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We propose a model for cell-matrix decohesion that highlights the role of elasticity in this process. In doing this, we specialize our previous study of focal adhesion, an integrin mediated structure that oversees and guides the mutual interactions between cells and the extracellular matrix. Specifically, we consider a two-scale asymptotic homogenization technique to study the multi-scale nature of decohesion. Thus, we are able to use micro-structural information available at length scales smaller than those at which focal adhesions are observed. Based on classical two-scale asymptotic techniques the proposed approach allows to define effective elastic coefficients encoding the intrinsic heterogeneous properties of both focal adhesions and extracellular matrix.

Traditional olive groves are generally characterized by low planting density, considerable age of the trees, large size of the canopies and alternate fruit productions so that a rejuvenation pruning is highly required. In this context, pruning residues are usually burned by the farmers. The present paper is finalized to assess the production of biomass from rejuvenation pruning of a traditional olive orchard in Southern Italy and to characterize it in order to evaluate its potential energetic value according to dimensional classes. A four-year study was carried out to evaluate the effect of rejuvenation pruning on the olive trees. In particular, an intense pruning by immediately selecting the final primary branches of the canopy was applied in ‘Carolea’ cultivar in 2019 and shreddable and non-shreddable removed materials were separately collected and weighted per tree in each year of experimentation. Pruning material was also analyzed according to dimensional classes in order to evaluate the possibility for energetic use. Results showed that the amount of removed material was very high in the first year of pruning with a ratio around 1.0 for shreddable and non-shreddable fractions. Pruning intensity strongly decreased during the following years with a prevalence of shreddable material and a very low pruning time requirement for tree. The energy characteristics of olive pruning residues recorded significant differences only for the sample with diameter < 20 mm (shreddable foliage) confirming the suitability of the bigger fraction (> 20 mm) to be used for the production of olive pruning pellets for domestic use (boilers even with low thermal powers) respecting the limits of class B of EN ISO 17225-2. In conclusion, while shreddable pruning material was the prevalent fraction and it can be useful to improve the soil organic matter content if maintained in the olive orchard, non-shreddable fraction can offer an interesting source for energy production. In particular, it can represent a secondary source of income for the farm to recover the cost incurred for the rejuvenation pruning of the traditional olive orchard or to design interesting alternative agricultural energetic supply chains., Proceedings of the 30th European Biomass Conference and Exhibition, 9-12 May 2022, Online, pp. 249-253

Background: Levosimendan is a pyridazone-dinitrile derivative. Its primary action is to increase cardiac contractility: binding to troponin C in a calcium-dependent manner and stabilizing it, levodimendan induces actomyosin cross-bridging without increasing myocardial consumption of adenosine triphosphate (ATP) or intracellular calcium concentration. Thus, cardiac performance and contractility are improved with no increase in the total myocardial energy demand and oxygen consumption. Exerting its effects mainly during systole, regular ventricular filling and coronaric flow are preserved in dyastole. Moreover, arrhytmogenesis is not increased as total intracellular calcium levels are not raised. Levosimendan’s peripheral actions are mainly related do vasodilatation, with reduction of cardiac afterload. Independent to the beta-adrenergic pathway, levosimendan increases cardiac inotropism, reduces peripheral vasoconstriction even in presence of the beneficial effects of beta-blockade. Clinical trials have already evaluated the potential clinical application of this drug in acute decompensated heart failure (AHF), without being conclusive for a definite beneficial effect of levosimendan on major outcomes over classic inotropic drugs, such as beta-agonists [1, 2], actually representing an expensive, secondline option in this setting. On the other hand, only small, nonrandomized studies have evaluated the role of the pulsed i.v. administration of this drug in patients affected by chronic heart failure (CHF) with low ejection fraction [3, 4]. To our knowledge, one RCT has been performed on a the oral formulation of levosimendan in this setting [5], and a larger trial on the i.v. pulsed administration is still ongoing [6]. Aims of the study: To describe how pulsed, chronic i.v. administration of levosimendan affected survival, funtional class, number of admissions due to AHF and ejection fraction in ten patients with chronic, compensated heart failure followed by our Internal Medicine department. Materials and methods: Ten consecutive male patients, homogeneous for pathology (postischemic hypertrophic-dilated cardiopathy) and functional class (NYHA class IIIB-IV) were selected for pulsed administration of levosimendan, 0.15 lg/kg/min every 3 weeks starting from 01/01/2007. History and physical examination were performed every admission. Echocardiography and BNP were performed at the time of the first infusion and every 3 months. Statistical analysis was performed with SPSS 13.0 for Windows. Results: Mean age of the group was 76 ± 12 years. All the patients were under therapy with beta-blocker, an ACE-I or an ARB, loop diuretics, spironolactone or similar anti-aldosteronic drugs and statins. Two patients died for acutely decompensated heart failure (32 and 14 months, respectively, after the first infusion). 40% of the group needed further admissions for acutely decompensated heart failure. Mean survival of the group was 25.6 ± 16.5 months. Ejection fraction was 30.8 ± 6.2% at baseline and increased to 40 ± 5.9% at 3 months (p\0.05, using Wilcoxon Signed rank test and t test for repeated measures). BNP mean level was 718. ± 227.2 ng/ml at baseline and decreased to 503 ± 159.3 ng/ml at 3 months (p\0.05, using Wilcoxon Signed rank test and t test for repeated measures). NYHA class remained constant within the controls (p[0.05 using Chi-squared test). Discussion: In this small case series, survival and rehospitalization rates were lower than the ones described in literature [7]. We also observed an overall improvement of echocardiographic and laboratoristic parameters in patients undergoing to levosimendan therapy. Since large, randomized, studies of the use of this drug in chronic, compensated heart failure are still ongoing [6], our data are only suggestive fore possible a role of i.v. administration of levosimendan in manteinance therapy in CHF. These data are consistent with those already described in other studies [3, 4]. References 1. Follath F, Cleland JG et al (2002) Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised doubleblind trial. Lancet 360(9328):196–202 2. Mebazaa A, Nieminen MS et al (2007) Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial. JAMA 297(17):1883–1891 3. Nanas JN, Papazoglou P et al (2005) Efficacy and safety of intermittent, long-term, concomitant dobutamine and levosimendan infusions in severe heart failure refractory to dobutamine alone. Am J Cardiol 95(6):768–771 4. Drakos SG, Kanakakis JV et al (2009) Intermittent inotropic infusions combined with prophylactic oral amiodarone for patients with decompensated end-stage heart failure. J Cardiovasc Pharmacol 53(2):157–161 (PubMed PMID: 19188832) 5. Nieminen MS, Cleland JG et al (2008) Oral levosimendan in patients with severe chronic heart failure—the PERSIST study. Eur J Heart Fail 10(12):1246–1254 (Epub 2008 Oct 21) S92 Intern Emerg Med (2010) 5 (Suppl 2):S91–S128 123 6. Altenberger J, Parissis JT, Ulmer H, Poelzl G, LevoRep Investigators (2010) Rationale and design of the multicentre randomized trial investigating the efficacy and safety of pulsed infusions of levosimendan in outpatients with advanced heart failure (LevoRep study). Eur J Heart Fail 12(2):186–192 7. Fauci AS, Braunwald E et al (1998) Harrison’s Principles of Internal Medicine, 17th edn. McGraw-Hill, New York This contribution has been awarded as Best Communication.

Background: Atherosclerosis is a systemic process, involving multiple arterial districts at the same time. Carotid doppler ultrasound is an easy and non-invasive test, able to evaluate the layers of the neck arteries and the involvement of this district in the atherosclerotic process. Carotid intima-media-thickness (IMT) is known to be a marker of the systemic atherosclerotic process. Dopper ultrasound could become useful, allowing a correct risk stratification in the systemic involvement by the atherosclerotic process. Moreover, it could be functional, in association with the other already-validated rulers, in targeting the best therapeutic choice for acute coronary heart disease [6]. An increase of IMT or the presence of atherosclerotic plaque in asymptomatic patients have been associated to an increased risk for coronary heart disease (CHD) in large, perspective studies [1–4]. On the other hand, a recent meta-analysis [5] showed that neither the presence of an increased IMT neither the presence of a plaque were discriminatory enough to be considered a reliable screening test among patients with symptomatic CHD. Aims of the study: To evaluate a correlation between carotid arteries ultrasonographic pattern and coronaric pathology extension among symptomatic CHD patients living in our region. Materials and methods: In the period 01/2007–01/2008, we enrolled 100 consecutive patients admitted to our Internal Medicine Department for acute coronary syndrome (ACS). For each patient, we evaluated the classical risk factors (familiarity, known CHD, diabetes mellitus, dyslipidemia, hypertension, smoke and obesity), the extent of the atherosclerotic pathology (cerebrovascular events, peripheral arteries pathology and CHD) and the therapy at the moment of the admission. Every subject underwent to doppler ultrasound: IMT, presence of carotid plaque and degree of stenosis were evaluated. Coronarographic assessment evaluated the number of arteries with significant obstruction, the total coronary score (TCS), the site and the degree of stenosis. We performed the statistical analysis with SPSS 13.0 package for Windows systems. Results: The absence of a previous history of CHD and a negative carotid ultrasound (normal IMT, no evidence of any plaque) were the strongest protective factors for multiple-vessel coronary disease (CHD: OR = 0.132; 95% CI 0.027–0.628, p\0.05; Negative US: OR = 0.223; 95% CI: 0.067–0.742, p\0.05). Lower percentages of stenosis were associated to lower TCS as detected at coronarography (0–30% stenosis at US: OR = 6.76 [95% CI: 19.25–2.37, p\0.05] of obtaining a low TCS) with a decrease of the risk of low TCS with proportional to the increase of carotid stenosis. Discussion: In this small, retrospective analysis we correlate a normal carotid ultrasonographic pattern with a low risk of multiple-vessel involvment at coronarography. Moreover, in this population of symptomatic patients, we correlate the percentage of carotid stenosis with a proportional increase of the risk of an higher TCS at coronarography. These data suggest that among high-risk, symptomatic patients, carotid ultrasound and doppler evaluation can be a reliable indicator of the extent of coronary pathology. References 1. Simon A, Chironi G, Levenson J (2007) Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals. Eur Heart J 28(24):2967–2971 (review) 2. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX (1997) Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 146:483–494 3. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 340:14–22 4. Salonen T, Salonen R (1991) Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 11:1245–1249 5. Wald DS, Bestwick JP (2009) Carotid ultrasound screening for coronary heart disease: results based on a meta-analysis of 18 studies and 44,861 subjects. J Med Screen 16(3):147–154 6. Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Winkel T, van Gestel YRBM, Verhagen HJM, Bax JJ, Poldermans D, Rotterdam, and Leiden, The Netherlands, Coronary Artery Disease Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events

Case report: We report a case of two successful pregnancies in a patient with a prior diagnosis of essential thrombocytemia with secondary portal vein thrombosis and portal hypertension. A 19-year-old woman affected by undefined thrombocytosis (platelets count 650,000 mmc-1) since 1990 was admitted to our department in May 1995 for severe abdominal pain and hepatosplenomegaly. History was negative for smoking or autoimmune disorders and laboratoristic exams showed a slight increase of leukocytes, erythrocytes, hemoglobin, transaminases, bilirubin, and decreased PT. Portal hypertension secondary to inferior vena cava thrombosis was confirmed by Doppler evaluation that revealed the presence of a complete splenoportal occlusion. Ultrasonographic assessment showed also severe hepatosplenomegaly and presence of ascites. Thrombolytic therapy with urokinase was started within 3 h from the admission. She underwent to diuretic and beta-blocking ther- apy, with gradual remission of the presenting clinical features and progressive reperfusion of the vessel. Recanalization of the portal axis was documented by ultrasound and subsequent MRI with contrast medium. Bone marrow aspiration and biopsy resulted highly suggestive for essential thrombocytemia (ET), and the cause of the clinical epiphenomena were referred to this chronic mye- loproliferative syndrome. A course of interferon-alpha, according to literature, was started and subsequent follow-ups showed a stability of clinical and laboratoristic data. Two years later, the patient was admitted again for the occurrence of ascites, subcutaneous venous collaterals and acute bleeding of oesophageal varices. She underwent to endoscopic band ligation in the emergency depart- ment. CT scan and subsequent MRI with arteriographic evaluation of splancnic arteries and veins were highly suggestive of Budd- Chiari syndrome with subsequent portal and splancnic hyperten- sion. Imaging suggested the presence of hypervascular nodules in the liver, narrowing of the vena cava and left hepatic vein occlusion. Liver biopsy showed areas of nodular hyperplasia. On- cocarbide was started, and patient was put in list for liver transplantation. Orthotopic liver transplantation was performed in November 1998, with a regular clinical course. Serial clinical and laboratoristic controls were in the normal range. In the following years patient continued her therapy with interferon-alpha. Despite her clinical history, she had two uncomplicated pregnancies after withdrawal of oncocarbide. Currently both the patient and her children are doing well. Discussion: Essential thrombocythemia (ET) is an acquired mye- loproliferative disorder with a prolonged clinical course and a near- normal life expectancy [1, 2]. It is characterized by a sustained elevation of platelet number with an increased risk for thrombosis and hemorrhage. Whereas most of the patients with ET are asymptomatic, some may experience vasomotor, thrombotic, or hemorrhagic disturbances. Arterial and venous thromboses, as well as platelet-mediated transient occlusions of the microcirculation and bleeding, represent the main risks for ET patients. This pathology has been described to complicate pregnancy with recurrent abortions, intrauterine death, and fetal growth retardation due to placental infarctions [3]. However, pregnants affected by ET have often a favourable outcome. An increased risk for thrombosis is always present among pregnants, and it can be increased in the ET subgroup. On the other hand, hemorrhagic risk is low, except in patients with acquired Von Willebrand’s disease [4]. Many pregnancies in ET have a successful outcome with minimal ther- apy. Cytoreductive treatment should preferably be avoided, especially during the first trimester [5]. Moreover, none of these has a product license for use in pregnancy. Interferon use has been associated with a higher live birth rate, whereas ASA treatment didn’t affect any major outcome [2]. IFN-a does not cross the placental barrier, and represents a potential therapeutic solution when platelet reduction is required for high risk patients. Reducing the platelet count using IFN-a might improve the chance of a successful outcome in subsequent pregnancies [5]. References 1. Birgega ̊rd G (2009) Long-term management of thrombocytosis in essential thrombocythaemia. Ann Hematol 88(1):1–10 2. Melillo L, Tieghi A, Candoni A et al (2009) Outcome of 122 pregnancies in essential thrombocythemia patients: A report from the Italian registry. Am J Hematol 84(10):636–640 3. Buyukbayrak EE, Ergen B, Karageyim Karsidag AY et al (2010) Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case. J Matern Fetal Neonatal Med 23(2):187–189 4. Griesshammer M, Heimpel H, Pearson T (1996) Essential thrombocythemia and pregnancy. Leuk Lymphoma 22(Suppl 1):57–63 5. Jean B Brie`re (2007) Essential thrombocythemia. Orphanet J Rare Dis 2:3. doi:10.1186/1750-1172-2-3