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This paper aims at collating and reviewing all data collected using the ESCA (Ecological Status of Coralligenous Assemblages) index from 2009 to 2018 during different local applications, in order to evaluate at large spatial scale its effectiveness and temporal variability. To this scope, the large-scale response of ESCA to anthropogenic disturbance was tested comparing ESCA values calculated at 42 sites of the Western Mediterranean Sea with the anthropization index. Moreover, the sensitivity of ESCA to punctual human disturbance and the robustness of the index across the natural space and time variability were evaluated. The large spatial scale study showed significant correlation between ESCA and the anthropization index, while very low correlation was detected when descriptors of ESCA (i.e., sensitivity levels, α-diversity, and β-diversity) were considered separately. The three impact evaluation studies highlighted significantly lower values of the ESCA index in disturbed conditions than in the control ones. The coastal monitoring study confirmed the robustness of the index which showed a high ecological quality of coralligenous reefs in reference conditions compared to more anthropized sites, and this pattern was maintained throughout the ten years study period. Application of the ESCA index to different situations tested positively its sensibility to different levels and type of human disturbance and its stability with respect to regional spatio-temporal variability. This confirm the reliability of the ESCA index already tested on the local and annual scale, thus broadening its range of application and validating it on a wider space–time scale.

Competing Interests: The authors declare no conflict of interest.

Objective: To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective., Materials and Methods: After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups according to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables., Results: According to the variability of two parameters, Stroke Volume Variation and Pulse Pressure Variation, patients were classified as stable or unstable. Unstable patients showed a significant alteration in several hemodynamic indices, in comparison to stable ones. According to the intraoperative monitoring, eight high risk patients could have been sent to an ordinary ward due to their stability, with a reduction in the improper use of CSDU and, consequently, in costs., Conclusions: Hemodynamic monitoring with PRAM can be useful in these patients, both for intraoperative management and for the choice of the more appropriate postoperative setting, possibly reducing the improper use of CSDU for hemodynamically stable patients who are judged to be at high risk preoperatively, and re-evaluating low surgical risk patients with an unstable intraoperative pattern, with a possible reduction in costs., (Copyright © 2024 Giacomelli et et al. This article is available under a Creative Commons License.)

Competing Interests: One of the authors has received research or educational grants from Abbott, Amgen, Asahi Inteec., AstraZeneca, Boston Scientific, Cardinal Health, CSL Behring, Chiesi, Daiichi Sankyo, Edwards, Medtronic, Menarini, Pfizer, Sanofi, Shockwave, Teleflex and Volcano/Philips; another author reports receiving speaker and consultation fees from Medtronic, Edwards and Boston Scientific. The other authors have no conflict of interest to declare.

Introduction: In 2020, the SARS-CoV-2 pandemic outbreak required restrictive measures to limit the spread of the virus. This study aimed to assess how changes in dietary habits and lifestyle associated with such measures have affected the characteristics of patients with acute coronary syndromes (ACS) in the post-lockdown period. In particular, we evaluated if the incidence of ACS was higher in younger patients, who were more negatively affected by lockdown measures., Methods: We analysed 609 ACS patients and compared the clinical, laboratory, and angiographic characteristics of those admitted six months before lockdown (n = 312) and those admitted in the same six-month period after lockdown. Moreover, we compared several anthropometric and laboratory data between pre- and post-lockdown in younger (≤55 years old) and older patients., Results: The incidence of ACS in young adults (≤55 years) was significantly higher in the post- vs. pre-lockdown period (17.5% vs. 10.9%, p = 0.019). A trend to a higher percentage of ST-elevation myocardial infarction (STEMI) was observed in the post-lockdown period together with a significantly lower incidence of non-STEMI (p = 0.033). Moreover, in the post-lockdown period, we observed in younger patients a significant increase in weight, body mass index, admission glycaemia, and triglycerides while in older patients, these parameters were significantly reduced., Conclusion: The lockdown may have negatively affected cardiovascular risk, thus increasing the incidence of ACS, particularly in younger patients who probably underwent more relevant lifestyle changes, with several consequent anthropometric and metabolic alterations. Such evidence should be considered to take preventive measures in case a new state of emergency occurs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Capobianco et al.)

Despite significant advances in understanding and outcomes in various domains of cardiology, the prognosis of infective endocarditis (IE) remains dismal. One of the main reasons may rely on an even more intricate diagnosis since epidemiology has shifted towards an aggressive infection, typically in older patients with the involvement of prosthetic valves and cardiovascular implantable electronic devices with earlier clinical presentation. In this novel setting, it is critical to avoid a delay in diagnosis that may delay subsequent adequate treatment, further complications, and ultimately poor clinical outcomes. Accordingly, based on the available data, we will examine the proper use of first-line echocardiography representing the first-line imaging method in patients with clinical suspicion of IE. We will focus on the following three crucial questions: (1) What is the threshold to start the echocardiographic diagnostic workup in stable patients? (2) Has infective endocarditis become a time-dependent diagnosis, even in stable patients? (3) What is the appropriate use of echocardiography in unstable patients? Finally, we propose a new mindset to improve the echocardiographic diagnostic workflow., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 The Author(s). Published by IMR Press.)

Intravenous drug use is a predisposing condition for infective endocarditis (IE). We report the clinical features of IE, taken from the Italian Registry of IE, in people who inject drugs (PWIDs). The registry prospectively collected epidemiological, clinical, in-hospital, and follow-up data on patients with IE from 17 Italian centers. A total of 677 patients were enrolled, and 61 (9%) were intravenous drug users (IDUs). Most PWIDs were male (78.6%), and aged between 41 and 50 years old (50%). The most frequent comorbidities were HIV (34.4%) and chronic liver disease (32%). Predisposing factors for IE were present in 6.5% of the patients, and 10% had minor valvular abnormalities. IE had occurred previously in 16.4% of the patients, and 50% of them had undergone heart surgery. Overall mortality was 9.8% in IDUs and 20% in patients with recurrent IE. IE in PWIDs mostly affected the native valves (90%). The echocardiographic diagnosis of IE was based on the detection of vegetation in 91.82% of cases. Staphylococcus aureus was the main microorganism isolated (70%) from blood cultures. Thirty patients (49%) underwent heart surgery: thirteen had aortic valves, eleven had mitral valves, and six had tricuspid valve interventions. IE in PWIDs was relatively common, and patients with native valve right-sided IE had a better prognosis, with a low rate of surgical interventions.

Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old., (Published on behalf of the European Society of Cardiology. © The Author(s) 2020.)

Objective: The SYNTAX trial was designed to evaluate whether multivessel disease patients could benefit from percutaneous or surgical revascularization using a paclitaxel eluting stents, but after the introduction of second generation stents, this score needs to be reevaluated. The aim of our study was to analyze the association between SYNTAX score and the prognosis of multivessel patients submitted to percutaneous coronary intervention (PCI) and second generation everolimus eluting stents (EES) implantation., Materials and Methods: Data on 289 patients with multivessel coronary artery disease submitted to PCI with EES were stored in a dedicated database and retrospectively analyzed. During a mean follow-up period of 14.4±6.4 months, major adverse cardiac and cerebrovascular events (MACCE) including death from any cause, myocardial infarction, target lesion revascularization (TLR) and stroke, were systematically assessed., Results: The incidence of MACCE at follow-up was 13.1%; death from any cause occurred in 19 patients (6.6%) and myocardial infarction in 9 patients (3.1%). TLR was detected in 2.7% of patients and stroke was observed in 2 patients. The SYNTAX score did not prove to be an independent predictor of overall death at multivariable analysis., Conclusion: At mid-term follow-up, the incidence of MACCE in multivessel disease patients submitted to PCI and EES implantation was low; no significant association was found between SYNTAX score severity and MACCE at follow-up, suggesting that it should be modified after the introduction of EES., (Copyright © 2020 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Background: In spite of the increased use of Trans-catheter Aortic Valve Implantation (TAVI) due to the better patient selection, well-trained operators and improved technology, the choice of the best anesthesia regimen remains an open question. In particular, it remains to be clarified whether deep sedation (DS) in spontaneous breathing or femoral local anesthesia (LA) is best., Objective: This study compared the hemodynamic variations determined by deep sedation (DS) with spontaneous breathing and local femoral anesthesia (LA) in 2 groups of patients submitted to TAVI with two different kinds of anesthesia, using a beat-by-beat pulse contour method (MostCare ®-UP )., Methods: 82 patients with severe aortic stenosis and similar baseline characteristics and indications underwent trans-femoral TAVI: 50 with LA and 32 with DS. All patients were submitted to minimally invasive hemodynamic monitoring. The following parameters were measured: pressure indexes : systolic, diastolic, mean (SysP, DiaP, MAP) and dicrotic (DicP) pressures; flow indexes : cardiac output (CO), stroke volume (SV); ventriculo-arterial coupling indexes (VAC): peripheral arterial elastance (Ea P ), systemic vascular resistance (SVR); cardiovascular system performance : cardiac cycle efficiency (CCE), dP/dt max&#95;rad ., Results: The TAVI procedure was successful in 89% of patients (VARC-2 criteria) with no difference between the 2 groups. Anesthesia induction determined a higher decrease of pressures in DS than in LA (P<0.01) with no differences in CO. The VAC parameters (Ea P , SVR) decreased (P<0.01) in DS with an improvement in CCE (P<0.001); these parameters did not change in LA. The post-TAVI flow and VAC parameters, especially Ea, increased (P<0.05) more significantly in the LA group than in the DS group (P<0.001). Using logistic regression, the occurrence of the post-TAVI aortic regurgitation was correctly associated with the pressure gradient MAP-DicP in 63% of the study population (P=0.033). This association was more effectively detected in the LA group (78%, P=0.011) with a ROC AUC=0.779, than the DS group., Conclusion: The use of the pulse contour method to track the fast-hemodynamic changes during the TAVI procedure proved suitable for the aim. As expected, LA and DS induced different pre-TAVI hemodynamic conditions, which influenced the post-TAVI hemodynamic changes. The hemodynamic conditions induced by LA, enabled the occurrence of post-TAVI aortic regurgitation to be detected more effectively., Competing Interests: S.M. Romano is owner of the PRAM method patent. D. Payen received grant from Vygon Ltd (Ecouen, France) for clinical study and development on PRAM system. Other authors have no conflict of interests to declare., (AJCD Copyright © 2020.)

Introduction: Studies have shown that a hemodynamic-guided therapy improves the post operative outcomes of high-risk patients.This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a post-cardiac surgery step-down unit (SDU), may identify patients at higher risk of 6-month adverse events after cardiac surgery. Methods: From December 2016-May 2017,173 patients were admitted in SDU within 24-48 hours of major cardiac surgery procedure, and submitted to clinical, laboratoristic and echocardiographic evaluation and a 1-hour PRAM recording to obtain a "biohumoral snapshot" of individual patient's.156 173 patients (17 patients were lost at follow-up) were phone interviewed six months after surgery,to evaluate, as a composite end-point, the adverse events during follow-up. A multivariable logistic regression analysis was used to identify a model clinical-biohumoral (CBM) and clinical-biohumoral hemodynamics (CBHM). Results: No data from past clinical history and no conventional risk score (EuroScore II, STS score)independently predicted the risk of 6-month major events in our study. The risk of adverse events at six-month follow-up was directly related, in the CBM, to sustained post-operative cardiac arrhythmias, higher values of NT-proBNP and of arterial pH; inversely related to values of hs-C-reactive protein (hs-CRP) and, in the CBHM, to low values of cardiac cycle efficiency (CCE) and dP/dt max . Conclusion: Our study although limited by its observational nature and by the limited number of patients enrolled, showed that a short period of minimally invasive hemodynamic monitoring increased the accuracy to identify patients at major risk of mid-term events after cardiac surgery., (© 2020 The Author(s).)

3,5-diiodo-L-thyronine (3,5-T2) is an endogenous derivative of thyroid hormone with potential metabolic effects. It has been detected in human blood by immunological methods, but a reliable assay based on mass spectrometry (MS), which is now regarded as the gold standard in clinical chemistry, is not available yet. Therefore, we aimed at developing a novel ad-hoc optimized method to quantitate 3,5-T2 and its isomers by MS in human serum. Serum samples were obtained from 28 healthy subjects. Two ml of serum were deproteinized with acetonitrile and then subjected to an optimized solid phase extraction-based procedure. To lower background noise, the samples were furtherly cleaned by hexane washing and acetonitrile precipitation of residual proteins. 3,5-T2 and its isomers 3,3'-T2 and 3',5'-T2 were then analyzed by HPLC coupled to tandem MS. Accuracy and precision for T2 assay were 88-104% and 95-97%, respectively. Recovery and matrix effect averaged 78% and +8%, respectively. 3,5-T2 was detected in all samples and its concentration averaged (mean ± SEM) 41 ± 5 pg/ml, i.e., 78 ± 9 pmol/l. In the same samples the concentration of 3,3'-T2 averaged 133±15 pg/ml, i.e., 253±29 pmol/l, while 3',5'-T2 was not detected. 3,5-T2 concentration was significantly related to 3,3'-T2 concentration ( r = 0.540, P < 0.01), while no significant correlation was observed with either T3 or T4 in a subset of patients in which these hormones were assayed. In conclusion, our method is able to quantify 3,5-T2 and 3,3'-T2 in human serum. Their concentrations lie in the subnanomolar range, and a significant correlation was detected between these two metabolites in healthy individuals.

Objectives: Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis., Methods: This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases., Results: Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio  = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70)., Conclusions: Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.

Objectives: Minimal access mitral valve surgery (MVS) has already proved to be feasible and effective with low perioperative mortality and excellent long-term outcomes. However, experience in more complex valve diseases such as infective endocarditis (IE) still remains limited. The aim of this retrospective study was to evaluate early and long-term results of minimal access MVS for IE., Methods: Data were entered into a dedicated database. Analysis was performed retrospectively for the 8-year period between January 2007 and April 2015., Results: During the study period, 35 consecutive patients underwent minimal access MVS for IE at our department. Twenty-four had diagnosis of native MV endocarditis (68.6%) and 11 of mitral prosthesis endocarditis (31.4%).Thirty patients underwent early MVS (85.7%), and 5 patients were operated after the completion of antibiotic treatment (14.3%). Seven patients underwent MV repair (20%), 17 patients underwent MV replacement (48.6%), and 11 patients underwent mitral prosthesis replacement (31.4%). Thirty-day mortality was 11.4% (4 patients). No neurological or vascular complications were reported. One patient underwent reoperation for prosthesis IE relapse after 37 days. Overall actuarial survival rate at 1 and 5 years was 83%; freedom from MV reoperation and/or recurrence of IE at 1 and 5 years was 97%., Conclusions: Minimally invasive MVS for IE is feasible and associated with good early and long-term results. Preoperative accurate patient selection and transoesophageal echocardiography evaluation is mandatory for surgical planning., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Concerns about global warming phenomena induced the development of research about the control of anthropogenic greenhouse gases emissions. The current work studies on the scaling up of aqueous mineral carbonation route to reduce the CO 2 emissions at the chimney of industrial emitters. The reactivity of serpentinite in a stirred tank reactor was studied for several partial pressures of CO 2 (pCO 2 ) (0.4, 0.7, 1.3 and 1.6 bar). Prior to carbonation, the feedstock was finely grinded and dehydroxyled at 650 °C by a thermal treatment. The major content of magnetite was removed (7.5 wt% · total weight -1 ). Experiments were carried out under batch mode at room temperature using real cement plant flue gas (14-18 vol% CO 2 ) and open pit drainage water. The effect of the raw water and the pCO 2 on the carbonation efficiency was measured. First, the main results showed a positive effect of the quarry water as a slight enhancement of the Mg leaching in comparison with distilled water. Secondly, a pCO 2 of 1.3 bar was the optimal working pressure which provided the highest efficiency of the carbonation reaction (0.8 gCO 2 · g residue -1 ). Precipitation rates of dissolved CO 2 ranged from 7% to 33%. Pure precipitate was obtained and essentially composed of Nesquehonite. At a pCO 2 of 1.3 bar, additional physical retreatment of the solid material after being contacted with 6 batches of gas enhanced considerably mineral carbonation efficiency (0.17 gCO 2 · g residue -1 .)., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: This study aimed to test the association of both the baseline values and post-procedural variations of urinary and serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C (CysC) with contrast induced nephropathy (CIN) occurrence in patients undergoing percutaneous coronary invasive procedures (PCIP), and compare them to serum creatinine and the estimated glomerular filtration rate (eGFR)., Methods: In 43 patients admitted to our Cardiac Step-Down Unit and submitted to PCIP, we measured serum creatinine and eGFR as the standard markers for CIN diagnosis, and compared them to both serum and urinary NGAL as well as serum CysC, assessed before and 4 hours after PCIP., Results: Patients who developed CIN (16%) were older, with significantly higher discharge creatinine values, lower eGFR values at creatinine peak, and higher baseline and post-PCIP CysC values. We did not detect any significant association between baseline serum and urinary NGAL values and their 4 hour variations after contrast medium administration and CIN occurrence. Furthermore, we observed that the baseline values of both serum and urinary NGAL were significantly higher in patients with greater neutrophil count., Conclusion: In our population submitted to PCIP, neither baseline serum and urinary NGAL nor their variations after PCIP were related to CIN occurrence, while CysC results were associated with CIN development, earlier than creatinine and eGFR variations., (Copyright © 2017 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Background: AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum., Methods: AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up., Results: Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively., Conclusions: IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location., (Copyright © 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.)

Aims: To compare the effects of two thrombus aspiration devices, the manual catheter Export® and the more complex and expensive mechanical Angiojet®, on several indices of reperfusion in acute ST-elevation myocardial infarction (STEMI)., Methods and Results: Clinical, hemodynamic and procedural characteristics of 185 STEMI patients, randomized to treatment with Export (n=95) or Angiojet (n=90) during primary percutaneous coronary intervention (PPCI) were analyzed. The primary endpoint was ST-segment elevation reduction 90 min after culprit vessel re-opening. Secondary endpoints included variations in some angiographic parameters (TIMI Flow, TIMI Frame Count and Myocardial Blush Grade) and Infarct Size and Severity at myocardial scintigraphy. A significant reduction in ST-elevation was observed in both groups after PPCI without significant differences between the two groups. No significant difference between Angiojet vs. Export was observed in ST-segment resolution >50% and ≥ 70%, in TIMI Flow, TIMI Frame Count and Myocardial Blush Grade before vs. after PPCI and in Infarct Size and Severity., Conclusions: PPCI with thrombus aspiration was effective in both groups of patients, without differences in myocardial reperfusion and necrosis indices. These results could support the routine use of manual devices during PPCI, reserving the more expensive Angiojet in case of manual device failure and persistent or massive intracoronary thrombosis, with favorable implications in terms of cost containment., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Mineral carbonation (MC) represents a promising alternative for sequestering CO2. In this work, the CO2 sequestration capacity of the available calcium-bearing materials waste concrete and anorthosite tailings is assessed in gas-solid-liquid and gas-solid routes using 18.2% flue CO2 gas. The objective is to screen for a better potential residue and phase route and as the ultimate purpose to develop a cost-effective process. The results indicate the possibility of removing 66% from inlet CO2 using waste concrete for the aqueous route. However, the results that were obtained with the carbonation of anorthosite were less significant, with 34% as the maximal percentage of CO2 removal. The difference in terms of reactivity could be explained by the accessibility to calcium. In fact, anorthosite presents a framework structure wherein the calcium is trapped, which could slow the calcium dissolution into the aqueous phase compared to the concrete sample, where calcium can more easily leach. In the other part of the study concerning gas-solid carbonation, the results of CO2 removal did not exceed 15%, which is not economically interesting for scaling up the process. The results obtained with waste concrete samples in aqueous phase are interesting. In fact, 34.6% of the introduced CO2 is converted into carbonate after 15 min of contact with the gas without chemical additives and at a relatively low gas pressure. Research on the optimization of the aqueous process using waste concrete should be performed to enhance the reaction rate and to develop a cost-effective process., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Hypocalcemia is frequent in the setting of endocrine disorders, bone diseases and renal failure. When hypocalcemia is severe it can predispose to life-threatening ventricular arrhythmias; in such cases a rapid admission to hospital and a prompt correction of electrolyte imbalance are needed. We report the case of an old patient suffering from renal failure that was admitted to our cardiac step-down unit because of severe hypocalcemia associated with ventricular arrhythmias. Hypocalcemia was promptly treated and an endocrinologic consult was requested for investigating the causes of this electrolyte imbalance. Our experience suggests the creation of a new synergy between cardiologists and endocrinologists that led us to build a simple and schematic algorithm for the diagnosis and treatment of hypocalcemia.

Background: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown., Methods and Results: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality., Conclusions: S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality., (© 2015 American Heart Association, Inc.)

Estetrol (E4) is a natural human estrogen present at high concentrations during pregnancy. Due to its high oral bioavailability and long plasma half-life, E4 is particularly suitable for therapeutic applications. E4 acts as a selective estrogen receptor (ER) modulator, exerting estrogenic actions on the endometrium or the central nervous system, while antagonizing the actions of estradiol in the breast. We tested the effects of E4 on its own or in the presence of 17β-estradiol (E2) on T47-D ER+ breast cancer cell migration and invasion of three-dimensional matrices. E4 administration to T47-D cells weakly stimulated migration and invasion. However, E4 decreased the extent of movement and invasion induced by E2. Breast cancer cell movement requires a remodeling of the actin cytoskeleton. During exposure to E4, a weak, concentration-dependent, re-distribution of actin fibers toward the cell membrane was observed. However, when E4 was added to E2, an inhibition of actin remodeling induced by E2 was seen. Estrogens stimulate ER+ breast cancer cell movement through the ezrin-radixin-moesin family of actin regulatory proteins, inducing actin and cell membrane remodeling. E4 was a weak inducer of moesin phosphorylation on Thr(558), which accounts for its functional activation. In co-treatment with E2, E4 blocked the activation of this actin controller in a concentration-related fashion. These effects were obtained through recruitment of estrogen receptor-α. In conclusion, E4 acted as a weak estrogen on breast cancer cell cytoskeleton remodeling and movement. However, when E2 was present, E4 counteracted the stimulatory actions of E2. This contributes to the emerging hypothesis that E4 may be a naturally occurring ER modulator in the breast.

Background and Purpose: Although several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty., Methods and Subjects: We analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred., Essential Results: Unadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30-0.54] and TLR (HR 0.55; 95%CI 0.36-0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95%CI 0.21-0.67). Second- (n=179) vs. first- (n=337) generation DES showed a further reduction in TLR (HR 0.17; 95%CI 0.05-0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES., Principal Conclusions: DES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting., (Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardiogenic shock complicating non-ST-elevation myocardial infarction. Echocardiographic evaluation showed also a severe degree of both left ventricular dysfunction and mitral regurgitation. The patient was initially stabilized with inotropes and mechanical ventilation was necessary because of concurrent pulmonary edema. The day after, he was submitted to coronary angiography showing bivessel coronary disease. Given the high estimated operative risk, the patient was treated with angioplasty and bare metal stent implantation on both right coronary and circumflex artery; contemporarily, balloon aortic valvuloplasty (BAV) was performed with anterograde technique, obtaining a significant increase in planimetric valve area and reduction in transvalvular peak gradient. Few days after the procedure echocardiogram showed an increase in left ventricular ejection fraction, moderate aortic stenosis with mild regurgitation and moderate mitral regurgitation. Hemodynamic and clinical stabilization were also obtained, allowing amine support discontinuation and weaning from mechanical ventilation. At three months follow-up, the patient reported a further clinical improvement from discharge, and echocardiographic evaluation showed moderate aortic stenosis and an additional increase in left ventricular function and decrease in mitral regurgitation degree. In conclusion, combined BAV and coronary angioplasty were associated in our patient with hemodynamic and clinical stabilization as well as with a significant reduction in transvalvular aortic gradient and mitral regurgitation and an increase in left ventricular ejection fraction both in-hospital and at three month follow-up; this case suggests that these procedures are feasible even in hemodynamically unstable patients and are associated with a significant improvement in quality of life.