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Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77).Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Introduction: Ischaemic stroke patients with atrial fibrillation (AF) are at high risk of stroke recurrence despite oral anticoagulation therapy. Patients with cardiovascular comorbidities may take both antiplatelet and oral anticoagulation therapy (OAC/AP). Our study aims to evaluate the safety and efficacy of OAC/AP therapy as secondary prevention in people with AF and ischaemic stroke.Patients and methods: We performed a post-hoc analysis of pooled individual data from multicenter prospective cohort studies and compared outcomes in the OAC/AP cohort and patients on DOAC/VKA anticoagulation alone (OAC cohort). Primary outcome was a composite of ischaemic stroke, systemic embolism, intracranial bleeding, and major extracranial bleeding, while secondary outcomes were ischaemic and haemorrhagic events considered separately. A multivariable logistic regression analysis was performed to identify independent predictors for outcome events. To compare the risk of outcome events between the two cohorts, the relation between the survival function and the set of explanatory variables were calculated by Cox proportional hazard models and the results were reported as adjusted hazard ratios (HR). Finally another analysis was performed to compare the overall risk of outcome events in both OAC/AP and OAC cohorts after propensity score matching (PSM).Results: During a mean follow-up time of 7.5 ± 9.1 months (median follow-up time 3.5 months, interquartile range ±3), 2284 stroke patients were on oral anticoagulants and 215 were on combined therapy. The multivariable model demonstrated that the composite outcome is associated with age (OR: 1.03, 95% CI: 1.01–1.04 for each year increase) and concomitant antiplatelet therapy (OR: 2.2, 95% CI: 1.48–3.27), the ischaemic outcome with congestive heart failure (OR: 1.55, 95% CI: 1.02–2.36) and concomitant antiplatelet therapy (OR: 1.93, 95% CI: 1.19–3.13) and the haemorrhagic outcome with age (OR: 1.03, 95% CI: 1.01–1.06 for each year increase), alcoholism (OR: 2.15, 95% CI: 1.06–4.39) and concomitant antiplatelet therapy (OR: 2.22, 95% CI: 1.23–4.02). Cox regression demonstrated a higher rate of the composite outcome (hazard ratio of 1.93 [95% CI, 1.35–2.76]), ischaemic events (HR: 2.05 [95% CI: 1.45–2.87]) and bleeding outcomes (HR: 1.90 [95% CI, 1.06–3.40]) in OAC/AP cohort. After PSM analysis, the composite outcome remained more frequent in people treated with OAC + AP (RR: 1.70 [95% CI, 1.05–2.74]).Discussion: Secondary prevention with combination of oral anticoagulant and antiplatelet therapy after ischaemic stroke was associated with worse outcomes in our cohort.Conclusion: Further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischaemic stroke in patients with atrial fibrillation.

An innovative method for the preparation of elastomeric magnetic films with increased magneto-responsivity is presented. Polymeric films containing aligned magnetic microchains throughout their thickness are formed upon the magnetophoretic transport and assembly of microparticles during polymer curing. The obtained films are subsequently magnetized at a high magnetic field of 3 T directed parallel to the orientation of the microchains. We prove that the combination of both alignment of the particles along a favorable direction during curing and the subsequent magnetization of the solid films induces an impressive increase of the films’ deflection. Specifically, the displacements reach few millimeters, up to 85 times higher than those of the nontreated films with the same particle concentration. Such a process can improve the performance of the magnetic films without increasing the amount of magnetic fillers and, thus, without compromising the mechanical properties of the resulting composites. The proposed method can be used for the fabrication of magnetic films suitable as components in systems in which large displacements at relatively low magnetic fields are required, such as sensors and drug delivery or microfluidic systems, especially where remote control of valves is requested to achieve appropriate flow and mixing of liquids.

Patent foramen ovale (PFO) in pulmonary embolism (PE) is associated with an increased risk of complications. However, little is known about PFO and ischemic stroke prevalence, particularly in acute intermediate-risk PE. In addition, in this context, the so-called “gold standard” method of PFO diagnosis remains unknown. We aimed to evaluate PFO and ischemic stroke prevalence and determine which of transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) is the best PFO diagnostic method in this context.

Arterial thromboembolism in patients with an unknown source of embolization is associated with significant morbidity and mortality. Once the acute process has been treated, a search of the offending embolic source must be conducted to prevent additional episodes. The most common sources of peripheral embolism include intracardiac thrombi (85%), thrombus within arterial aneurysm, thrombus overlying complex atherosclerotic plaques, and paradoxical embolization from deep venous thrombus. A strong association has been shown between protruding, noncalcified plaques 4 cm in the aorta detected by transesophageal echocardiography and the risk of embolism. Moreover, as many as 25–50% of protruding plaques may have superimposed mobile thrombi ranging from one to several centimeters, and this imparts a high embolic risk. The formation of thrombi in morphologically normal aorta is a rare event. We report a case of peripheral embolization in a young man caused by a thrombus in the descending aorta detected by transesophageal echocardiography.

A new alkoxysilane was used to reduce the hydrophilic character of the silica used in reinforcing styrene/butadiene elastomers for the tyre industry. The surface properties of silica modified with 17 wt.‐% of this silane were estimated by inverse GC. A clear change from hydrophilic to hydrophobic character was observed. Styrene/butadiene copolymers loaded with modified silicas were characterized were characterized using vulcanization tests, stress/strain measurements and morphological analysis. The best tensile properties were obtained with TESPT‐modified silica. The properties of the compound loaded with sb1‐pre‐grafted silica are scantily lower that the ones of the other compounds. This difference must be ascribed to a higher crosslink density given by the sulfur deriving from the TESPT decomposition during the vulcanization process.

Alternative N fertilizers that stimulate low greenhouse gas emissions from soil are needed to reduce the impact of agriculture on global warming. Corn (Zea maysL.) grown in a calcareous silt loam soil in northwestern Italy was fertilized with a municipal solid waste compost and vetch (Vicia villosaRoth.) green manure. Their potential to reduce N2O and CO2emissions was compared with that of urea (130 kg N ha−1). Gaseous fluxes were measured for 2 yr in the spring (after soil incorporation of fertilizers) and in summer. In spring, the slow mineralization of compost reduced N2O emissions (0.11% of supplied N) relative to urea (3.4% of applied N), without an increase in CO2fluxes. Nitrous oxide (2.31% of fixed N) and CO2emissions from rapid vetch decomposition did not differ from urea. When N2O and CO2fluxes were combined, compost reduced by 49% the CO2equivalent emitted following urea application. Vetch did not show such an effect. In summer, no fertilizer effect was found on N2O and CO2emissions. Compost proved to be potentially suitable to reduce the CO2equivalent emitted after soil incorporation while vetch did not. For a thorough evaluation, net greenhouse gas emissions assessment should be extended to the entire N life cycle. Differences between calculated N2O emission factors and the default Tier 1 value of the Intergovernmental Panel on Climate Change (1%) confirmed the need for site‐ and fertilizer‐specific estimations.

β- And α1-adrenoceptor antagonist properties of bufuralol, carvedilol, celiprolol, dilevalol, labetalol, and pindolol were investigated in human myocardium and mammary artery using binding techniques and functional studies. In myocardial membranes, β-adrenoceptor antagonists showed monophasic competition isotherms for [l25I]pindolol binding with high affinity (Kifrom 1–100 nM), except for celiprolol which displayed a bi-phasic competition isotherm (pKi= 6.4 ± 0.06 for prand 4.8 ± 0.07 for β2-adrenoceptors). Drug interactions with α1-adrenoceptors were evaluated in human mammary artery by [3H]prazosin binding and by measuring contractile responses to norepinephrine (NE). Labetalol and carvedilol showed a moderate affinity for a,-adreno-ceptors (pKi = 6.2 ± 0.01 and 6.1 ± 0.06, respectively), and inhibited NE-induced contractions (pA2= 6.93 ± 0.23 and 8.64 ± 0.24, respectively). Dilevalol, bufuralol, and pindolol displayed weak effect both in binding (Kiin micromolar range) and functional experiments (pA2= 5.98, 5.54, and 6.23, respectively). Celiprolol did not show antagonist properties up to 100 μ.Min functional studies, but displayed a slight affinity for a,-adrenoceptors in binding studies. The data indicate that the vasodilating activity of these p-adrenoceptor antagonists is caused in some instances by an α1adrenoceptor antagonism (labetalol, carvedilol), whereas for the others alternative mechanisms should be considered.

Abstract: Nerve conduction velocity distribution (CVD) study is a newly-developed electrodiagnostic method for detecting alterations in the composition of nerve fibres according to their conduction velocity. The presence of subclinical neuropathy was evaluated in 138 diabetic patients by CVD study of four motor nerves (external popliteal and ulnar nerves bilaterally) and two sensory nerves (median nerve bilaterally), and the data obtained were compared with standard electrophysiological parameters in the same nerve segments. CVD studies revealed an altered distribution pattern in 106 of 129 evaluable patients for motor nerves (82%) and in 67 of 115 evaluable patients for sensory nerves (58%), while standard examination gave abnormal findings in 92 of 137 patients (67%) and in 33 of 118 patients (11%), respectively. Of the patients adequately evaluated by both techniques, 21 of 129 patients (16%) revealed altered CVD data unaccompanied by slowing of maximum nerve conduction velocity, and 37 patients of 101 (37%) showed similar findings for sensory nerves. Subclinical alterations of motor and sensory nerve CVD were not significantly related to age or to metabolic control expressed as glycated haemoglobin levels; a significantly longer duration of disease was found in patients with motor and mixed subclinical neuropathy with respect to non-neuropathic patients. The CVD study allowed us to detect subclinical abnormalities of motor and sensory nerve fibres; often this is a more sensitive method than the standard electrodiagnostic study. This method can be very useful as a diagnostic tool and in research in the study of the progression of diabetic neuropathy.

To verify the possible contribution of β-adrenergic receptor down-regulation to the reversal of reflex tachycardia during chronic treatment with a dihydropyridine calcium antagonist. 11 hypertensive patients were studied with noninvasive blood pressure (BP) and heart rate (HR) monitoring after a placebo period, and on the first and seventh day of felodipine administration. 5 mg twice daily. Plasma catecholamines and neutrophil β-adrenergic receptors were measured on the first and seventh day of treatment, immediately before and 2 h after drug administration. The first administration of felodipine was followed by a significant drop in BP (peakreduction in mean BP 24 $$ 7 mm Hg). lasting 6 h and mirrored by reflex tachycardia (peak increase in HR 14 $$ 9 beats/min). On the mornin go the seventh day. 12 gafter the previous felodipine administration, mean BP (MBP) was 16 mm Hg lower than on the last placebo day. while HR was unchanged. The next administration of felodipine was followed by a smaller drop in BP (MBP – 15 $$ 7 mm Hg; NS vs. placebo), while reflex tachycardia was the same as after acute felodipine (HR 13 $$ 8 beats/min; p < 0.05 vs. placebo. NS vs. acute administration). Plasma noradrenaline concentration increased after both acute and chronic administration (p < 0.0001), and preadministration values were highest on day 7 (p < 0.05). Neutrophil β-adrenergic receptor density and affinity did not change either acutely or chronically. This study gives both indirect and direct evidence that β-adrenoceptor down-regulation does not occur during repeated felodipine administration in hypertension. Reflex tachycardia is not abolished, but is reset to lower BP levels

With the brain electrical activity mapping. we started to create typical patterns of potentials distributions on the scalp during various neurootological experiments. We are applying this technique for spatiotemporal analysis of cerebral evoked potentials due to vestibular stimulation. We obtain the vestibular evoked potentials (VbEP) using for the stimulation, the rotatory chair. We control it, with an external computer. that by means of an interactive program builds different sort of stimuli varying each one of the stimulus components. The electrodes are distributed on the scalp in agreement with the international system 10/20. We recognize with security, 4 positive-negative waves in a period among 70 to 490 ms. We designate the waves N1, N2, P2, N3 and N4. Vestibular evoked potentials is a newly developed tool, which we also can utilize for differentiating central and peripheral vestibular diseases.

The high risk of recurrence and comorbidity after a stroke associated with atrial fibrillation (AF) justifies an aggressive diagnostic approach so that anticoagulant treatment can be initiated.