foi cateterizado em todos os pacientes, não havendo desconforto adicional ou complicações em nenhum caso. O número de veias da parede posterior do ventrículo esquerdo foi 3,1 e na parede anterior, 1,9 pPURPOSE: To study the angiographic anatomy of human coronary veins and the possibility of epicardial venous mapping through microelectrode catheters. METHODS: We evaluated 30 patients with sustained ventricular tachycardia using a catheter which provided occlusion of the coronary sinus ostium during venous angiography. They were 25 males, 5 females, ages ranging from 24 to 76 years (mean=52.7). The veins were studied according to their number, caliber and distribution in the anterior and posterior wall of the left ventricle. RESULTS: Coronary sinus was catheterized in all patients. No discomfort or complications were observed. The number of veins from posterior wall of the left ventricle was 3.1 and anterior wall, 1.9, p

The demographic, economic and social changes that have characterized the last decades, and the dramatic financial crisis that has taken place since 2008, have led to a demand for structural changes in the pension sector and a growing interest in individual pension products. Hence the need, for most elderly people, to liquidate their fixed assets, which are usually the homes in which they live. This highlights products such as reverse mortgages and domestic reversibility plans. Within this context, we propose a contractual scheme where an immediate life annuity is obtained by paying a single-premium in the form of real estate rights (RERs), for example by transferring to an insurer the property title of a house or a similar realty, while keeping its usufruct or a restricted bundle of rights. The level of the installments depends on the fair value of the transferred RER at the contract's issue, the life expectancy of the insured and the expected growth rate of the real estate market value. The contract design is developed by considering the control of the financial risk inherent in the contract itself, because of the prospective changes in the value of the RERs, and the level of the insurer's leverage. Finally, we provide some numerical evidence of the proposed contractual structure, in order to compare the level of the installments according to the house return forecasts in different European countries. [ABSTRACT FROM AUTHOR]

There are no controlled clinical trials evaluating drug therapy in patients with ventricular arrhythmias and chronic chagasic cardiomyopathy. Empirical treatment with disopyramide (400-1,000mg/d), phenytoin (4-6mg/d), mexiletine (600-1,200mg/d), propafenone (900mg/d), amiodarone ( loading: 1,000mg/d, 10-14 days; maintenance 200-600mg/d), and sotalol (320mg/d) had efficacy and tolerance ranging from 18% to 90% with heterogeneous criteria for efficacy definition. Further studies with homogenous criteria are required to determine which is the most appropriate drug therapy for patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.

Abstract: The present study focuses on the morphotectonic evolution of the axial portion of the Southern Apennine chain between the lower Calore River valley and the northern Camposauro mountain front (Campania Region). A multidisciplinary approach was used, including geomorphological, field‐geology, stratigraphical, morphotectonic, structural, 40Ar/39Ar and tephrostratigraphical data. Results indicate that, from the Lower Pleistocene onwards, this sector of the chain was affected by extensional tectonics responsible for the onset of the sedimentation of Quaternary fluvial, alluvial fan and slope deposits. Fault systems are mainly composed of NW‐SE, NE–SW and W‐E trending strike‐slip and normal faults, associated to NW‐SE and NE–SW oriented extensions. Fault scarps, stratigraphical and structural data and morphotectonic indicators suggest that these faults affected the wide piedmont area of the northern Camposauro mountain front in the Lower Pleistocene–Upper Pleistocene time span. Faults affected both the oldest Quaternary slope deposits (Laiano Synthem, Lower Pleistocene) and the overlying alluvial fan system deposits constrained between the late Middle Pleistocene and the Holocene. The latter are geomorphologically and chrono‐stratigraphically grouped into four generations, I generation: late Middle Pleistocene–early Upper Pleistocene, with tephra layers 40Ar/39Ar dated to 158±6 and 113±7 ka; II generation: Upper Pleistocene, with tephra layers correlated with the Campanian Ignimbrite (39 ka) and with the slightly older Campi Flegrei activity (40Ar/39Ar age 48±7 ka); III generation: late Upper Pleistocene–Lower Holocene, with tephra layers correlated with the Neapolitan Yellow Tuff (~15 ka); IV generation: Holocene in age. The evolution of the first three generations was controlled by Middle Pleistocene extensional tectonics, while Holocene fans do not show evidence of tectonic activity. Nevertheless, considering the moderate to high magnitude historical seismicity of the study area, we cannot rule out that some of the recognized faults may still be active. Copyright © 2018 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

• Practical E-MPC scheme for space heating demand response was developed. • The scheme relies on dwelling-level heat metering and simple thermal zoning. • Co-simulation of a case study was used to test the scheme. • The scheme yields the same load shifting as when using room-level heat measurements. • The scheme eliminates the need for investments in room heat meters. Recent research has indicated a significant potential for providing demand response using Economic Model Predictive Control (E-MPC) of radiators in residential space heating systems. Previous studies indicate the need for distinct temperatures in different rooms, which would require an E-MPC with different temperature constraints across the dwelling. Studies on E-MPC concepts for this purpose often assume that it is possible to measure the heating power delivered to each room separately. However, this assumption is not valid in typical existing residential buildings heated by hydronic radiators; they only have one heat meter measuring the heating use of the entire housing unit. This study presents a simulation-based study of a novel dual-zone E-MPC scheme that relies on indoor air temperature measurements in individual rooms of the housing unit, and only one heat meter measuring the total heating use for space heating and domestic hot water. The results indicate that the proposed scheme has the same load shifting potential as an E-MPC using room-level heat metering. The proposed scheme thus reduces the additional hardware and data infrastructure needed for the practical realization of E-MPC of residential space heating systems for demand response purposes. [ABSTRACT FROM AUTHOR]

• Load shifting experiments were performed in a single-family inhabited house. • Room radiators were controlled with variable set-point schedules. • Heat consumption was successfully shifted from the controlled rooms. • The total load shifting on a building level was limited. • A list of challenges for developing E-MPC in real buildings was identified. Recent simulation-based studies have indicated that load shifting using Economic Model Predictive Control (E-MPC) of radiators for residential space heating can be utilized for demand response purposes in energy systems. However, there is a lack of studies on whether this load shift potential can be realized in real, inhabited buildings. This paper reports on a field experiment aiming at realizing load shifting of space heating in a single-family house with a hydronic radiator system connected to the local district heating. Radiators in a limited number of 'active' rooms were controlled using set-point schedules mimicking the typical behavior of E-MPC. The results indicate that it was possible to load shift heating consumption in the 'active' rooms but that the load shift for the building as a whole was limited due to the hydronics of the radiator system. The paper also reports on the several practical issues encountered during the experiments – issues that in different ways are barriers to the practical realization of demand response from E-MPC of hydronic space heating systems. [ABSTRACT FROM AUTHOR]