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Introduction: atherosclerosis is one of the leading causes of death and morbidity worldwide. It consists in the development of plaques in the intima media layers of arteries due to lipid accumulation and oxidation, causing massive inflammation. We aim to better understand the role of Galectin-3 (Gal-3) and Lipoprotein(a) [Lp(a)] as possible peripheral markers of plaque presence. Methods: Gal-3 and Lp(a) were measured in plasma samples from 99 patients undergoing carotid endarterectomy and 78 healthy controls, by immunometric assays. Plaques were classified histologically, according to the American Heart Association (AHA) guidelines as type Va (fibroatheroma), Vb (mainly calcific) and Vl (complicated lesion). Results: Gal-3 and Lp(a) plasma levels are higher in patients compared to controls [19.8 ng/mL (SD 5.8) vs 14.0 ng/mL (3.6)], p

Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study (Clinicaltrial.gov NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sex- and gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes. The integration of sex and gender in this translational project on IHD will contribute to the identification of new targets for further innovative clinical interventions.

Contains fulltext : 196096.pdf (Publisher’s version ) (Open Access) Advances in neonatal cardiac imaging permit a more comprehensive assessment of myocardial performance in neonates that could not be previously obtained with conventional imaging. Myocardial deformation analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in neonates. Cardiac strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. These measurements are obtained in neonates using tissue Doppler imaging (TDI) or two-dimensional speckle tracking echocardiography (STE). There is an expanding body of literature describing longitudinal reference ranges and maturational patterns of strain values in term and preterm infants. A thorough understanding of deformation principles, the technical aspects, and clinical applicability is a prerequisite for its routine clinical use in neonates. This review explains the fundamental concepts of deformation imaging in the term and preterm population, describes in a comparative manner the two major deformation imaging methods, provides a practical guide to the acquisition and interpretation of data, and discusses their recognized and developing clinical applications in neonates.

Contains fulltext : 196080.pdf (Publisher’s version ) (Open Access) In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.

In the assessment of existing constructions for seismic vulnerability, one of the most challenging tasks is the determination of the mechanical properties of the materials. In this paper, results of an experimental campaign on rural masonry buildings are presented. Slightly-destructive and destructive tests were performed with the aim of evaluating the mechanical characteristics of masonry and providing useful indications on the methodologies and testing procedures to be applied in practice. In particular, results from what are termed “shove” tests and splitting tests on cores with inclined mortar joints will be presented and discussed, together with results of diagonal compression and shear-compression destructive tests. The failure modes observed and the parameters obtained from the different experimental tests will be analysed, with the objective of combining and comparing the outputs of the different tests, in order to evaluate the reliability of the proposed techniques.

Questo lavoro tratta il tema della sicurezza sismica dei componenti non strutturali di elevato valore, e dell’effetto sulla loro risposta dell’amplificazione dell’azione sismica con la quota. Si considerano in particolare oggetti semplicemente appoggiati, per i quali devono essere svolte verifiche di stabilità nei riguardi di oscillazione e ribaltamento. Tra i metodi di verifica presenti in letteratura, in questo lavoro si fa riferimento a quelli basati sulle misure di intensità (IM) in accelerazione e velocità. Si esaminano due differenti tipologie di edifici in c.a., una con struttura sismoresistente a telaio ed una a parete. Per entrambe le configurazioni si ricavano gli spettri di piano in accelerazione sia con metodi semplificati che mediante analisi time-history lineari e non lineari. Si valuta inoltre l’incremento della velocità con la quota allo scopo di mettere a punto indicazioni e strumenti operativi per una valutazione speditiva della sicurezza sismica di elementi contenuti di elevato valore. This paper deals with the seismic safety of remarkable non structural elements and building contents. The effects of seismic amplification with height is examined and discussed with reference to different RC structures’ typologies (i.e. 3 and 6 floors RC frame-and wall-systems). Particular attention is paid to free standing elements, for which oscillation and overturning stability checks must be performed. Among the verification methods proposed in literature, this work refers to those based on the intensity measures (IM) acceleration and velocity. For the RC structures considered in the present study, the floor acceleration response spectra are obtained by adopting simplified methods as well as by using the results of time-history analyses (linear and nonlinear). Finally, the amplification of peak ground velocity is estimated in order to provide practical indications and operational tools for a simplified evaluation of the seismic safety of contents elements of remarkable value

Per ridurre la vulnerabilità sismica di costruzioni esistenti in cemento armato, alle tecniche più tradizionali di miglioramento e adeguamento sismico, basate essenzialmente su interventi diffusi o sull’inserimento di nuovi elementi strutturali sismoresistenti, negli ultimi anni sono state affiancate tecniche più innovative basate sull’utilizzo di sistemi basati sulla dissipazione di energia. L’utilizzo di dissipatori isteretici tipo Brad (Buckling Restrained Axial Damper) prevede generalmente il loro diretto inserimento all’interno della maglia strutturale, spesso in serie con profili in acciaio (profili ad H o tubolari), a costituire un diagonale di controvento.

Contains fulltext : 196159.pdf (Publisher’s version ) (Open Access) One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.

Contains fulltext : 196161.pdf (Publisher’s version ) (Open Access) Neonatologists can use echocardiography for real-time assessment of the hemodynamic state of neonates to support clinical decision-making. There is a large body of evidence showing the shortcomings of conventional echocardiographic indices in neonates. Newer imaging modalities have evolved. Tissue Doppler imaging is a new technique that can provide measurements of myocardial movement and timing of myocardial events and may overcome some of the shortcomings of conventional techniques. The high time resolution and its ability to assess left and right cardiac function make tissue Doppler a favorable technique for assessing heart function in neonates. The aim of this review is to provide an up-to-date overview of tissue Doppler techniques for the assessment of cardiac function in the neonatal context, with focus on measurements from the atrioventricular (AV) plane. We discuss basic concepts, protocol for assessment, feasibility, and limitations, and we report reference values and give examples of its use in neonates.

Contains fulltext : 196081.pdf (Publisher’s version ) (Open Access) Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.

Item does not contain fulltext There is a growing interest worldwide in using echocardiography in the neonatal unit to act as a complement to the clinical assessment of the hemodynamic status of premature and term infants. However, there is a wide variation in how this tool is implemented across many jurisdictions, the level of expertise, including the oversight of this practice. Over the last 5 years, three major expert consensus statements have been published to provide guidance to neonatologists performing echocardiography, with all recommending a structured training program and clinical governance system for quality assurance. Neonatal practice in Europe is very heterogeneous and the proximity of neonatal units to pediatric cardiology centers varies significantly. Currently, there is no overarching governance structure for training and accreditation in Europe. In this paper, we provide a brief description of the current training recommendations across several jurisdictions including Europe, North America, and Australia and describe the steps required to achieve a sustainable governance structure with the responsibility to provide accreditation to neonatologist performed echocardiography in Europe.

Contains fulltext : 196118.pdf (Publisher’s version ) (Open Access) Cardiac ultrasound techniques are increasingly used in the neonatal intensive care unit to guide cardiorespiratory care of the sick newborn. This is the first in a series of eight review articles discussing the current status of "neonatologist-performed echocardiography" (NPE). The aim of this introductory review is to discuss four key elements of NPE. Indications for scanning are summarized to give the neonatologist with echocardiography skills a clear scope of practice. The fundamental physics of ultrasound are explained to allow for image optimization and avoid erroneous conclusions from artifacts. To ensure patient safety during echocardiography recommendations are given to prevent cardiorespiratory instability, hypothermia, infection, and skin lesions. A structured approach to echocardiography, with the same standard views acquired in the same sequence at each scan, is suggested in order to ensure that the neonatologist confirms normal structural anatomy or acquires the necessary images for a pediatric cardiologist to do so when reviewing the scan.