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Background Diabetes mellitus ( DM ) is a major risk factor for cardiovascular events. We aimed to investigate the coronary plaque phenotype of diabetic patients who presented with acute coronary syndromes by optical coherence tomography. Methods and Results A total of 322 patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of the culprit lesion were included. Culprit plaque characteristics were compared between patients with DM (n=95) and those without DM (n=227). In the subgroup of 250 patients in whom sufficient length of nonculprit region in the culprit vessel was imaged by optical coherence tomography, the characteristics of nonculprit plaques were also evaluated. Patients with DM had a higher prevalence of lipid‐rich plaque (58.9% versus 44.9%, P =0.030) and macrophage accumulation (60.0% versus 44.9%, P =0.019) in the culprit lesion compared with patients without DM . The prevalence of plaque rupture (33.7% versus 30.4%, P =0.896) and plaque erosion (21.1% versus 22.0%, P =0.458) was similar. In the nonculprit lesions, the DM group had greater maximal lipid arc (248.9°±83.9° versus 179.9°±58.3°, P =0.006), thinner fibrous cap thickness (103.3±56.2 μm versus 140.7±70.0 μm, P =0.013), and a higher prevalence of thin‐cap fibroatheroma (17.2% versus 6.3%, P =0.031), compared with the non‐ DM group. Conclusions Compared with patients without DM , those with DM had more vulnerable features in both culprit and nonculprit lesions, thus indicating a higher level of panvascular instability. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01110538.

Background The role of endothelial dysfunction in predicting angina recurrence after percutaneous coronary intervention is unknown. Design We assessed the role of peripheral endothelial dysfunction measured by reactive-hyperaemia peripheral-artery tonometry (RH-PAT) in predicting recurrence of angina after percutaneous coronary intervention. Methods We enrolled consecutive patients undergoing percutaneous coronary intervention with second-generation drug-eluting stents. RH-PAT was measured at discharge. The endpoint was repeated coronary angiography for angina recurrence and/or evidence of myocardial ischaemia at follow-up. Patients with in-stent restenosis and/or significant de novo stenosis were defined as having angina with obstructed coronary arteries (AOCA); all other patients as having angina with non-obstructed coronary arteries (ANOCA). Results Among 100 patients (mean age 66.7 ± 10.4 years, 80 (80.0%) male, median follow-up 16 (3–20) months), AOCA occurred in 14 patients (14%), ANOCA in nine patients (9%). Repeated coronary angiography occurred more frequently among patients in the lower RH-PAT index tertile compared with middle and upper tertiles (14 (41.2%) vs. 6 (18.2%) vs. 3 (9.1%), p = 0.006, respectively). ANOCA was more frequent in the lower RH-PAT index tertile compared with middle and upper tertiles. In the multivariate regression analysis, the RH-PAT index only predicted angina recurrence. The receiver operating characteristic curve of the RH-PAT index to predict the angina recurrence demonstrated an area under the curve of 0.79 (95% confidence interval: 0.69–0.89; p Conclusions Non-invasive assessment of peripheral endothelial dysfunction using RH-PAT might help in the prediction of recurrent angina after percutaneous coronary intervention, thus identifying patients who may need more intense pharmacological treatment and risk factor control.

Objective Recent studies suggest that conservative management with antithrombotic therapy without stenting may be an option in selected patients with acute coronary syndrome (ACS). We evaluated whether a glycoprotein IIb/IIIa inhibitor, tirofiban, would offer additional benefit in patients with plaque erosion presenting with ACS who were treated with antiplatelet therapy without stenting. Patients and methods Forty-nine patients who completed 1-year follow-up optical coherence tomography imaging in the EROSION study were divided into two groups: tirofiban (n=32) versus no tirofiban (n=17). Thrombus volume, thrombus burden, and the incidence of major adverse cardiovascular events were evaluated. Results At baseline, the tirofiban group had similar thrombus volume [3.73 (1.27-12.49) vs. 3.51 (1.70-8.65) mm, P=0.983] and marginally greater thrombus burden [17.9 (10.1-26.1) vs. 10.6 (6.8-19.0)%, P=0.097]. At 1 month, the tirofiban group had smaller residual thrombus volume [0.00 (0.00-1.78) vs. 0.94 (0.07-4.20) mm, P=0.054], thrombus burden [0.0 (0.0-6.4) vs. 7.0 (1.8-14.8)%, P=0.024], and greater reduction of thrombus volume (85.4±24.6 vs. 67.1±27.1%, P=0.021). These differences were maintained up to 1 year. Complete resolution of thrombus at 1 month was more frequent in the tirofiban group (53.1 vs. 17.6%, P=0.031). None of the patients experienced major bleeding during the initial hospitalization. The 1-year major adverse cardiovascular events rate was not different (5.6 vs. 15.0%, P=0.336). Conclusion In patients with ACS caused by plaque erosion who were managed conservatively without stenting, tirofiban provided additional benefit in reducing residual thrombus without an increased risk for bleeding.

Anatase (TiO2) and multiwalled carbon nanotubes bearing polyethylenimine (PEI) anchored on their surface were hybridized in different proportions according to a sol-gel method. The resulting nanocomposites (TiO2@PEI-MWCNTs), characterized by BET, XRD, XPS, SEM, and UV techniques, were found efficient catalysts for CO2 photoreduction into formic and acetic acids in water suspension and under visible light irradiation. PEI-grafted nanotubes co-catalysts are believed to act as CO2 activators by forming a carbamate intermediate allowing to accomplish the first example in the literature of polyamines/nanotubes/TiO2 mediated CO2 photoreduction to carboxylic acids.

ST-segment elevation myocardial infarction (STEMI) complicated by coronary microvascular obstruction (CMVO) is one of the major causes of death and of decrease of patient’s quality of life due to recurrent myocardial infarction and heart failure. High costs for health system are associated with death and recurrent hospitalization of STEMI patients. No single treatment against CMVO is currently considered effective to improve the clinical outcome so far of STEMI patients and their quality of life. This chapter will describe how different temporal windows may be used and integrated for treating CMVO starting from the pre-hospital to the coronary care unit phase.

Acute coronary thrombosis with plaque erosion is responsible for about one-third of patients with acute coronary syndromes. The relationship between endothelial shear stress (ESS) and plaque erosion has not been systematically studied in patients so far. A total of 18 acute coronary syndrome

Thin films are deposited on open-cell polyurethane (PU) foams using an atmospheric pressure dielectric barrier discharge (DBD) fed with helium and hexafluoropropene (C3F6). During deposition processes, a foam substrate is sandwiched between the dielectric-covered electrodes of a parallel plate DBD reactor, so that the discharge can ignite also inside its three-dimensional (3D) interconnected porous structure. This affords the deposition of a fluorocarbon coating on both the exterior and interior of the foam. Scanning electron microscopy (SEM) observations allow estimating the thickness of the coating deposited on the foam struts, while X-ray photoelectron spectroscopy (XPS) analyses show moderate changes in surface chemical composition moving from the outer to the inner surfaces of the plasma-treated foams under all explored experimental conditions.

A general method for the preparation of superhydrophobic organic-inorganic nanocomposite coatings by atmospheric pressure cold plasma is presented. The method consists of a single-step room-temperature aerosol-assisted deposition process in which the aerosol of a dispersion of oleate-capped ZnO nanoparticles in liquid hydrocarbon precursors (i.e., a mixture of n-octane and 1,7-octadiene) is injected in a dielectric barrier discharge. The plasma-deposited hydrocarbon polymer/ZnO nanoparticles nanocomposite coatings show multifunctional behavior and specifically combine the photocatalytic properties of ZnO with superhydrophobicity; the latter results from the synergistic effect of the hierarchical multiscale surface texture due to the incorporation of nanoparticles and the low surface energy organic component formed via plasma polymerization of the hydrocarbon precursors.

This paper describes the development of a plasma process to produce a durable water repellent and anti-stain thin film on synthetic textile, utilized for the upholstery in the automotive field. The coatings were deposited in non equilibrium low pressure plasmas fed with 1H, 1H, 2H-perfluo-ro- 1-decene employing, as substrates, polyethylene terephthalate and polyethylene terephthalate thermo-coupled to polyurethane foam. It was found that the XPS F/C ratio of the deposit was higher than 1.4 and that the treated textile was always very hydrophobic (WCA > 140˚) and oil re- sistant (motor oil CA > 110˚), even after wear.

Aims Functional alterations of epicardial coronary arteries or coronary microcirculation represent a frequent cause of myocardial infarction and non-obstructive coronary arteries (MINOCA). We aimed at assessing the prognostic value of intracoronary provocative tests in patients presenting with MINOCA and in which other causes of MINOCA have been excluded. Methods and results We prospectively evaluated patients with a diagnosis of MINOCA, excluding patients with aetiologies other than suspected coronary vasomotor abnormalities. Immediately after coronary angiography, an invasive provocative test using acetylcholine or ergonovine was performed. The incidence of death from any cause, cardiac death, and recurrence of acute coronary syndrome (ACS) was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires (SAQ). We enrolled 80 consecutive patients [mean age 63.0 ± 10.7 years, 40 (50%) male]. Provocative test was positive in 37 (46.2%) patients without any complication. Among patients with a positive test, epicardial spasm was detected in 24 (64.9%) patients and microvascular spasm in 13 (35.1%) patients. After a median follow-up of 36.0 (range 12.0-60.0) months, patients with a positive test had a significantly higher occurrence of death from any cause [12 (32.4%) vs. 2 (4.7%); P = 0.002], cardiac death [7 (18.9%) vs. 0 (0.0%); P = 0.005], and readmission for ACS [10 (27.0%) vs. 3 (7.0%); P = 0.015] as well as a worse angina status as assessed by SAQ [Seattle score: 88.0 (33.0-100.0) vs. 100.0 (44.0-100.0); P = 0.001] when compared with patients with a negative test. Conclusions We demonstrate that in patients presenting with MINOCA and suspected coronary vasomotor abnormalities, a positive provocative test for spasm is safe and identifies a high-risk subset of patients.

Background: Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) leads to higher incidence of both early and late complications. A number of single nucleotide polymorphisms in 9p21 chromosome have been shown to affect angiogenesis in response to ischaemia. In particular, Rs1333040 with its three genotypic vriants C/C, T/C and T/T might influence the occurrence of MVO after pPCI. Methods: We enrolled ST-elevation myocardial infarction (STEMI) patients undergoing pPCI. The Rs1333040 polymorphism was evaluated by polymerase chain reaction-restriction fragment length polymorphism using restriction endonucleases (Bsml). Two expert operators unaware of the patients’ identity performed the angiographic analysis; collaterals were assessed applying Rentrop’s classification. Angiographic MVO was defined as a post-pPCI Thrombolysis In Myocardial Infarction (TIMI)Results: Among our 133 STEMI patients (mean age 63 ± 11 years, men 72%), 35 (26%) and 53 (40%) respectively experienced angiographic or electrocardiographic MVO. Angiographic and electrocardiographic MVO were different among the three variants ( p= 0.03 and p=0.02 respectively). In particular, T/T genotype was associated with a higher incidence of both angiographic and electrocardiographic MVO compared with C/C genotype ( p=0.04 and p=0.03 respectively). Moreover, Rentrop score Conclusion: Rs1333040 polymorphism genetic variants portend different MVO incidence. In particular, T/T genotype is related to angiographic and electrocardiographic MVO and to worse collaterals towards the culprit artery.

Bio-polyols synthesized from vegetables oils are a great alternative to petrochemical polyols for polyurethanes industry. The simplest approach to bio-polyols synthesis involves epoxidation of carbon–carbon double bond of unsaturated fatty ester moieties and subsequent epoxide ring-opening by nucleophilic reagents. In order to improve the latter process by increasing both productivity and product quality, the advantages of flow chemistry were exploited, such as facile automation, reproducibility, improved safety and process reliability, investigating for the first time in the literature the methanolysis reaction of epoxidized soybean oil (ESO) in a continuous flow mode. Compared with batch reaction, flow mode allowed the cut of the reaction time from 30 min to 2 min, and the reduction of catalyst concentration by an order of magnitude, which brought significant benefits in terms of cost efficiency and eco-sustainability, rendering the method suitable for industrial applications.

Aims Microvascular obstruction (MVO) is associated with a worse prognosis in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). However, data about incidence, clinical outcome and correlates of MVO in latecomers after STEMI are still lacking. Methods We prospectively enrolled consecutive patients that were latecomers after STEMI (symptoms onset >12h) undergoing PCI. We performed an angiographic analysis to assess the occurrence of MVO [defined as TIMI flow grade ≤2 or 3 with a myocardial blush grade Results Seventy-eight patients were enrolled [mean age 67.58±11.72years, 57 (73%) male; mean time of symptom onset 23.14±16.06h] with a mean follow-up time of 29.7±14.1months. MVO occurred in 39 (50%) patients. Patients with MVO had a higher rate of MACE [18 (46%) vs. 3 (8%), p Conclusions Latecomers after STEMI have a high risk to develop MVO that is related to an adverse prognosis. Appropriate management and follow-up strategies should be implemented in such high-risk patients group.

Low pressure plasma was used for preparing heterogeneous organocatalysts 2-(A)-(C) suitable for dioxirane-mediated epoxidations. Heterogenization was accomplished by adsorption of the methyl perfluoroheptyl ketone (2) on fluorinated supports (A)-(C) deriving from the treatment of commercial C8-silica gel in low pressure plasma fed with fluorocarbons. Catalyst 2-(C) proved to be the most efficient one, promoting epoxidation of an array of alkenes, including unsaturated fatty esters like methyl oleate (10) and the triglyceride soybean oil (11), with the cheap potassium peroxymonosulfate KHSO5 (caroate) as a green oxidant. Notably, the perfluorinated matrix gives rise to the activation of caroate, generating singlet oxygen. Materials were characterized by infrared Attenuated Total Reflectance spectroscopy (ATR-FTIR), X-ray Photoelectron Spectroscopy (XPS ) and Emission Scanning Electron Microscope (FESEM).

During the last years, the employment of light polymeric materials, to replace those commonly used in the automotive industry, has been investigated by many equipment manufacturers. Polymeric glazing, e.g. polycarbonate, are desirable because of their ability to reduce weight and fuel consumption, while providing good optical properties and impact resistance. In this paper, we report a two steps low pressure plasma treatment composed by an etching, optimized for the nano-texturing of polycarbonate to improve its anti-reflective property by simulating the so-called “Moth eye” effect, and by a plasma enhanced-chemical vapour deposition process to enhance the scratch resistance. Reflectance/transmittance measurements showed that this approach is able to increase the anti-reflective property of the polycarbonate without drastically damaging its transmittance, while scratching test by “car wash” simulator demonstrated the increase of scrape resistance. The haze test confirmed the transparency of the plasma treated polymer also after washing.

Our study aimed to elucidate mechanisms underlying discordance between fractional flow reserve (FFR) and hyperemic stenosis resistance (hSR) in some patient subsets. To do this, we enrolled 30 consecutive patients with stable angina or non-ST elevation myocardial infarction (non-STEMI) and with a nonculprit intermediate coronary lesion (40% to 70%) by coronary angiography. We measured aortic pressure, flow velocity, and pressure distal to lesion simultaneously at basal level and during adenosine-induced (fixed intracoronary dose of 120 μg) hyperemia using a dual-sensor-equipped guidewire. Microvascular resistance (MR; pressure distal to lesion/flow velocity, mm Hg/cm/s) and variation (Δ) in MR levels were calculated both at baseline and after hyperemia, whereas FFR (cutoff0.80) and hSR [(aortic pressure - pressure distal to lesion)/flow velocity, cutoff0.80 mm Hg/cm/s] were assessed after intracoronary adenosine. Twenty-three patients (76.7%) showed concordance and 7 patients (23.3%) showed discordance between FFR and hSR (all cases with FFR0.80 and hSR0.80). Discordant patients presented more frequently with non-STEMI (85.7% vs 39.1%, p = 0.04), significantly higher C-reactive protein serum levels (median [interquartile range] 5.9 [5.1 to 6.8] vs 4.9 [3.7 to 6.2] mg/L, p = 0.007), and lower ΔMR (p = 0.03) values compared with concordant patients. In conclusion, patients with non-STEMI and those with increased C-reactive protein levels show a lower reduction in MR after intracoronary adenosine-induced hyperemia, leading to FFR underestimation.

A facile atmospheric pressure cold plasma process is presented to deposit a novel organic-inorganic hydrocarbon polymer/ZnO nanoparticles nanocomposite coating. Specifically, this method involves the utilization of an atmospheric pressure dielectric barrier discharge (DBD) fed with helium and the aerosol of a dispersion of oleate-capped ZnO nanoparticles (NPs) in n-octane. As assessed by X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, the deposited nanocomposite coating combines the chemical features of both the oleate-capped ZnO NPs and the polyethylene-like organic component originated from the plasma polymerization of n-octane. Additionally, scanning electron microscopy (SEM) and transmission scanning electron microscopy (TSEM) confirm the synthesis of hierarchical micro/nanostructured coatings containing quasi-spherical NPs agglomerates. The polyethylene-like polymer covers the NPs agglomerates to different extents and contributes to their immobilization in the three-dimensional network of the coating. The increase of both the deposition time (1-10 min) and the NPs concentration in the dispersion (0.5-5 wt %) has a significant effect on the chemical and morphological structure of the thin films and, in fact, results in the increase the ZnO NPs content, which ultimately leads to superhydrophobic surfaces (advancing and receding water contact angles higher than 160°) with low hysteresis due to the hierarchical multiscale roughness of the coating.

Thin films containing carboxylic acid groups are deposited on open-cell polyurethane (PU) foams by using an atmospheric pressure non-equilibrium plasma jet, in dielectric barrier discharge configuration, fed with helium, acrylic acid and ethylene. The arrangement of the plasma jet, the sample holder, and the substrate is carefully optimized to enable the penetration of the plasma ejected from the remote source throughout the three-dimensional (3D) porous structure of the foam, and, therefore, to achieve the uniform coverage of the entire substrate. X-ray photoelectron spectroscopy analyses and scanning electron microscopy observations confirm that both the outer and the inner surfaces of the foam can be functionalized with the plasma-deposited coating, showing moderate changes in surface chemical composition and coating thickness moving from the exterior to the interior of the plasma-treated samples. The ability of the foams to adsorb heavy metals from water is tested through evaluation of cadmium ions (Cd2+) removal. The foams adsorption capacity can increase more than 10 times after plasma deposition and remains unchanged over 8 adsorption-release cycles.

Electromagnetic interferences (EMI) deriving from electrical devices may affect implantable cardioverter defibrillators (ICD). Improved algorithms have been developed in order to minimize adverse effects. However, caution should be still recommended in ICD recipients when handling electrical devices. Here we describe the case of an ICD patient with recurrent syncopal episodes due to inhibition of pacing by oversensing of electrical noise from a not properly grounded washing machine.

Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non-ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24). Primary end points of the study were incidence of angiographic microvascular obstruction (Thrombolysis In Myocardial Infarction flow grade of

No-reflow after primary percutaneous coronary intervention (pPCI) may be reversible. 40 patients undergoing pPCI were evaluated by assessing either improvement or lack of changes regarding angiographic and electrocardiographic indexes of no-reflow between admission and pre-discharge. Myeloperoxidase (MPO; in nanograms per milliliter), C-reactive protein (CRP; in milligrams per liter), endothelin-1 (ET-1; in nanograms per milliliter), angiopoietin-2 (Ang-2, in picograms per milliliter), and their pre-discharge/basal values variations (Δ) were related to no-reflow evolution. ΔMPO and ΔCRP were greater in patients with sustained no-reflow or lack of ST-segment resolution (STR) as compared with those with reversible no-reflow or lack of STR (p = 0.033, p = 0.04, p

Persistent oxidative stress may play a key role in microvascular obstruction (MVO). We aimed at assessing the role of platelet gp91phox (NOX2), the catalytic subunit of NADPH oxidase in MVO.We enrolled 40 patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention within 12 h from symptoms onset, either with angiographic MVO (n=20) or good angiographic myocardial reperfusion (MR) (n=20). Angiographic MVO was defined as a final thrombolysis in myocardial infarction (TIMI) flow ≤2 or TIMI flow of 3 with myocardial blush grade2. NOX2 and isoprostanes (8-iso-PGF2α) levels, as assessed by enzyme-linked immunoadsorbent assay (ELISA) or by an enzyme immunoassays, respectively, were measured on admission, at 24 h and pre-discharge.NOX2 levels increased from baseline to pre-discharge in patients with angiographic MVO (20.25 (15-24.75) pg/ml vs 25.50 (17-29.25) pg/ml, p=0.02), but not in MR patients (p=0.45), with a significant interaction between baseline and pre-discharge levels among the two groups (p=0.04). The levels of 8-iso-PGF2α showed a trend to increase from baseline to pre-discharge in angiographic MVO patients (295 (183.50-389.25) pmol/l vs 322 (206-370) pmol/l, p=0.06), but not in patients with MR (p=0.56), with a trend for interaction between baseline and pre-discharge levels among the two groups (p=0.09).Patients with MVO, but not those with myocardial reperfusion, have a sustained increase of NOX2 and 8-iso-PGF2α. Therapies targeting NOX2 or high dosage antioxidants should be tested for MVO prevention and treatment.

This contribution briefly reviews our recent progress in the preparation of hybrid organic/inorganic nanocomposite coatings by using an aerosol-assisted atmospheric pressure cold plasma process. The deposited coatings show multifunctional behavior due to the combination at the nanoscale level of the specific properties of the organic and inorganic components.

Plaque rupture (PR) represents the most common substrate of coronary thrombosis, in at least 50% of cases. Chronic low grade inflammation is a common background for atherosclerosis development; however, increased plaque inflammation may predispose by itself to PR. In the last decade, studies performed by optical coherence tomography (OCT) have allowed to establish the severity of plaque inflammation by assessing macrophage infiltration (MØI). Our retrospective study aimed at assessing the role of plaque inflammation in PR among patients with acute coronary syndrome (ACS) using OCT.We enrolled 56 patients with ACS exhibiting PR at the site of the culprit stenosis identified by OCT. Patients were divided into two cohorts according to the presence of MØI at OCT analysis, defined as signal-rich, distinct, or confluent punctate regions that exceed the intensity of background speckle noise. Serum high-sensitivity C-reactive protein (CRP) was measured on admission by latex-enhanced immunophelometric assay. Thirty-seven (66%) patients had MØI at the site of PR, whereas 19 (34%) patients had no evidence of MØI. Patients with MØI showed a higher rate of CRP values 3 mg/dL as compared with those without MØI (92% vs. 47%, P = 0.004). In contrast, patients without MØI had a higher prevalence of hypertension compared with those with MØI (89% vs. 59%, P = 0.021). Furthermore, the group with MØI exhibited a significantly higher rate of lipid-rich plaques (86% vs. 50%, P = 0.008), a higher rate of multifocal disease (59% vs. 10%, P 0.001), and an MØI in both culprit and remote lesions (97% vs. 0%, P 0.001) compared with those without MØI. At multivariate analysis, CRP value 3 mg/dL was the only independent predictor of MØI in the culprit plaque (OR 8.72, 95% CI 1.78-41.67, P= 0.007).In conclusion, PR can be caused by predominant inflammatory or non-inflammatory mechanisms, over a common low-grade chronic inflammatory background well known from pathology observations.

Background Natriuretic peptides are diagnostic/prognostic biomarkers in major cardiovascular diseases. We aimed at assessing the predictive role of N-terminal pro-A-type (NT-proANP) and pro-B-type (NT-proBNP) natriuretic peptides levels toward cardiovascular outcome in both stable and unstable coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in a non-primary PCI setting. Methods A total of 395 patients undergoing PCI with stent implantation for either stable angina (SA) or non ST-elevation acute coronary syndrome (NSTE-ACS) were enrolled. Pre-procedural NT-proANP and NT-proBNP levels were measured. Occurrence of major adverse cardiac events (MACEs), composite of cardiac death, non-fatal myocardial infarction, and clinically driven target lesion revascularization (c-TLR), was the endpoint of the study. Follow up mean time was 48.53±14.69months. Results MACEs occurred in forty-four patients (11%) during follow up. Both NT-proANP levels [3170 (2210–4630) vs 2283 (1314–3913) fmol/mL, p =0.004] and NT-proBNP levels [729 (356–1353) vs 511 (267–1006) fmol/mL, p =0.04] were significantly higher in patients with MACEs compared to patients without MACEs. Similar results were found when considering hard MACEs (myocardial infarction and cardiac death). NT-proANP levels were significantly higher in patients with c-TLR compared with patients without c-TLR [3705 (2766–5184) vs 2343 (1340–3960) fmol/mL, p =0.021]. At multivariate analysis, NT-proANP levels were a significant predictor of MACEs (HR 1.09, 95% CI 1.03–1.18, p =0.04). Kaplan–Meyer curves revealed that patients with elevated NT-proANP levels (>2.100fmol/mL) had a lower MACE free survival ( p =0.003). Conclusions Both NT-proANP and NT-proBNP levels were higher in CAD patients experiencing MACEs following PCI in a non-primary setting. Notably, only NT-proANP levels significantly affected prognosis after PCI.

Cytotoxin-associated gene antigen (CagA)-positive strains of Helicobacter pylori have previously been associated with acute coronary syndromes. However, the role of CagA-positive strains of Helicobacter pylori in recurring cardiac events after ST-segment elevation myocardial infarction (STEMI) has not yet been assessed.We enrolled 181 consecutive patients (155 men, mean age 64±13 years) presenting with STEMI. In all patients, serum levels of IgG anti-CagA were assessed. Levels of IgG anti-hepatitis A virus were also evaluated in all patients in order to exclude the presence of a bystander activation of the immune system. Finally, a previous history of acute coronary syndrome and the rate of major adverse cardiovascular events as a composite of cardiovascular death, recurring myocardial infarction and target lesion revascularisation within 2 years follow-up were evaluated.Anti-CagA IgG seropositive patients presented more frequently with a previous history of acute coronary syndrome compared with seronegative patients (28.3% vs. 14%, P=0.019). Interestingly, no differences were observed between anti-CagA IgG seropositive and anti-CagA IgG seronegative patients concerning the prevalence of anti-hepatitis A virus IgG seropositivity (20% vs. 21.4%, P=0.48). At 2-year follow-up, 40 patients experienced major adverse cardiovascular events. The major adverse cardiovascular event rate was higher in anti-CagA IgG seropositive compared with seronegative patients (hazard ratio 2.25, 95% confidence interval 1.34-2.95, P=0.013), which was confirmed at Cox multivariate analysis (hazard ratio 2.33, 95% confidence interval 1.30-3.14, P=0.009).CagA-positive strains of Helicobacter pylori seem to be involved in the pathogenesis of recurring acute coronary syndromes, and seropositivity for anti-CagA IgG predicts prognosis after STEMI, possibly due to the increased risk of recurring cardiac events.

BACKGROUND Angiographic and electrocardiographic (ECG) indexes of microvascular obstruction (MVO) have been described. We aimed at assessing by cardiac magnetic resonance (CMR) anatomical features underlying concordance between them. METHODS Forty-one patients were enrolled. Patients presented with neither angiographic nor ECG indexes of MVO (without MVO) (44%), with either angiographic or ECG indexes of MVO (discordant with MVO) (22%) or with both angiographic and ECG indexes of MVO (concordant with MVO) (34%). All patients underwent in-hospital CMR. Echocardiographic data obtained after 6 months were compared with those obtained in hospital. RESULTS Concordant patients with MVO had larger infarct size, lower myocardial salvage index and higher rate of myocardial haemorrhage (all assessed by CMR) [33% (25-41%), 15% (10-29%) and 88%, respectively] as compared with patients without MVO [12% (9-16%), 66% (52-79%) and 0%; Bonferroni-adjusted P

The success rate of recanalization of coronary chronic total occlusion (CTO) has improved in recent years, but the clinical benefit associated with successful CTO recanalization in the drug-eluting stent (DES) era is not well known. A cohort of 317 consecutive patients (mean age 65 ± 10, 84% men) with CTOs (defined as Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 and duration >3 months) of native coronary vessels in which percutaneous coronary intervention was attempted was enrolled from June 2005 to March 2009. All successful procedures (196 patients) were performed by DES implantation. The incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and repeat revascularization) was assessed during a mean follow-up period of 3 years. MACE predictors were assessed in clinical, angiographic, and procedural data, including procedural success. Patients with successful percutaneous coronary intervention experienced a significantly lower MACE rate compared to those with failed procedures (17 [9%] vs 32 [26%], p = 0.008). Patients with multivessel disease experienced MACEs more frequently than those with single-vessel disease (45 [22%] vs 4 [4%], p = 0.002). On multiple Cox regression analysis, the presence of multivessel disease and CTO opening failure were independent predictors of MACEs (hazard ratio 2.31, 95% confidence interval 1.17 to 4.96, p = 0.01, and hazard ratio 1.81, 95% confidence interval 1.33 to 4.12, p = 0.02, respectively). The worst prognosis was confined to patients with multivessel disease and failed procedures (hazard ratio 2.73, 95% confidence interval 1.21 to 3.92, p = 0.03). In conclusion, successful recanalization of CTOs with DES translates into a reduction of the 3-year MACE rate compared to failed procedures, and the worst prognosis is observed in patients with failed procedures and multivessel disease, a notion that might be taken into account in the management of patients with coronary CTOs.

Low pressure plasma, generated in a radio frequency reactor under rotation, was utilized to modify the ability of granular substrates to adsorb volatile acid compounds. Carbon black granules were treated with NH3 or allylamine containing feeds, while sepiolite granules were processed only in allylamine fed discharges. The chemical modifications induced by plasma treatments were evaluated by means of X-ray photoelectron spectroscopy studies and water contact angle measurements, while scanning electron microscope and Brunauer, Emmet, Teller analyses were performed to study the surface morphological changes caused by plasma processes. The ability of the treated materials to adsorb acids, in gas or vapour phase, was estimated with hydrochloric, acetic and propanoic acid, employing a home-made test system. The results show that the optimized plasma treatments are able to improve the adsorption ability of carbon black and sepiolite granules for the three acids investigated. re la tiv e ad so rb ed e qu iv al en ts % /se pi ol ite g HCl CH3CO2H CH3CH2CO2H

This work describes the plasma-enhanced chemical vapor deposition of thin films at atmospheric pressure using dielectric barrier discharges fed with argon, oxygen and different methyldisiloxanes, i.e., hexamethyldisiloxane, pentamethyldisiloxane, and 1,1,3,3-tetramethyldisiloxane. The influence of the methyldisiloxane chemical structure and of the oxygen/ methyldisiloxane feed ratio is investigated in order to provide insights into the organosilicon plasma chemistry at atmospheric pressure. As expected the FT-IR and XPS analyses show that the carbon content of the coatings depends on the number of methyl groups in the precursor molecule; in the case of coatings obtained with PMDSO and TMDSO carbon removal seems to be further enhanced by the presence of Si H bonds. Gaschromatography-mass spectrometry analyses of the exhaust gas allow to assess the precursor depletion and to perform the quali-quantitative determinationof by-products (e.g., silanes, siloxanes, silanols) formed by plasma activation. The results are exploited to rise hypotheses on the contribution of the different reaction pathways on the deposition mechanism.

ST elevation myocardial infarction in a 61-year-old man with a history of previous coronary artery bypass grafts. Spasm of collaterals to the circumflex coronary artery was the cause of acute presentation and was successfully treated by intracoronary nitrates. Chronic therapy with calcium channel blockers was added in the discharge medications chart.

This study deals with the investigation by means of gas chromatography-mass spectrometry (GC-MS) of the exhaust gas of an rf low pressure (LP) glow discharge and of an atmospheric pressure (AP) FDBD fed with hexamethyldisiloxane (HMDSO), O2, and Ar. The influence of feed composition on monomer depletion and on the qualitative‐quantitative distribution of stable by-products formed by recombination of plasma intermediates is investigated. Without O2 addition to the feed almost comparable values of HMDSO depletion are observed both at low and AP. Oxygen addition does not influence the monomer depletion at LP while it induces a slight decrease of the depletion at AP. Whatever the working pressure, O2 controls the overall chemistry of the plasma, since it influences the concentration of by-products (e.g., silanes, silanols, linear, and cyclic methylsiloxanes). At AP evidences of the importance of methyl abstraction from HMDSO molecule have been obtained, whileatLPtheprevalence ofSi‐Obondrupture, of fragmentation, and oligomerization reactions is observed. The comparison of results from the GCMS investigation of the exhaust gas with FT-IR spectra of the deposited coatings allows to enhance hypotheses on the formation of silanols in the gas phase and in the deposit.

The myocardial no-reflow phenomenon is characterized by a reduced antegrade myocardial blood flow despite an open infarct-related artery in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Importantly, no-reflow is known to be associated with unfavorable clinical outcome and prognosis. It is a complex phenomenon and is caused by the variable combination of four pathogenetic components: distal atherothrombotic embolization, ischemic injury, reperfusion injury and susceptibility of coronary microcirculation to injury. As a consequence, appropriate strategies to prevent or treat each of these components are expected to reduce the occurrence of no-reflow. Mechanical and pharmacological approaches performed before, during and after performing myocardial revascularization have been investigated in recent studies, in order to reduce the rate of no-reflow. In this article, we concentrate on the major preventive and therapeutic approaches currently available for the management of the no-reflow phenomenon.

Carbon black granules were coated by thin polymers in radio frequency glow discharges fed with acrylic acid/argon mixtures at different input powers, in order to improve the adsorption ability of basic compounds in the liquid and gas phases. The treated surfaces were characterized by X-ray photoelectron spectroscopy analyses and water contact angle measurements, performed immediately after the plasma treatment, after ageing in water and in air, and after heating up to 150 °C. The adsorption ability of basic compounds in the liquid and gas phases was evaluated with Boehm titrations and ammonia adsorption, respectively. Scanning electron microscopy observations and Brunauer, Emmett, Teller specific surface area measurements were performed to evaluate the morphological changes induced by the plasma treatments on the carbon black granule surface. The results show that the plasma treatments significantly improve the absorption ability of carbon black mainly for grafting of carboxylic groups and not for surface morphological modifications.

Surface engineering has been explored using plasma enhanced chemical vapur deposition (PECVD) of SiO2-like coatings on different metallic substrates in order to improve their resistance to corrosion. Specifically, the coatings have been deposited onto silver-based alloys which are prone to unaesthetic tarnishing, by means of PECVD in radio frequency (RF) plasma fed with tetraetoxysilane/oxygen/argon mixture. Microchemical and microstructural characterization of the coatings has been carried out by means of X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR), atomic force microscopy (AFM) and field emission scanning electron microscopy (FESEM). The protective effectiveness against tarnishing of SiO2-like layers has been evaluated by immersion tests in 0.1M Na2S aerated solution at room temperature. It has been found that SiO2-like coatings deposited by increasing the oxygen-to-monomer ratio in the feeding-gas mixture and the input power density possess excellent barrier effects, and the coating adhesion increases if the deposition process is performed after a hydrogen plasma treatment. The protective effectiveness of PECVD coatings may be related to their barrier effect against the diffusion of water and other gaseous aggressive agents present in the environment and coming into contact with the metal surface. Copyright (C) 2010 John Wiley & Sons, Ltd.

The thin film deposition in DBDs fed with Ar/HMDSO/O2 mixtures was studied by comparing the FT-IR spectra of the deposits with the GC-MS analyses of the exhaust gas. Under the experimental conditions investigated, oxygen addition does not enhance the activation of the monomer while it highly influences the chemical composition and structure of the deposited coating as well as the quali-quantitative distribution of by-products in the exhaust. Without oxygen addition a coating with high monomer structure retention is obtained and the exhaust contains several by-products such as silanes, silanols, and linear and cyclic siloxanes. The dimethylsiloxane unit seems to be the most important building block of oligomers. Oxygen addition to the feed is responsible for an intense reduction of the organic character of the coating as well as for a steep decrease, below the quantification limit, of the concentration of all by-products except silanols. Some evidences induce to claim that the silanol groups contained in the deposits are formed through heterogeneous (plasma-surface) reactions.

The deposition and etching of plasma-polymerized fluorocarbon thin films were studied in filamentary dielectric barrier discharges (FDBDs) fed with Ar–CF 4 –H 2 and Ar–CF 4 –O 2 mixtures, respectively. The etching/polymerization competition was investigated as a function of the feed composition. Hydrogen addition to CF 4 promotes thin films deposition, with a maximum deposition rate at 20% H 2 , and reduces the F/C ratio of the deposit, while the oxygen addition promotes the etching of the plasma-deposited film. It is demonstrated that fluorine atoms can perform the etching of the fluoropolymer also without ion bombardment. The correlation between the trend of the etch rate and the trend of the surface chemical composition of fluoropolymers etched in Ar–CF 4 –O 2 mixtures allows to enhance hypotheses on the reaction mechanism and on the role of the different active species involved in plasma–surface interactions.

In this paper a single step process for the synthesis of composite thin films made of platinum nanoclusters embedded in a porous hydrocarbon matrix is proposed. The process consists of a simultaneous plasma enhanced-chemical vapour deposition of ethylene and sputtering of a platinum target. Films were characterized by means of Fourier transform-infrared spectroscopy, X-ray photoelectron spectroscopy, atomic force microscopy, scanning electron microscopy and transmission electron microscopy. Optical emission spectroscopy was used to investigate the plasma phaseand tofind correlations with the metal content of thefilm. The effect of radio frequency power, deposition time, and ethylene flow rate on the chemical composition and structure of the film is presented. Results show that the platinum content in the film can be controlled by tuning the power delivered to the plasma and the monomer flow rate, and that the metal aggregates in crystalline nanoclusters uniformly distributed in the material. Film morphology is characterized by columnar structures of variable diameter and orientation depending on the deposition conditions.