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Myocardial bridging (MB) is a congenital anomaly characterized by the intramyocardial coronary course that can cause coronary compression during systole leading to myocardial ischemia, often with the concomitant presence of endothelial dysfunction. Improvements in computed tomography (CT) technology have increased the burden of MB detection during coronary-CT (cCT) but their anatomical and functional assessment is often challenging. A stress-rest myocardial perfusion imaging (MPI) by single-photon emission CT (SPECT) is usually required to decide the correct patient management. However, SPECT has long acquisition protocols, poor spatial resolution, and significant radiation doses for the patient. The recent advances in CT scan technology have allowed the evaluation of stress-rest MPI, representing a promising alternative to SPECT. In this paper, we report six cases of MBs assessed with cCT examination and further evaluated with a stress-rest dynamic-CT MPI and SPECT. A reversible perfusion defect in the left anterior descending (LAD) territory segments potentially due to MB was detected in two of six patients, and they were referred for heart team evaluation. In conclusion, cCT and stress-rest dynamic-CT MPI allowed to detect MBs, evaluate their functional significance, and decide the patients' management in a "one-stop shop" examination. Improvements in computed tomography (CT) technology have increased the burden of myocardial bridging (MB) detection during coronary-CT but their anatomical and functional assessment is often challenging. A stress-rest myocardial perfusion imaging (MPI) by single-photon emission CT (SPECT) is then usually required to decide the correct patient management. Recent advances in CT scan technology have allowed the evaluation of stress-rest MPI, that represent a promising alternative to SPECT. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined. In this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI. 54 patients (mean age 66 ± 13) experienced a subsequent re-AMI after MINOCA and follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n = 695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p = 0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p = 0.049). Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30–49%), and 41.7% showed obstructive coronary atherosclerosis (≥50% stenosis). Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55 mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up. In the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population. [ABSTRACT FROM AUTHOR]

Early dietary treatment is mind-saving in patients with phenylketonuria. A "diet-for-life" is advocated, aimed to prevent effects of chronic exposure to hyperphenylalaninemia. While adherence to diet is significant during childhood as patients are followed-up at specialized metabolic centers, during adolescence and adulthood percentage of patients discontinuing diet and/or lost at follow-up is still high. The process of passing skills and responsibilities from pediatric team to adult team is defined "transition". The goal of transition clinics is to set up specific multidisciplinary care pathways and guarantee continuity of care and compliance of patients to care. In 2017, "The complete European guidelines on phenylketonuria" were published. These guidelines, however, do not provide an easy way to illustrate to adult patients how to follow correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of adults with phenylketonuria and to provide food pyramid for this population. The pyramid built shows that carbohydrates should be consumed every day (3 portions), together with fruits and vegetables (5 portions), extra virgin olive oil, and calcium water (almost 1 L/day); weekly portions can include 150 g potatoes walnuts and hazelnuts (20 g). At top of pyramid, there are two pennants. The green means that, based on individual metabolic phenotype and daily phenylalanine tolerance, patients need personalized supplementation (specific phenylalanine free amino acid mixtures, vitamins and omega 3 fatty acids); the one red indicates foods that are banned from diet (aspartame and protein foods exceeding individual dietary phenylalanine tolerance). [ABSTRACT FROM AUTHOR]

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This study proposed a typological analysis to identify the archetypes of classrooms equipped with controlled mechanical ventilation (CMV) in Italy and an experimental campaign on 58 typical classrooms to identify the main indoor microclimatic characteristics and CO 2 concentrations. From the analyses carried out, general information was gathered on the heating systems and the main energy and acoustic improvements carried out in the schools. The typological analysis identified four different types of mechanical ventilation systems installed in three different classroom archetypes: wide, square and deep, with percentages of window area of 25 %, 30 % and 40 % respectively. The field measurement campaign showed that, in terms of CO 2 concentration, mechanical ventilation was effective in the winter period, while in the mid-season and summer periods, natural ventilation was predominant due to the opening of windows by the occupants. Furthermore, in the case of manual control, incorrect use of the machine by the occupants, who reported noise-related problems or insufficient user training, resulted in CO 2 levels above the recommended limits. Multivariate regressions developed for schools equipped with CMVs predicted maximum and average CO 2 concentrations as a function of minimum and maximum indoor and outdoor temperatures with a significance (R2 , correct) of 76 % and 83 % respectively. • Identification of archetypes of mechanically ventilated classrooms. • Identification of typical and minimum window percentages based on classroom shape. • Measurement of CO 2 and microclimate parameters in 56 different classrooms. • Realisation of predictive CO 2 models of mechanically ventilated classrooms. [ABSTRACT FROM AUTHOR]

The extraction of crude oil is one of the principal sources of pollution for our ecosystem. Technologies to solve this problem are many, but few use eco-sustainable methodologies. However, microalgae can also be considered excellent environmental bioremediators. In this study, the microalga Haematococcus pluvialis was subjected to high selective pressure to obtain mutant genotypes able to remove contaminants deriving from oil. The results show that Haematococcus pluvialis can survive in so stressful environment modifying its metabolisms. Two of the five isolated genotypes, PA1002 and PA1004 remove hydrocarbons from the medium (1 %) by 60.99 % and 95.28 %, respectively. Moreover, the PA1004 genotype, found to be the most performing, showed improvements in the level of fatty acids and antioxidant activity following the hydrocarbon removal process, also being less cytotoxic than the untreated control. This represents a central point for circular economy where microalgae remove pollutants from the environment and produce useful subproduct. • Selective pressure induced by crude oil modifies H. pluvialis. • H. pluvialis grows in presence of the crude oil. • H. pluvialis and its mutants use organic carbon from crude oil in anaerobiosis condition. • H. pluvialis mutants PA1004 reduces hydrocarbons both from water and biomass. [ABSTRACT FROM AUTHOR]

Objective: Research suggests that inflammation is linked to both late-onset depression (LOD) and cognitive decline, and that LOD might have biological underpinnings differentiating it from recurrent depression. Evidence from inflammatory proteome analyses in large prospective cohorts is scarce. The aim of this study was to assess whether and which inflammation-related biomarkers are associated with LOD, recurrent depression, and cognitive decline due to vascular pathology (vascular dementia).Design: Ongoing population-based cohort study of older adults followed for up to 17 years with regard to clinical diagnosis of various age-related diseases (ESTHER study, n = 9,940).Setting: Longitudinal cohort started in 2000-2002 in a community setting in Saarland, a southwestern German state.Participants: Subgroup of randomly selected participants of the ESTHER study (n = 1,665).Measurements: Inflammatory biomarkers were measured with the Olink Target 96 in baseline samples.Results: Out of 78 biomarkers interleukin 10 (IL-10) and C-C chemokine ligand 4 (CCL4) were associated with significantly increased risk of LOD after multiple testing correction. Hazard ratios (95-confidence interval) per 1 standard deviation increase were 1.37 (1.15-1.63) for IL-10 and 1.34 (1.13-1.59) for CCL4. None of the inflammatory markers was associated with recurrent depression. The dose-response analysis showed a similar monotonic risk increase for LOD and vascular dementia with increasing IL-10 levels.Conclusion: These results suggest that inflammatory markers are involved in the etiology of LOD, but not of recurrent depression and that LOD and vascular dementia might share common inflammatory etiology with respect to IL-10. [ABSTRACT FROM AUTHOR]

Visceral adipose tissue (VAT) is a recognized risk factor for cardiometabolic disease, and dual energy X-ray absorptiometry (DXA) has been recently validated for the quantification of VAT. This study aims to explore VAT prediction by utilizing bioimpedance analysis (BIA), anthropometric measures and biochemical markers. Data from BIA, anthropometric measures, biochemical markers and DXA scans were collected in 1064 older adults participants (761 F, 303 M) with a mean age of 82 ± 6 years old. DXA-VAT was quantified at the android region (DXA-VAT – volume cm3) using the enCore software. Multifactorial linear regression analysis was used to establish the proposed predicting equations and define the values more associated with VAT. In our multivariate model, the main VAT predictable markers were in both genders, weight (kg), Triglycerides (mmol/L) and height (m). These models (stratified for gender) included the BIA outcomes as regressor factors. The VAT calculation equation formula was VAT = 148.89 + (weight (kg)∗33.81) + (Trg (mmol/L)∗1.41) + (height (m)∗−8.99) for females and VAT = 1481.22 + (weight (kg)∗43.94) + (Trg (mmol/L)∗−21.27) + (height (m)∗3.57) for males. In both equations, the r2 was 0.76. The Network analysis showed a strong link network between weight and resistance (Rz). The independent and combined use of anthropometric measures and biochemical markers could accurately predict VAT in the older adults' population. Because of the strong link between Rz and weight, BIA might be included in future equations predicting VAT but different data pools and populations are needed. [ABSTRACT FROM AUTHOR]

Data on patients requiring a second run of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in patients affected by postcardiotomy cardiogenic shock (PCS) are very limited. The authors aimed to investigate the effect of a second run of VA-ECMO on PCS patient survival. Retrospective analysis of an international registry. Multicenter study, tertiary university hospitals. Data on adult PCS patients receiving a second run of VA-ECMO. A total of 674 patients with a mean age of 62.9 ± 12.7 years were analyzed, and 21 (3.1%) patients had a second run of VA-ECMO. None of them required more than two VA-ECMO runs. The median duration of VA-ECMO therapy was 135 hours (interquartile range [IQR] 61-226) in patients who did not require a VA-ECMO rerun. In the rerun VA-ECMO group the median overall duration of VA-ECMO therapy was 183 hours (IQR 107-344), and the median duration of the first run was 114 hours (IQR 66-169). Nine (42.9%) of the patients who required a second run of VA-ECMO died during VA-ECMO therapy, whereas five (23.8%) survived to hospital discharge. No differences between patients treated with single or second VA-ECMO runs were observed in terms of hospital mortality and late survival. In patients requiring a second VA-ECMO run, the actuarial survival estimates at three and 12 months after VA-ECMO weaning were 23.8% ± 9.3% and 19.6% ± 6.4%, respectively. Repeat VA-ECMO therapy is a valid treatment strategy for PCS patients. Early and late survivals are similar between patients who have undergone a single or second run of VA-ECMO. [ABSTRACT FROM AUTHOR]

Myotonic dystrophy type 1 (DM1) is a rare inherited neuromuscular disease associated with insulin resistance, and its association with metabolically associated fatty liver disease (MAFLD) has never been explored in prospective studies. The aim of this study was to assess the clinical features of MAFLD in DM1 patients. We investigated the prevalence and the diagnostic features of MAFLD in a cohort of 29 outpatient fully characterized DM1 patients; afterward, we compared the selected cohort of DM1-MAFLD individuals with a propensity-matched cohort of non-DM1-MAFLD 13/29 (44.83%) DM1 patients received a clinical diagnosis of MAFLD. Compared to DM1 patients with normal liver, DM1-MAFLD individuals showed a higher male prevalence (p = 0.008), BMI (p = 0.014), HOMA score (p = 0.012), and GGT levels (p = 0.050). The statistical comparison showed that the DM1-MAFLD group had a more severe MAFLD according to the FIB4 score than non-DM1-MAFLD patients. This association of a more severe form of liver disease with DM1 remained significant after logistic regression analysis (OR: 6.12, 95% CI 1.44- 26.55). [ABSTRACT FROM AUTHOR]

The optimal duration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. The present study was conducted to investigate the effect of VA-ECMO duration on hospital outcomes. Retrospective analysis of an international registry. Multicenter study including 19 tertiary university hospitals. Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicenter PC-ECMO registry. Patients were stratified according to the following different durations of VA-ECMO therapy: ≤three days, four-to-seven days, eight-to-ten days, and >ten days. A total of 725 patients, with a mean age of 62.9 ± 12.9 years, were included. The mean duration of VA-ECMO was 7.1 ± 6.3 days (range 0-39 d), and 39.4% of patients were supported for ≤three days, 29.1% for four-seven days, 15.3% for eight-ten days, and finally 20.7% for >ten days. A total of 391 (53.9%) patients were weaned from VA-ECMO successfully; however, 134 (34.3%) of those patients died before discharge. Multivariate logistic regression showed that prolonged duration of VA-ECMO therapy (four-seven days: adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; eight-ten days: adjusted rate 61.3%, OR 0.51, 95% CI 0.29-0.87; and >ten days: adjusted rate 59.3%, OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤three days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for eight-ten days (OR 1.96, 95% CI 1.15-3.33) and >10 days (OR 1.85, 95% CI 1.14-3.02) had significantly greater mortality compared with those on VA-ECMO for 4 to 7 days. PCS patients weaned from VA-ECMO after four-seven days of support had significantly less mortality compared with those with shorter or longer mechanical support. [ABSTRACT FROM AUTHOR]

GATA3 plays critical roles in the development and function of various tissues and organs throughout the body. Likewise, TGF-β signaling is critical for placental development and can interact with GATA3. We aimed to investigate the involvement of the multifunctional cytokine and transcription factor in trophoblast development. By using immunohistochemistry, we evaluated the localization and expression level of GATA3 and TGF-β in placentas at term of normal pregnancy and with pre-eclampsia. Up-regulation of both GATA3 and TGF-β was observed in pathological placentas, with localization in the villus epithelium (syncytiotrophoblast) stroma and decidua. Our data show altered expression of TGF-β and GATA3, which downstream could lead to a cascade of events that negatively influence trophoblast development and contribute to the pathogenesis of pre-eclampsia. • GATA3 is involved in placental development, regulating expression of genes crucial for trophoblast invasion/differentiation. • Dysregulation of GATA3 expression/function can lead to placental defects and pregnancy complications such as pre-eclampsia. • The interplay between GATA3 and TGF-β is crucial in understanding placental development and disorders like pre-eclampsia. • Both GATA3 and TGF-β show increased expression in pre-eclampsia placentas compared to normal ones. • Their interaction may modulate processes like trophoblast EMT cells, impacting trophoblast invasion and placental function. [ABSTRACT FROM AUTHOR]

The authors evaluated the outcome of adult patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (ARDS) requiring the use of extracorporeal membrane oxygenation (ECMO). Multicenter retrospective, observational study. Ten tertiary referral university and community hospitals. Patients with confirmed severe COVID-19–related ARDS. Venovenous or venoarterial ECMO. One hundred thirty-two patients (mean age 51.1 ± 9.7 years, female 17.4%) were treated with ECMO for confirmed severe COVID-19–related ARDS. Before ECMO, the mean Sequential Organ Failure Assessment score was 10.1 ± 4.4, mean pH was 7.23 ± 0.09, and mean PaO 2 /fraction of inspired oxygen ratio was 77 ± 50 mmHg. Venovenous ECMO was adopted in 122 patients (92.4%) and venoarterial ECMO in ten patients (7.6%) (mean duration, 14.6 ± 11.0 days). Sixty-three (47.7%) patients died on ECMO and 70 (53.0%) during the index hospitalization. Six-month all-cause mortality was 53.0%. Advanced age (per year, hazard ratio [HR] 1.026, 95% CI 1.000-1-052) and low arterial pH (per unit, HR 0.006, 95% CI 0.000-0.083) before ECMO were the only baseline variables associated with increased risk of six-month mortality. The present findings suggested that about half of adult patients with severe COVID-19–related ARDS can be managed successfully with ECMO with sustained results at six months. Decreased arterial pH before ECMO was associated significantly with early mortality. Therefore, the authors hypothesized that initiation of ECMO therapy before severe metabolic derangements subset may improve survival rates significantly in these patients. These results should be viewed in the light of a strict patient selection policy and may not be replicated in patients with advanced age or multiple comorbidities. Clinical Trial Registration: identifier, NCT04383678. [ABSTRACT FROM AUTHOR]

Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population. The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes. A total of 8303 patients with obesity, aged 18 to 90 y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m2) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p < 0.0001) in women while FFM index (FFMI) was higher in men (p < 0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p < 0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both. The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity. [Display omitted] • BIA in patients with severe obesity is debated. • PhA decreases with increasing BMI. • BIA ranges in severe obesity were shown. [ABSTRACT FROM AUTHOR]

Background: Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis.Objective: The purpose of this study was to identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D electroanatomic mapping (3D-EAM).Methods: We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance imaging, coronary angiography, 3D-EAM, and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and 24-hour electrocardiographic Holter monitoring.Results: We enrolled 54 consecutive patients (mean age 41 ± 14 years; 32(59%) men) with normal ventricular function; left ventricular and right ventricular (RV) late gadolinium enhancement was present, respectively, in 21 (46%) and 6 (13%) of the 46 patients who underwent cardiac magnetic resonance. In 31 patients, the histological diagnosis was myocarditis, while in 14 patients, focal replacement myocardial fibrosis (FRMF); in 9 patients, specimens were inadequate (diagnostic yield of EMB 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22 ± 16 cm2 vs 3 ± 2 cm2; P = .02; left ventricular bipolar mean scar area 13 ± 5 cm2 vs 4 ± 2 cm2; P = .02, respectively). At a follow-up of 21 months, freedom from sustained VAs was 58% in myocarditis and 92% in FRMF (log-rank, P = .008). Histological diagnosis of myocarditis and RV endocardial scar were independent predictors of sustained VAs (P = .02 for both).Conclusion: Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs. [ABSTRACT FROM AUTHOR]

COVID-19 has caused about 700M cases and 7M deaths worldwide. Cardiac injury is common, linked to poor outcomes and can be detected by high troponin levels. Studies on these biomarkers are focused mostly on acute in-hospitalized patients. More research is needed to study the relevance of cardiac biomarkers in post-COVID-19 syndrome. Evaluate the variation of cardiac biomarkers over time in a cohort of patients with previous hospitalization for severe COVID-19 between May/2020 and June/2021 (CARDIO COVID 19-20 Registry) and who were followed during February/2022 and March/2023 (CARDIO COVID 20-21 Registry) The CARDIO COVID 19-20 Registry included 3260 hospitalized patients with confirmed COVID-19. CARDIO COVID 20-21 Registry planned to follow those discharged and alive patients (in-person or virtually) who had severe COVID-19 to evaluate long-term cardiac complications and post-COVID-19 syndrome. Blood tests performed included hemogram, troponin, NT-proBNP (N-Terminal pro-brain natriuretic peptide), D-dimer and creatinine. Qualitative variables were presented in frequency tables and quantitative variables with measures of central tendency depending on the normality of the distribution. CARDIO COVID 19-20 registry included 3260 patients of which 1980 had severe COVID-19. 30 days after hospital discharge, 1626 patients (82.1%) were alive. For CARDIO COVID 20-21 registry, 272 patients (13.6%) from 5 Latin American countries were included and 188 of those patients (69.1%) had laboratory tests performed and were included in this analysis. Median age was 59 years (IQR 50-68) with a male predominance of 58.5%. The main cardiovascular complication was new-onset hypertension (5.3%) and myocardial injury (4.3%). During hospitalization, Troponin was elevated in 21.8%, D-dimer in 72.1% and NT-proBNP in 88.9% of cases. Regarding biomarkers after more than 20 months of follow-up, troponin was elevated in 8.7% of cases, D-dimer in 34.2% and NT-proBNP in 22.9%. There was a decreasing trend of those values over time (Figure 1). A considerable percentage of patients show a persistent elevated cardiac biomarkers level almost 2 years after a severe COVID-19 episode. Further analysis models (like Generalized Linear Mixed Models) should be conducted to evaluate the correlation between different cardiac biomarkers and outcomes. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a significant health problem with a prevalence around 26 million people worldwide. Prevalence is increasing because of ageing of the population and improved cardiovascular treatment. Except for North America, information about HF for the rest of the continent is limited; therefore, regional clinical research is needed with the aim of creating consolidated data about the diagnosis, behavior, and clinical management of HF in the continent. Describe demographic, clinical and hemodynamic characteristics of HF patients in the Americas, based on information collected in the AMERICCAASS Registry. Descriptive, observational, prospective, multicenter registry, including patients older than 18 years with HF divided into two groups: hospitalized and ambulatory. Sociodemographic, comorbidities, physical examination, laboratory, diagnostic, clinical and hemodynamic variables were included. Information was collected in the REDCap platform. Univariate analysis was performed, qualitative variables were expressed as frequency and percentage. The normality of quantitative variables was found using the Shapiro Wilk test and they were expressed as median and interquartile range. The first 2500 patients recruited from 67 institutions in 20 countries in the American continent were included, 882 hospitalized and 1618 ambulatory. Overall median age was 66.2 years (RIC 56.1, 75.3), 59.7% were male. For both groups (hospitalized and ambulatory), the most prevalent comorbidity was arterial hypertension, and the most prevalent etiology was ischemic. More than half of patients for both groups had reduced left ventricular ejection fraction (LVEF) (<40), 61.2% and 58.2%, respectively. In ambulatory patients, NYHA II predominate (57.9%). In hospitalized patients, NYHA III predominate (47.7%), as well as warm/wet hemodynamic profile (62.7%) and decompensated HF as clinical profile (72.1%). (Table 1 and 2). AMERICCAASS registry is the first continental project in patients with HF. The results show a high prevalence of patients with reduced LVEF. The clinical and hemodynamic conditions of ambulatory and hospitalized patients show great similarities with international registries; however, we expect that further analysis may show significant differences in population of the American continent. [ABSTRACT FROM AUTHOR]

Emerging literature suggests that diet plays an important modulatory role in rheumatoid arthritis (RA) because diet is an environmental factor that affects inflammation, antigen presentation, antioxidant defense mechanisms and gut microbiota. Patients with RA frequently ask their doctors about which diets to follow, and even in the absence of advice from their physicians, many patients are undertaking various dietary interventions. Given this background, the aim of this review is to evaluate the evidence to date regarding the ideal dietary approach for management of RA in order to reduce the counteracting inflammation, and to construct a food pyramid for patients with RA. The pyramid shows that carbohydrates should be consumed every day (3 portions of whole grains, preferably gluten free), together with fruits and vegetables (5 portions; among which fruit, berries and citrus fruit are to be preferred, and among the vegetables, green leafy ones.), light yogurt (125 ml), skim milk (200 ml), 1 glass (125 ml) of wine and extra virgin olive oil; weekly, fish (3 portions), white meat (3 portions), legumes (2 portions) eggs (2 portions), seasoned cheeses (2 portions), and red or processed meats (once a week). At the top of the pyramid, there are two pennants: one green means that subjects with RA need some personalized supplementation (vitamin D and omega 3) and one red means that there are some foods that are banned (salt and sugar). The food pyramid allows patients to easily figure out what to eat. [ABSTRACT FROM AUTHOR]

We report molecular subtype impact on 1325 early breast cancer (BCa) patients treated with whole breast hypofractionated (WBH) adjuvant forward-planned intensity modulated radiotherapy (F-IMRT) without boost. From 02/2009-05/2017 1325 patients with pTis-pT3, pNx-N1aM0 BCa who underwent breast conservation surgery were treated with WBHF-IMRT in our institute, to a total dose of 40 Gy/15 fractions, without boost. Median age: 62 (interquartile range-IQR-:51.14–70.53) years. Histology: 8% in situ carcinoma (ISC), 92% invasive tumors. Molecular subtypes (invasive tumors): 49.9% Luminal A, 33.1% Luminal B Her2 negative (−), 6.2% Luminal B Her2 positive (+), 3.6% Hormone Receptor (HR)- Her2+, 7.1% Triple negative (TNBC), and 0.2% HR+. Chemotherapy (CT) was prescribed in 28% of patients, hormonal therapy in 80.3%, monoclonal antibodies (MAb) in 86.8% of Luminal B Her2+ and 97.7% of HR- Her2+ patients. Median follow up was 72.43 (IQR: 44.63–104.13) months. The 5-year Kaplan-Meier estimates of local relapse-free survival (LRFS) was 97.8%, regional-(RRFS) 98.6%, loco-regional- (LRRFS) 96.9%, distant- (DRFS) 96.6%, disease-free survival (DFS) 94.8% and overall survival (OS) 95.5%. Considering molecular subtypes, 5-year LRFS was: 99.8% for Luminal A, 96.7% for Luminal B Her2-, 94.1% for Luminal B Her2+, 87.9% for HR- Her2+, 95.1% for TNBC and 99.1% for in situ carcinoma. While the overall estimated probability of LR within 5 years after WBHF-IMRT without boost is good (2.2%), molecular subtypes have a strong impact, despite MAb therapy in Her2+ patients, and CT for TNBC patients, and could be used as a parameter in deciding the boost prescription. • Hypofractionated three-weeks radiotherapy ensures good local control whitout boost. • In 1325 early stage breast cancers 5-year local relapse without boost was 2.2%. • Molecular subtypes have a strong impact on estimated probability of local relapse. • 5-year local control (LC) was 99.8% for Luminal A vs 87.9% for HR- Her2+. • 5-year LC was 96.7% for Luminal B Her2-, 94.1% for Luminal B Her2+, 95.1% for TNBC. [ABSTRACT FROM AUTHOR]

Moderate hypofractionated radiation therapy (HypoRT) is an attractive alternative to conventionally fractionated radiation therapy for prostate cancer. However, most studies using HypoRT only included the prostate as the target volume. We report long-term outcomes of patients with high-risk prostate cancer treated with androgen deprivation therapy (ADT) and HypoRT to the prostate and nodal areas with a simultaneous integrated boost technique. Patients with localized, high-risk prostate cancer entered a prospective phase I/II study with a HypoRT regimen of 60 Gy/20 fractions (4 weeks) to the prostate volume while the nodal areas received 44 Gy in the same 20 fractions delivered with intensity modulated radiation therapy with a simultaneous integrated boost technique. ADT started 2 to 3 months before HypoRT. Toxicity was prospectively assessed according to the Common Terminology Criteria for Adverse Events v3. Outcomes rates were calculated by the actuarial method of Kaplan–Meier from the date of last radiation treatment until date of event. We report on the first 105 patients treated between October 2010 and February 2014. Median follow-up was 74 months, with 97% of patients followed for more than 36 months. Median ADT duration was 18 months. The worst grade 2 or higher late gastrointestinal or genitourinary toxicity was seen in 7% and 9%, respectively. There was no grade 4 or 5 toxicity. At the last follow-up, the rates of grade ≥2 gastrointestinal or genitourinary toxicity were 2% and 3%, respectively, with no residual grade ≥3 toxicity. The 5- and 7-year actuarial overall survival and relapse free survival were 91% and 85% and 87% and 81%, respectively. The longest follow-up report of moderate HypoRT (plus ADT) to the prostate and pelvic nodes shows that this approach is feasible, well tolerated, and effective. It is convenient for patients and the health system. A larger randomized trial using this approach is warranted. [ABSTRACT FROM AUTHOR]

Spine deformities could be considered a possible manifestation of the childhood hypotonia, typical feature of Kleefstra Syndrome (KS). There is a paucity of literature describing posterior spinal fusion in the Kleefstra syndrome patient. For patients who develop severe scoliotic curve, bracing is often ineffective and surgery is recommended. We report the first corrective surgery for scoliosis in one patient with KS. We describe a case of 13-year-old female with severe developmental scoliosis in KS. Preoperative examination showed a thoracolumbar scoliosis with left convex thoracic curve (T3-T9, 97°) and right convex thoracolumbar curve (T9-L3, 88°). Posterior correction, pedicle screw fixation and bone graft fusion T3-L5 was performed. Postoperatively, the thoracic curve was corrected to 33° while the thoracolumbar one to 26° and better standing posture was obtained. Six month follow-up images showed no loosening of the hardware. The patient is still in our follow-up program. Scoliosis seems to be a rare evenience of the severe hypotonia of patients with KS. We report the first case of scoliosis in KS treated successfully with surgery. Corrective surgery for spinal deformity, such as scoliosis, could help in posture and improve the quality of life especially in complicated patients such as syndromic ones. [ABSTRACT FROM AUTHOR]

Granulicatella adiacens is a nutritional variant of streptococcus (NVS), which has been rarely reported as an etiologic agent in spondylodiscitis (SD). We report a case of a 51-year-old male with from chronic low-back pain associated with right sciatica and ipsilateral monoparesis. Spinal MRI showed radiological signs on L1-L2 and L5-S1 discs consistent with SD. We also performed a systematic review of the pertinent literature in order to retrieve all the key information regarding microbiological and clinical features. Including our patients, seven cases with a mean age 56 ± 10.2 years were reported in English literature. Six patients were conservatively managed with antibiotic therapy (66%), whereas three with surgery in combination with antibiotics (33%). An endocarditis was associated in three cases, and a pacemaker infection in one. All patients received targeted antibiotic therapy resulting in a quick improvement of clinical symptoms with favorable outcome. Our case is the only with a skip spontaneous SD, which needed a surgical decompression due to the associated neurological symptoms. This incidence of SD sustained by Granulicatella adiances could be underestimated due to their particular microbiological conditions requested for their cultures. However, this infection should be suspected in cases of culture-negative SD, especially when associated with endocarditis. [ABSTRACT FROM AUTHOR]

The placenta, a temporary organ that forms during pregnancy, is the largest fetal organ and the first to develop. It is recognized as an organ that plays a vital role as a metabolic and physical barrier in the fetoplacental unit; throughout fetal development it acts as the lungs, gut, kidneys, and liver of the fetus. When its two components, the fetal and the maternal one, successfully interact, pregnancy proceeds healthily. However, in some cases there may be pregnancy disorders, such as preeclampsia (PE) and gestational diabetes mellitus (GDM), which can lead to a different outcome for the mother and the newborn. In recent years, several studies have been conducted to try to understand how the expression of factors involved in the development of the placenta varies under pathological conditions compared with normal conditions. The purpose of this review is to summarize recent discoveries in this field. [ABSTRACT FROM AUTHOR]

• Carbon fiber reinforced (CFR)-PEEK implants have been developed for spinal fixation in oncological disease. • CFR-PEEK implants constitute a feasible and effective way to restore stability as standard titanium. • Further studies are needed to clarify their potentially enormous oncological advantagess. In spinal oncology traditional titanium implants could significantly impair evaluation of postoperative imaging because of artifacts, potentially affecting proper planning and execution of radiotherapy and adequate radiological follow-up to rule out progression of the disease. This is why carbon fiber reinforced (CFR)-PEEK implants have been developed for spinal fixation. The advantages of this system include fewer artifacts on imaging, potentially improving the execution and quality of radiotherapy, with also a reduced scattering effect to neighboring tissues. A comparative clinical and radiological study between new CFR-PEEK and standard titanium implants is described. Data recorded for each case included patient demographics, clinical, radiological and surgical data, intra- and postoperative complications, follow-up information. The goal of this study was to verify the safety and effectiveness of CFR-PEEK devices compared to standard titanium implants. A total number of 78 patients were reviewed. 36 patients underwent CFR-PEEK fixation, while titanium implants were used for 42 patients. Functional recovery was obtained in both groups and registered at last follow-up in terms of axial pain and neurological status. No significative differences were found between the two groups in terms of post-operative clinical complications and hardware-related complications. CFR-PEEK implants constitute a feasible and effective way to restore stability in metastatic spine tumors. This study found a non inferior favorable profile in terms of intraoperative and postoperative complications and functional recovery, compared to titanium. Further prospective studies are needed to clarify the potential oncological advantage of their radiolucency. [ABSTRACT FROM AUTHOR]

Background: Ventricular arrhythmias (VAs) are the most common cause of death in athletes. The differences in the electroanatomic substrate in athletes and nonathletes with complex VA are unknown.Objective: The purpose of this study was to compare the electroanatomic substrate of complex VA in athletes vs nonathletes.Methods: The study prospectively enrolled young athletes and nonathletes with VA. Patients underwent 2-dimensional echocardiography, cardiac magnetic resonance (CMR) imaging, coronary angiography, 3-dimensional electroanatomic mapping (3D-EAM), and 3D-EAM-guided endomyocardial biopsy (EMB). Follow-up included 24-hour electrocardiographic Holter or implantable cardioverter-defibrillator/loop recorder interrogation for VA recurrence.Results: Thirty-three patients were enrolled: 18 competitive athletes (56%) and 15 nonathletes (44%). Left ventricular and right ventricular (RV) findings by echocardiography and CMR did not show structural disease. Nine athletes (50%) were asymptomatic compared to 1 nonathlete (7%; P <.05). Unifocal origin of VA was reported in 14 athletes (93%) and 17 nonathletes (94%). Athletes showed a larger RV unipolar than bipolar scar (18 ± 17 cm2 vs 3 ± 3.8 cm2; P = .04). Diagnostic yield of EMB was 50% in athletes and 40% in nonathletes. Among athletes, the final diagnosis was myocarditis in 2, arrhythmogenic ventricular right cardiomyopathy in 1, and focal replacement fibrosis in 1. Among nonathletes, EMB revealed focal replacement fibrosis in 4 cases. At median follow-up of 18.7 months, Kaplan-Meier curves showed lower VA recurrence in detrained athletes than nonathletes (53% vs 6%; P = .02).Conclusion: This study showed the need for extensive diagnostic workup in apparently healthy young patients with complex VA in order to characterize concealed cardiomyopathies. [ABSTRACT FROM AUTHOR]

This study explored the impact of donor left ventricular ejection fraction (EF) and left ventricular wall thickness (LVWT) on mortality among heart transplant (HTx) recipients. Utilizing data from the United Network for Organ Sharing (UNOS) registry, adult HTx recipients between 2006-2022 were analyzed. Patients were categorized into four groups based on donor EF(>50 % or ≤50 %) and LVWT(<1.4 cm or ≥1.4 cm). 21,012 patients were included. There were significant differences in baseline characteristics among the groups. Unadjusted mortality was 6.3 %, 6.0 %, 6.0 %, and 2.4 %(p=0.86) at 30-days; 16.2 %, 13.5 %, 16.8 %, and 7.3 %(p=0.08) at 1-year; and 32.2 %, 29.2 %, 35.4 %, and 29.0 %(p=0.18) at 5-years, respectively. In addition, adjusted mortality did not differ across the groups. There were no significant differences in recipient mortality in groups based on donor EF and LVWT. Expanding the donor selection criteria would allow for increase in the donor pool and assist in decreasing the mortality, while on the waitlist for HTx. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) is a chronic metabolic disease of unknown etiology that results from β-cell destruction. The onset of the disease, which arises after a long asymptomatic period of autoimmune attack, may be followed by a relapsing and remitting progression, a phenomenon that is most evident during the partial remission phase (PR). This stage lasts for a few months, shows minor requirements of exogenous insulin and could be explained by a recovery of immunological tolerance. This study aims to identify new biomarkers at early stages of pediatric T1D that reflect immunoregulatory changes. To that end, pediatric patients with T1D (n = 52) and age-related control subjects (n = 30) were recruited. Immune response-related molecules and lymphocyte subsets were determined starting at T1D onset and until the second year of progression. Results showed that circulating TGF-β levels decreased during PR, and that betatrophin concentration was increased in all the considered stages without differing among studied checkpoints. Moreover, an increase of regulatory T, B and NK subsets was found during T1D progression, probably reflecting an attempt to restore self-tolerance. By contrast, a reduction in monocyte levels was observed at the early stages of diabetes. The results reveal significant changes in immunological parameters during the different early stages of T1D in children, which could ultimately serve as potential biomarkers to characterize the progression of T1D. [ABSTRACT FROM AUTHOR]

An experimental study was conducted to improve the comfort and liveability of urban open spaces during the hottest months of the summer by implementing an overhead water mist cooling system. The campaign was conducted in two different Italian urbanscapes (Ancona and Rome, representative of Cfa and Csa climates) one after the other. Monitoring data and comfort questionnaires were combined to extract useful information by means of statistical tests, regressions and data mining algorithms and, ultimately, to delineate design and operating guidelines to maximize people's satisfaction with the misted environment. The cloud of droplets reduced the temperature and the UTCI by 8.2 °C and 7.9 °C respectively, against a 7% mean humidity premium. The vertical cooling and humidification profiles obeyed a Lorentzian distribution, peaking within approximately 0.5 m of the injection. The severe overheating experienced outside of the cooled areas evanished under the spray, with 67% (Ancona) to 90.6% (Rome) of respondents reporting only slight bending from thermal neutrality. Perception and preferences towards solar radiation, humidity level and wind all improved within the droplets mist. In terms of comfort-oriented, optimized design criteria, the system proved to work best with a dominant and steady light breeze (1–2 m/s), in highly irradiated sites and suspended at 1.2–1.5 m above the average height of users. Image 1 • Urban comfort was experimentally investigated in two Mediterranean cities. • Water nebulization was implemented to cool down the air and comparatively assessed. • Measurements and comfort questionnaires were collected over the warmest months. • Data were interpreted via statistical tests, regressions and data mining algorithms. • Optimal design criteria for the use of nebulization in urban open spaces were derived. [ABSTRACT FROM AUTHOR]

Despite advances in the management of ST-elevation myocardial infarction (STEMI), when associated with heart failure (HF) its prognosis remains ominous. This study assessed the differences in admission and mortality of HF complicating STEMI at admission (HFad) in a middle-income country. Data from the National Registry of STEMI of Argentina (ARGEN-IAM-ST) from January 1, 2016, to September 30, 2020, were analyzed. HFad was defined by the identification of Killip/Kimball ≥2 at admission. About 3174 patients were analyzed (22.3% had HFad). Patients with HFad were older, more often women, hypertensive, and diabetic. Received less reperfusion (87.6% vs 92.6%, P < 0.001) and had increased in-hospital mortality (28.4% vs 3.0%, P < 0.001). In multivariate analysis HFad was an independent predictor of death (OR: 4.88 [95%CI: 3.33-7.18], P < 0.001) and reperfusion adjusted to HFad was associated with lower mortality (OR: 0.57 [95%CI: 0.34-0.95], P = 0.03). HFad in STEMI is associated with a worse clinical profile, receives fewer reperfusion strategies, and carries a higher risk of in-hospital mortality while reperfusion reduces mortality. [ABSTRACT FROM AUTHOR]

The coronavirus disease (COVID-19) has been associated with myocardial injury or cardiac involvement. Current evidence indicates that elevated cardiac biomarkers are associated with worse outcomes. Evaluate and compare which cardiac biomarker have the greatest clinical relevance in patients with COVID-19. CARDIOCOVID 19-20 is an observational, ambispective, multicenter registry that included hospitalized patients with confirmed COVID-19 in 44 hospitals in 14 Latin American and Caribbean countries. We included patients who had troponin, natriuretic peptide, and D-dimer tests performed during hospitalization and divided them into 4 groups, those who had one, two or three abnormal or positive biomarkers, and those who had all negative. 476 patients had troponin, D-dimer, and natriuretic peptide tests performed during hospitalization and were classified as follows: 139 patients had 1 abnormal test (1AT), 190 had 2 abnormal tests (2AT), 118 had 3 abnormal tests (3AT) and 29 with all 3 tests normal (0AT). Median age was 64 years, and older patients were those that presented 3AT (69 years, p<0.001). In all groups, male was the predominant gender (Table 1A). Decompensated heart failure occurred in 35.6% of patients with 3AT, 18.4% of patients with 2AT, and 5.0% of patients with 1AT, while no patient with 0AT presented this complication (p<0.001). Invasive mechanical ventilation was required in more than 50% and ICU admission was required in more than 70% in those who presented at least one AT. Regarding mortality, the greater the number of elevated biomarkers, the greater the mortality, being 50.0%, 31.1%, and 18.0% in patients with 3AT, 2AT, and 1AT groups, respectively (p<0.001). We analyzed the group with 2AT and found that the overall mortality was 31.0% (59). Mortality of those who had positive troponin and natriuretic peptide was 43.2%, positive troponin and D-dimer was 44.0%, and positive natriuretic peptide and D-dimer was 24.0%. Of the 59 patients who died, 29 patients had positive natriuretic peptide and D-dimer (49.2%) and 19 patients the combination troponin and natriuretic peptide (32.2%). This means that patients who had positive troponin and natriuretic peptide, and positive troponin and D-dimer were 1.4 and 1.5 times more likely to die compared to those who had positive natriuretic peptide and D-dimer, respectively (Table 1B, 1C). In COVID-19 patients, the higher the number of positive biomarkers (troponin, natriuretic peptide and / or D-dimer), the higher the prevalence of cardiovascular complications during hospitalization, and the higher the cardiovascular mortality. [ABSTRACT FROM AUTHOR]

The management of Pulmonary Arterial Hypertension (PAH) includes pharmacological and surgical strategies to control symptoms and increase survival. Current management guidelines provide recommendations about these strategies; however, their availability may be limited in different regions of the world. To evaluate the current availability and access to the pharmacological strategies for the management of PAH in Latin America and the Caribbean (LA&C). The Council on Heart Failure and Pulmonary Hypertension (CIFACAH) of the Inter-American Society of Cardiology (SIAC) conducted a survey to evaluate the availability and access (cost paid by patient) of pharmacological, interventional and surgical options for PAH in February 2023. Delegates from 21 LA&C countries that are part of the SIAC received and completed the survey. Regarding pharmacological treatment for PAH, 100% of the countries have access to at least one nitric oxide pathway medication (sildenafil), 81% of the countries have access to at least one endothelin pathway medication and 81% of the countries have access to at least one prostanoid pathway medication (Table #1).The survey classified access to pharmacological therapies as the percentage of the cost / value of medication that must be paid by the patient, as follows: 0%: No additional payment; <50%: pay for lest that 50% of the cost; 50-99%: Pay for most of the medication; 100%: Pay for all.Access to at least one medication at 0% cost (no additional payment) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 67%, 67% and 76% of the countries, respectively. By the other side, access to at least one medication paying full cost (100%) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 76%, 67% and 59% of the countries, respectively. The availability of pharmacological treatment for PAH is high and varies between pharmacological groups and different countries in LA&C. However, availability is different from accessibility, as the latter depends on many factors, including cost. Access to these medications at no cost or at full cost is available in almost two-thirds of LA&C countries, although most countries have health care systems that cover a percentage of the medication cost. [ABSTRACT FROM AUTHOR]

Severe Asthma (SA) is characterized by inadequate disease control despite maximal inhalation therapy. In November 2021, a 68-years old female patient presented at our facility referring a worsening in her asthma-related symptoms and a high exacerbations rate. She reported a liver transplantation in 2015 and was in treatment with tacrolimus. We started treatment with Mepolizumab 100 mg once every 28 days and monitored her lung function as well as her lymphocytes subsets. After one year follow-up, the patient had a substantial improvement in lung function, exacerbation rate, daily OCS intake dose and no variation in the blood concentration of tacrolimus. [ABSTRACT FROM AUTHOR]

To counter the increasing urban overheating, climate adaptation solutions are proposed. Among them, water mist spray recently acquired particular attention, due to its efficiency, cost-effectiveness, and versatility. However, spray devices require a large amount of water and energy to cool even limited areas, thus their environmental costs/benefits ratio should be carefully evaluated. This study analyses cooling benefits and resources consumption of mist devices in 11 cities within 3 climate contexts, through Recurrent Neural Networks (RNNs) trained with experimental data. RNNs predict the expected time series of thermal benefits and of energy and water consumptions, also considering different design solutions of devices. Results show that when sun/wind shielding is used in the sprayed area, or the height of nozzles is limited, higher cooling results are obtained. However, energy and water consumption are extremely high if misting systems are perennially active during the day. Considering all simulated conditions, the predicted average daily energy to obtain a unitary variation of the Mediterranean Outdoor Comfort Index is 4,17 Wh/m2, while the corresponding average daily volume of water is 0,56 l*h/m2. These results confirm the need for applications managed by control logics based on the acquisition of real-time climatic data to reduce the environmental loads. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this Special Communication is to summarize guidelines and recommendations stemming from an expert panel convened by the National Institutes of Health, National Center for Medical Rehabilitation Research (NCMRR) for a workshop entitled The Future of Medical Rehabilitation Clinical Trials, held September 29-30, 2016, at the NCMRR offices in Bethesda, Maryland. The ultimate goal of both the workshop and this summary is to offer guidance on clinical trials design and operations to the medical rehabilitation research community, with the intent of maximizing the effect of future trials. [ABSTRACT FROM AUTHOR]

Abstract Microbial fuel cells (MFCs) technology represents a new approach to the sustainable electric power production, thanks to the advantages of its green features. The performance and the cost efficiency of a MFC are affected by several factors, such as the reactor architecture, the microbial microflora and the "costs per power" ratio of the electrodes. For example, cathodes powered by platinum as catalyzer are really efficient, but also expensive. In this study, two materials for cathode were examined: i) an economical biochar-based material (BC), ii) an activated carbon (AC) cathode with a nickel mesh current collector and a polytetrafluoroethylene (PTFE) binder to limit oxygen diffusion to the anodic compartment. The performances were evaluated in terms of power density and current density. [ABSTRACT FROM AUTHOR]

Summary Background & aim The aim of this study was to establish the effectiveness of Body Cell Mass Index (BCMI) as a prognostic index of (mal)nutrition, inflammation and muscle mass status in the elderly. Methods A cross-sectional observational study has been conducted on 114 elderly patients (80 women and 34 men), with mean age equal to 81.07 ± 6.18 years. We performed a multivariate regression model by Structural Equation Modelling (SEM) framework. We detected the effects over a Mini Nutritional Assessment (MNA) stratification, by performing a multi-group multivariate regression model (via SEM) in two MNA nutritional strata, less and bigger (or equal) than 17. Results BCMI had a significant effect on albumin (β = +0.062, P = 0.001), adjusting for the other predictors of the model as Body Mass Index (BMI), age, sex, fat mass and cognitive condition. An analogous result is maintained in MNA<17 stratum. BMI has confirmed to be a solid prognostic factor for both free fat mass (FFM) (β = +0.480, P < 0.001) and Skeletal Muscle Index (SMI) (β = +0.265, P < 0.001), assessed by DXA. BCMI also returned suggestive evidences (0.05 < P < 0.10) for both the effect on FFM and on SMI in overall sample. Conclusions The main result of this study is that the BCMI, compared to BMI, proved to be significantly related to an important marker as albumin in geriatric population. Then, assessing the BCMI could be a valuable, inexpensive, easy to perform tool to investigate the inflammation status of elderly patients. [ABSTRACT FROM AUTHOR]

As a consequence of climate change, urban overheating has increased in all the cities of the world during the last decades. It is therefore paramount to counteract such effect by promoting the use of effective solutions to mitigate overheating at a micro-scale level. In this work, a modular experimental setup based on a water spray system was designed, realized and tested to evaluate its thermohygrometric performance in semi-outdoor spaces such as bus/train/taxi stops, street resting stations and corner shops. The setup allows to vary three operational parameters: (a) the height of the nozzles from the ground; (b) the presence of an upper shielding to reduce the impact of solar radiation; (c) the presence of a side shielding to reduce the impact of wind speed. The combination of the operational parameters allowed to evaluate the performance of five configurations for the water spray system. Several performance indexes were calculated to assess the impact of each operational parameter. It was found that the best configuration guarantees a −20% reduction of dry-bulb temperature, and the minimum specific water and electricity consumptions of the system are 0.020 L/m2 and 0.150 Wh/m2, respectively. Also, the presence of the side shielding is the parameter that mostly influences the performance of the system, followed by the height of the nozzles, while the presence of the upper shielding has a minor effect. These operational parameters, however, increase relative humidity inside the nebulization volume; it is therefore important to verify if undesired wet conditions are reached. • A modular water spray system is designed, realized and tested. • Three operational parameters and five configurations are evaluated. • The best configuration guarantees a −20% reduction of dry-bulb temperature. • The minimum specific water and electricity consumptions are 0.020 L/m2 and 0.150 Wh/m2. • The presence of the side shielding mostly influences the performance of the system. [ABSTRACT FROM AUTHOR]

Background Fibromyalgia (FM) is a common syndrome whose main characteristic is chronic widespread musculoskeletal pain, the severity of which is frequently worsened by concomitant obesity. Major depression (MD), particularly as part of a bipolar spectrum disorder (BSD), is associated with both obesity and FM. Objective To evaluate the relationship between lifetime MD, hypomanic symptoms and the body mass index (BMI) in patients with FM. Method Of the 115 patients originally screened, 87 women with FM finally entered the study. Forty-nine patients (57%) had a lifetime diagnosis of MD, assessed by a structured clinical interview based on DSM-IV criteria, and four of them (4.6%) had a current MD episode. Lifetime hypomanic symptoms were measured by means of the self-rated Hypomania Checklist. According to the international criteria for BMI, FM patients were classified as under/normal-weight (61%), overweight (30%) and obese (9%). Results 62 patients (71.2%) with FM had a bipolar spectrum disorder (BSD). Thirty (48.3%) of them met criteria for bipolar II disorder, 32 (51,6%) for bipolar disorder NOS (18 FM patients with MD associated to sub-syndromal hypomanic syndrome and 14 with hypomanic syndrome without MD). No patient had a bipolar I disorder. Only one patient met the criteria for a major depressive disorder (MDD). There was no significant difference in mean BMI between the patients with and without a lifetime diagnosis of MD, but there was a positive association between the level of hypomanic symptoms and BMI values (p < 0.009). When hypomania was considered categorically as hypomanic syndrome there was no significant effect on BMI. Conclusions Our finding adds to previous evidence indicating that hypomanic symptoms are a central feature of FM. In the case of the early identification of high-level hypomanic symptoms, body weight should be closely monitored in order to prevent obesity and its detrimental impact on females with FM. [ABSTRACT FROM AUTHOR]

Background Metabolic reprogramming is shaped to support specific cell functions since cellular metabolism controls the final outcome of immune response. Multiple sclerosis (MS) is an autoimmune disease resulting from loss of immune tolerance against central nervous system (CNS) myelin. Metabolic alterations of T cells occurring during MS are not yet well understood and their studies could have relevance in the comprehension of the pathogenetic events leading to loss of immune tolerance to self and to develop novel therapeutic strategies aimed at limiting MS progression. Methods and Results In this report, we observed that extracellular acidification rate (ECAR) and oxygen consumption rate (OCR), indicators of glycolysis and oxidative phosphorylation, respectively, were impaired during T cell activation in naïve-to-treatment relapsing remitting (RR)MS patients when compared with healthy controls. These results were also corroborated at biochemical level by a reduced expression of the glycolitic enzymes aldolase, enolase 1, hexokinase I, and by reduction of Krebs cycle enzymes dihydrolipoamide- S -acetyl transferase (DLAT) and dihydrolipoamide-S-succinyl transferase (DLST). Treatment of RRMS patients with interferon beta-1a (IFN beta-1a) was able to restore T cell glycolysis and mitochondrial respiration as well as the amount of the metabolic enzymes to a level comparable to that of healthy controls. These changes associated with an up-regulation of the glucose transporter-1 (GLUT-1), a key element in intracellular transport of glucose. Conclusions Our data suggest that T cells from RRMS patients display a reduced engagement of glycolysis and mitochondrial respiration, reversible upon IFN beta-1a treatment, thus suggesting an involvement of an altered metabolism in the pathogenesis of MS. [ABSTRACT FROM AUTHOR]

Basal forebrain neurons increase cortical blood flow by releasing acetylcholine (Ach), which stimulates endothelial cells (ECs) to produce the vasodilating gasotransmitter, nitric oxide (NO). Surprisingly, the mechanism whereby Ach induces NO synthesis in brain microvascular ECs is unknown. An increase in intracellular Ca 2+ concentration recruits a multitude of endothelial Ca 2+ -dependent pathways, such as Ca 2+ /calmodulin endothelial NO synthase (eNOS). The present investigation sought to investigate the role of intracellular Ca 2+ signaling in Ach-induced NO production in bEND5 cells, an established model of mouse brain microvascular ECs, by conventional imaging of cells loaded with the Ca 2+ -sensitive dye, Fura-2/AM, and the NO-sensitive fluorophore, DAF-DM diacetate. Ach induced dose-dependent Ca 2+ oscillations in bEND5 cells, 300 μM being the most effective dose to generate a prolonged Ca 2+ burst. Pharmacological manipulation revealed that Ach-evoked Ca 2+ oscillations required metabotropic muscarinic receptor (mAchR) activation and were patterned by a complex interplay between repetitive ER Ca 2+ release via inositol-1,4,5-trisphosphate receptors (InsP 3 Rs) and store-operated Ca 2+ entry (SOCE). A comprehensive real time-polymerase chain reaction analysis demonstrated the expression of the transcripts encoding for M3-mAChRs, InsP 3 R1 and InsP 3 R3, Stim1-2 and Orai2. Next, we found that Ach-induced NO production was hindered by L-NAME, a selective NOS inhibitor, and BAPTA, a membrane permeable intracellular Ca 2+ buffer. Moreover, Ach-elicited NO synthesis was blocked by the pharmacological abrogation of the accompanying Ca 2+ spikes. Overall, these data shed novel light on the molecular mechanisms whereby neuronally-released Ach controls neurovascular coupling in blood microvessels. [ABSTRACT FROM AUTHOR]

Background: The Universal Definition of Myocardial Infarction recommends the 99th percentile concentration of cardiac troponin in a normal reference population as part of the decision threshold to diagnose type 1 spontaneous myocardial infarction. Adoption of this recommendation in contemporary worldwide practice is not well known.Methods: We performed a cohort study of 276 hospital laboratories in 31 countries participating in the National Heart, Lung, and Blood Institute-sponsored International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial. Each hospital laboratory's troponin assay manufacturer and model, the recommended assay's 99th percentile upper reference limit (URL) from the manufacturer's package insert, and the troponin concentration used locally as the decision level to diagnose myocardial infarction were ascertained.Results: Twenty-one unique troponin assays from 9 manufacturers were used by the surveyed hospital laboratories. The ratio of the troponin concentration used locally to diagnose myocardial infarction to the assay manufacturer-determined 99th percentile URL was <1 at 19 (6.6%) laboratories, equal to 1 at 91 (31.6%) laboratories, >1 to ≤5 at 101 (35.1%) laboratories, >5 to ≤10 at 34 (11.8%) laboratories, and >10 at 43 (14.9%) laboratories. The variability in troponin decision level for myocardial infarction relative to the assay 99th percentile URL was present for laboratories in and outside of the United States, as well as for high- and standard-sensitivity assays.Conclusions: There is substantial hospital-level variation in the troponin threshold used to diagnose myocardial infarction; only one-third of hospital laboratories currently follow the Universal Definition of Myocardial Infarction consensus recommendation for use of troponin concentration at the 99th percentile of a normal reference population as the decision level to diagnose myocardial infarction. This variability across laboratories has important implications for both the diagnosis of myocardial infarction in clinical practice as well as adjudication of myocardial infarction in clinical trials. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to test the feasibility and dosimetric accuracy of a method that employs planning CT-to-MVCT deformable image registration (DIR) for calculation of the daily dose for head and neck (HN) patients treated with Helical Tomotherapy (HT). Methods For each patient, the planning kVCT (CTplan) was deformably registered to the MVCT acquired at the 15th therapy session (MV15) with a B-Spline Free Form algorithm using Mattes mutual information (open-source software 3D Slicer), resulting in a deformed CT (CTdef). On the same day as MVCT15, a kVCT was acquired with the patient in the same treatment position (CT15). The original HT plans were recalculated both on CTdef and CT15, and the corresponding dose distributions were compared; local dose differences <2% of the prescribed dose (DD2%) and 2D/3D gamma-index values (2%-2 mm) were assessed respectively with Mapcheck SNC Patient software (Sun Nuclear) and with 3D-Slicer. Results On average, 87.9% ± 1.2% of voxels were found for DD2% (on average 27 slices available for each patient) and 94.6% ± 0.8% of points passed the 2D gamma analysis test while the 3D gamma test was satisfied in 94.8% ± 0.8% of body’s voxels. Conclusions This study represents the first demonstration of the dosimetric accuracy of kVCT-to-MVCT DIR for dose of the day computations. The suggested method is sufficiently fast and reliable to be used for daily delivered dose evaluations in clinical strategies for adaptive Tomotherapy of HN cancer. [ABSTRACT FROM AUTHOR]

Recent investigations suggest the potential negative impact of SARS-CoV-2 infection on pregnant women and pregnancy outcome. In addition, some studies have described pathological changes in the placental tissue of SARS-CoV-2-positive mothers, which are related or not to the infection severity and/or infection trimester. Among the various molecules involved in the normal structure and functionality of the placenta, sialic acids (Sias) seem to play an important role. Hence, we aimed to investigate possible changes in the distribution and content of Sias with different glycosidic linkages, namely α2,3 and α2,6 Galactose- or N-acetyl-Galactosamine-linked Sias and polymeric Sia (PolySia), in placentas from pregnant women infected by SARS-CoV-2 during the three different pregnancy trimesters. α2,3 and α2,6 Galactose-linked Sias were evaluated by lectin histochemistry (Maackia amurensis agglutinin (MAA) and Sambucus nigra agglutinin (SNA), respectively), while immunohistochemistry was used for PolySia detection. Data showed lower levels of α2,3 Galactose-linked Sias in the trophoblast and underlying basement membrane/basal plasma membrane in placentas from women infected during the second and third infection trimester compared with uninfected cases and those infected during first trimester. On the other hand, higher levels of PolySia were detected in the trophoblast during the second and third infection trimester. Our findings suggest that changes in the sialylation status of trophoblast and its basement membrane/basal plasma membrane, together with other concomitant factors, could be at the basis of the most common placental histopathological alterations and gestational complications found especially in pregnancies with SARS-CoV-2 infection during the second and third trimester. • Sialylation status changes in placenta from pregnancies with SARS-CoV-2 infection. • Sialylation status may underlie placental histopathology upon SARS-CoV-2 infection. • Knowledge of placental sialylation status may help to develop novel therapies. [ABSTRACT FROM AUTHOR]

Due to lifestyle changes, people spend most of their time indoors at present; thus, Indoor Air Quality (IAQ) is a matter of utmost importance. Multi-functional and innovative finishes can help to passively improve the IAQ, benefitting the health and comfort of occupants. For this study, reference and pre-mixed commercial mortars are compared to a new multi-functional hydraulic lime mortar for indoor finishes, in which conventional aggregates are substituted by a highly porous adsorbent material and biomass waste ashes. The up to 20% higher accessible porosity of the multi-functional finish led to lower density (30%), higher thermal insulation properties (30%), higher water vapor permeability (more than 40%), and improved moisture buffering capacity (three times higher), when compared to the reference mortar. Different types of photocatalytic agents (TiO 2) were also added into the new multi-functional hydraulic lime mortar, in order to investigate their effect on the de-polluting properties of the finish. Even if the photocatalytic efficiency remained unexpressed under indoor conditions, due to the predominance of the adsorption process, the de-polluting properties of the new mix were more than 30% higher than that of the reference mortar. The obtained results confirm that the developed innovative multi-functional finish—besides fulfilling the ordinary requirements—is better than commercial mortars, as it can improve the IAQ passively, thus benefitting the health and comfort of occupants. • Innovative multifunctional patented finish is tested in laboratory condition and compared to reference and commercial mortars. • The patented finish has higher porosity, thermal insulation, water vapor permeability, and moisture buffering capacity. • The de-polluting properties of the patented finish were more than 30% higher than that of the reference mortar. [ABSTRACT FROM AUTHOR]

Digital technologies (e.g. Industry 4.0, Internet of Things, cloud computing, big data, blockchain, etc.), are profoundly affecting companies' activities and processes, thus leading to changes in firms' value creation, value delivery, and value capture mechanisms. Yet, despite significant investments in digital technologies and digital transformation, firms are struggling to yield the most out of them, thereby facing a digital paradox. This scenario has drawn the attention of academics and practitioners leading to a growing body of literature on the relationship between digital technology and business model innovation. Yet, the extant academic research in this area appears highly fragmented. Hence, this study conducts a systematic literature review to gather and synthesize the extant knowledge on this topic. The review identifies four main thematic areas, provides an interpretative framework, and suggests valuable future research directions within each thematic area. The article contributes to the theoretical and managerial discussion on digital-driven business model innovation. • Understanding the relationship between digital technology and business model innovation remains a research priority • The study is based on a systematic literature review of 106 articles • The study identifies five major investigated research areas • The study provides an interpretative framework and valuable future research avenues [ABSTRACT FROM AUTHOR]

Cardiogenic Shock is one of the main causes of death in ST segment Elevation Myocardial Infarction. To know the clinical characteristics, in-hospital evolution and mortality of patients with Cardiogenic Shock. Patients enrolled in the ARGEN-IAM-ST Registry were analyzed. Predictors of Cardiogenic Shock and death during hospital stay were established. A total of 6122 patients were admitted between 2015 and 2022. Cardiogenic Shock was present in 10.75% of cases. Patients with CS were older (64.5 vs 60 years), more females (41% vs 36%), with more antecedents of infarction and a higher prevalence of anterior location of infarction and multivessel disease. They were also less revascularized (88.5% vs 91.5%) and had a higher incidence of failed angioplasty (15.7% vs 2.7%). They also evidenced a higher occurrence of mechanical complications (6.8% vs 0.4%), ischemic recurrence (7.4% vs 3.4%) and cardiac arrest on admission (44.8% vs 2.6%). All the differences described showed statistical significance with P < 0.05. Overall mortality was 58% in contrast to 2.77% in patients without Cardiogenic Shock (P < 0.001). Only age, DBT, and early cardiac arrest were independent predictors of shock on admission whereas age, female gender, cardiac arrest on admission and failed angioplasty were independent predictors of death. One out of 10 patients with ST Elevation Myocardial Infarction presented cardiogenic shock. Its clinical characteristics were similar to those described more than 20 years ago. Despite a high use of reperfusion strategy cardiogenic shock continues to have a very high mortality Argentina. [ABSTRACT FROM AUTHOR]