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Transvenous pacing is nowadays the cornerstone of interventional management of bradyarrhythmias. It is still associated, however, with significant complications, mostly related to indwelling transvenous leads or device pocket. In order to reduce these complications, leadless pacemakers have been recently introduced into clinical practice, but no guidelines are yet available to indicate who are those patients that might benefit the most and whether leadless pacing should be preferred in the old or young population. This survey aims to describe the use of leadless pacemaker devices in a real-world setting.Eleven arrhythmia centers in the Lombardy region (out of a total of 17 participating centers) responded to the proposed questionnaire regarding patient characteristics and indications to leadless pacing.Out of a total of 411 patients undergoing leadless pacing during 4.2 ± 0.98 years, the median age was 77 years, with 0.18% of patients having less than 18 years, 29.9% 18-65 years, 34.3% 65-80 years and 35.6%80 years. The most common indication was slow atrial fibrillation (49% of patients), followed by atrioventricular block and sinoatrial dysfunction. Two centers reported in-hospital complications.Leadless pacemakers proved to be a safe pacing strategy actually destined mostly to elderly patients.

In an environmental background characterized by climate change, the seasonal trend increasingly affects the qualitative and quantitative expression of the vineyards. The sugar concentration, titratable acidity, the ratio sugar/acids and yield were related with heat accumulation (growing degree days accumulation), calculated in different period of grapevine cycle. The 21.5 °Babo threshold has been reached by Montepulciano grapes in the various years (2007-2019) even with 40 days difference. Over a period of 13 years, the sugar of Montepulciano grapes was influenced by thermal evolution between March to July. The relationship with high coefficient determination (R2 0.74) was obtained between heat accumulation and titratable acidity. According to this forecasting model, increases in heat accumulation of 100 degree-days in the period from March to June correspond to a reduction of about 0.85 g/l of acidity of the must at the harvest associated with an increase of 0.75 degree-days in the ratio between sugars and acids. The thermal evolution between June and July was correlated with yield of Montepulciano, an increase of 100 degree-days is associated with a decrease of about 1.86 t/ha. The thermal evolution between March and July is crucial for yield and grape quality of Montepulciano.

The chaotic growth of the Internet of Things (IoT) determined a fragmented landscape with a huge number of devices, technologies and platforms available on the market, and the consequential issues of interoperability on many system deployments. The Web of Things (WoT) architecture recently proposed by the W3C consortium constitutes a novel solution to enable interoperability across IoT platforms and application domains. At the same time, in order to see an effective improvement, a wide adoption of the W3C WoT solutions from the academic and industrial communities is required; this translates into the need of well-defined and complete support tools easing the deployment of W3C WoT applications. In this paper, we meet such requirement by proposing the WoT Store , a novel platform for managing and easing the deployment of Things and applications on the W3C WoT. The WoT Store allows the dynamic discovery of the resources available in the environment, i.e. the Things, and to interact with each of them through a dashboard, by visualizing their properties, executing commands or observing the notifications produced. In addition, similar to popular app stores, the WoT Store allows the search and execution of third-party WoT applications that interact with the available Things again in a seamless way. We validate the operations of our framework with two evaluation studies. First, through a small-case testbed, we demonstrate the Thing discovery and the possibility to run WoT applications that orchestrate the operations of multiple, heterogeneous Wireless Sensor Networks (WSNs). Second, through a mixed real/simulated large-scale crowdsensing scenario, we demonstrate the scalability of the platform, and the possibility to aggregate and visualize the data-streams produced by the WoT applications with minimal efforts for the users.

Part 1: The Internet of Things and WLANs; International audience; In Industry 4.0 scenarios, novel applications are enabled by the capability to gather large amount of data from pervasive sensors and to process them in order to devise the “digital twin” of a physical equipment. The heterogeneity of hardware sensors, communication protocols and data formats constitutes one of the main challenge toward the large-scale adoption of the Internet of Things (IoT) paradigm on industrial environments. To this purpose, the W3C Web of Things (WoT) group is working on the definition of some reference standards intended to describe in a uniform way the software interfaces of IoT devices and services, and hence to achieve the full interoperability among different IoT components regardless of their implementation. At the same time, due also to the recent appearance of the WoT W3C draft, few testbed and real-world deployments of the W3C WoT architecture has been proposed so far in the literature. In this paper, we attempt to fill such gap by describing the realization of a WoT monitoring application of a generic indoor production site: the system is able to orchestrate the sensing operations from three heterogeneous Wireless Sensor Networks (WSNs). We describe how the components of the W3C WoT architecture have been instantiated in our scenario. Moreover, we demonstrate the possibility to decouple the mash-up policies from the network functionalities, and we evaluate the overhead introduced by the WoT approach.

Notas: Artículo pegado a una hoja en blanco donde está apuntado a mano el nombre del periódico. 3 fotos del artículo sobre papel fotográfico acompañan el documento., Tipo de publicación: Periódico, Título de la publicación: Gazzetta del Popolo, Periodicidad: Diario

Background: In patients with an ischemic cardiomyopathy (ICM), the combination of late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility is known to be the desirable end point for a successful long-term outcome after VT ablation. We investigated whether LP abolition and VT noninducibilty have a similar impact on the outcomes of patients with non-ICMs (NICM) undergoing VT ablation. Methods: A total of 403 patients with NICM (523 procedures) who underwent a VT ablation from 2010 to 2016 were included. The procedure end points were the LP abolition (if the LPs were absent, other ablation strategies were undertaken) and the VT noninducibilty. Results: The underlying structural heart disease consisted of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular dysplasia (ARVD, 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). The epicardial access was performed in 57% of the patients. At baseline, the LPs were present in 60% of the patients and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure, the LP abolition was achieved in 79% of the cases and VT noninducibility in 80%. After a multivariable analysis, the combination of LP abolition and VT noninducibilty was independently associated with free survival from VT (hazard ratio, 0.45 [95% CI, 0.29–0.69], P =0.0002) and cardiac death (hazard ratio, 0.38 [95% CI, 0.18–0.74], P =0.005). The benefit of the LP abolition on preventing the VT recurrence in patients with ARVD and postmyocarditis appeared superior to that observed for those with DCM. Conclusions: In patients with NICM undergoing VT ablation, the strategy of LP abolition and VT noninducibilty were associated with better outcomes in terms of long-term VT recurrences and cardiac survival. Graphic Abstract: A graphic abstract is available for this article.

Limited data are currently available regarding the course of COVID-19 in lung and solid organ transplant recipients. We hereby present four cases of SARS-CoV-2 pneumonia in lung transplant recipients from our center, set in Milan, Italy. We reduced immunosuppressive regimen in all these patients, typically holding the antiproliferative agent and augmenting steroids; everybody received hydroxychloroquine, initial empiric antibiotic treatment with piperacillin/tazobactam, and high-dose low molecular weight heparin. Clinical course seemed favorable in three of our patients, but one of them deteriorated after 10 days of hospitalization, probably due to an acute form of graft dysfunction triggered both by COVID-19 and a nosocomial bacterial infection, and eventually died. Although short-term prognosis could be considered benign in the majority of our patients, we should carefully monitor these individuals in order to detect early sign of clinical deterioration and graft dysfunction in the next few months.

The lifting, peeling and exfoliation of physisorbed ribbons (or flakes) of 2D material such as graphene off a solid surface are common and important manoeuvres in nanoscience. The feature that makes this case peculiar is the structural lubricity generally realized by stiff 2D material contacts. We model theoretically the mechanical peeling of a nanoribbon of graphene as realized by the tip-forced lifting of one of its extremes off a flat crystal surface. The evolution of shape, energy, local curvature and body advancement are ideally expected to follow a succession of regimes: (A) initial prying, (B) peeling with stretching but without sliding (stripping), (C) peeling with sliding, (D) liftoff. In the case where in addition the substrate surface corrugation is small or negligible, then (B) disappears, and we find that the (A)-(C) transition becomes universal, analytical and sharp, determined by the interplay between bending rigidity and adsorption energy. This general two-stage peeling transition is identified as a sharp crossover in published data of graphene nanoribbons pulled off an atomic-scale Au(111) substrate., 10 pages, 5 figures

Cardiac laminopathies, associated with mutations in the LMNA gene, encompass a wide spectrum of clinical manifestations, involving electrical and mechanical alterations of cardiomyocytes. Thus, dilated cardiomyopathy, bradyarrhythmias and atrial or ventricular tachyarrhythmias may occur in a number of combined phenotypes. Nowadays, some attempt has been made to identify clinical predictors for the most life-threatening complications of LMNA-associated heart disease, i.e. sudden cardiac death and end-stage heart failure. The goal of this manuscript is to combine the most recent evidences in an updated review to show the state-of-the-art of such a complex disease group. This is supposed to be the starting point to collect more data and design new ad hoc studies to identify clinically useful predictors to stratify risk in mutation carriers, including probands and their asymptomatic relatives.

Background: In many genetic and acquired non-ischaemic cardiomyopathies (NICM) there have been frequent reports of involvement of the interventricular septum (IVS) by late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR). However, no studies have investigated the relationship between septal LGE and arrhythmias in different NICM subtypes. Methods: This study enrolled 103 patients with septal LGE at baseline CMR and different NICM: hypertrophic (n=29) or lamin A/C gene (LMNA)-associated (n=23) cardiomyopathy, and acute (n=30) or previous (n=21) myocarditis. During follow-up, the occurrences of malignant ventricular arrhythmias (MVA) and major bradyarrhythmias (BA) were evaluated. Results: At 4.9±0.7 years of follow-up, the occurrence of MVA and major BA in genetic vs acquired NICM were 10 of 52 vs 12 of 51, and 10 of 52 vs 4 of 51, respectively (both p=n.s.). However, MVA occurred more frequently in LMNA-NICM (eight of 23 vs two of 29 hypertrophic, p=0.015) and in previous myocarditis (nine of 21 vs three of 30 acute, p=0.016), while major BAs were particularly common in LMNA-NICM patients only (nine of 23 vs one of 29 hypertrophic, p=0.003). Different patterns of septal LGE were consistently retrospectively identified at baseline CMR: junctional and limited to the base in 79.3% of uneventful hypertrophic NICM; extended and focally transmural in LMNA-NICM with follow-up arrhythmias (both p

The aim of this study was to characterize, during sinus rhythm, the electric activation abnormalities in post-myocardial infarction patients undergoing ablation of ventricular tachycardia (VT) in order to identify specific signatures of those abnormal electrograms (EGMs).In the setting of VT ablation, substrate characterization hinges on the identification of local abnormal ventricular activity (LAVA) and late potentials (LPs) that are considered to be related to the VT circuit.Patients scheduled for VT ablation underwent high-density ventricular substrate mapping. The substrate map during sinus rhythm was then compared with the activation maps of the clinical VT. Abnormal EGMs (LAVA and LPs) during sinus rhythm were characterized according to their configuration, duration, and amplitude and distinguished as belonging to bystander region or to the re-entrant circuit. Underlying electrophysiological mechanisms (wave-front collision, slow conduction) were identified on the activation maps and assigned to corresponding EGMs.Ten patients satisfied the criteria to be enrolled in the study. A mean of 5 ± 1 slow-conduction areas and 4 ± 2 wave-front collisions were identified. LAVA was due to slow conduction in 60.5%, followed by wave-front collision (17.5%). LPs were caused by slow conduction in 52% of cases and by wave-front collision in 43% of cases. During sinus rhythm, entrance and exit sites were characterized by LAVA, while at the VT isthmus, only LPs were identified. Cutoff values of duration 24.5 ms (95% sensitivity and 99% specificity) and amplitude 0.14 mV (90% sensitivity and 48.1% specificity) discriminated those LPs belonging to the circuit from those playing a bystander role.In the setting of post-myocardial infarction cardiomyopathy, specific EGM signatures are expressions of distinct electrophysiological phenomena. LAVA and LPs may play a bystander or an active role in the VT circuit, but only LPs with low amplitude and short duration predicted the VT isthmus.

Background Ventricular tachycardias (VT) may occur late after myocarditis, as well as in the acute inflammatory phase of the disease. However, the role of catheter ablation (CA) in preventing VT recurrences in patients with acute (AM) vs. previous myocarditis (PM) has never been investigated so far. Purpose To evaluate the results of CA performed in patients presenting with VA and biopsy-proved myocarditis at different inflammatory stages. Methods We enrolled 46 consecutive patients (74% males, mean age 43±12y, mean LVEF 46±9%) with myocarditis and VT at index hospitalization. Based on endomyocardial biopsy and cardiac magnetic resonance (CMR) results, the patients were divided into AM and PM groups: in AM group, myocarditis was biopsy-proved, according to the ESC criteria; PM patients had a history of biopsy-proved myocarditis more than 12 months before, with no current signs of active inflammation (negative biopsy according to the ESC criteria; nonischaemic LGE at CMR with negative Lake-Louise criteria; absence of unexplained troponin abnormalities). ICD were implanted upon clinical indications. All of the patients underwent electroanatomical mapping (EAM) and VT CA. During 3 (2.5–3.5)y FU, VT recurrences were evaluated by 2/y Holter ECG and ICD interrogation. Results At baseline, 23 patients (50%) had AM, and 23 PM. Overall, 16 AM and 21 PM patients underwent ICD implant (p=n.s.). The clinical VT was monomorphic in 22 AM and 23 PM patients, respectively (p=n.s.) with a dominant right-bundle branch block with superior axis (RS) morphology in both groups (16 AM vs. 17 PM cases, p=n.s.). However, RS morphology was associated with left ventricular inferoposterior LGE at CMR in 9/16 AM vs. 17/17 PM patients (p=0.003). Similarly, inferoposterior localization of low-voltage areas at EAM was found in 11/16 AM vs. 17/17 PM patients (p=0.018). Furthermore, CMR showed a greater LGE transmural extension in AM patients (65±19%) as compared to PM ones (40±25%, p Conclusion In myocarditis patients presenting with VT, CA results are significantly better in PM cases as compared to AM ones. These findings are consistent with the different underlying substrate, and suggest the best role for ablation strategy after myocarditis healing. Acknowledgement/Funding None

Metal-surface physisorbed graphene nanoribbons (GNRs) constitute mobile nanocontacts whose interest is simultaneously mechanical, electronic, and tribological. Previous work showed that GNRs adsorbed on Au(111) generally slide smoothly and superlubrically owing to the incommensurability of their structures. We address here the nanomechanics of detachment, as realized when one end is picked up and lifted by an AFM cantilever. AFM nanomanipulations and molecular-dynamics (MD) simulations identify two successive regimes, characterized by (i) a progressively increasing local bending, accompanied by the smooth sliding of the adhered part, followed by (ii) a stick-slip dynamics involving sudden bending relaxation associated with intermittent jumps of the remaining adhered GNR segment and tail end. AFM measurements of the vertical force exhibit oscillations which, compared with MD simulations, can be associated with the successive detachment of individual GNR unit cells of length 0.42 nm. Extra modulations within one single period are caused by steplike advancements of the still-physisorbed part of the GNR. The sliding of the incommensurate moiré pattern that accompanies the GNR lifting generally yields an additional long-period oscillation: while almost undetectable when the GNR is aligned in the standard "R30" orientation on Au(111), we predict that such feature should become prominent in the alternative rotated "R0" orientation on the same surface, or on a different surface, such as perhaps Ag(111).

The current approach for catheter ablation (CA) of accessory pathways (AP) includes the use of standard catheters under fluoroscopic visualization. We hypothesize that use of contact force (CF) irrigated tip catheters might increase procedural safety in pediatric patients compared to standard irrigated tip catheters, by decreasing the number of radiofrequency (RF) pulses required to obtain AP elimination. Seventy-one pediatric patients (13.7 ± 2.5 years, 45 male) with ventricular pre-excitation were enrolled in the study. CA was performed with a standard irrigated tip catheter up to June 2013 in 41 patients (Group S) and with a CF sensing irrigated tip catheter later on in 30 patients (Group CF). In the Group CF, RF was applied with a minimal CF of 5 g; CF > 35 g was avoided. Group CF procedures required less fluoroscopy (6.8 ± 4.8 min), compared to Group S (12.2 ± 10.8 min, p = 0.007). The number of RF pulses was smaller in Group CF compared to Group S (2.5 ± 2.0 vs 5.5 ± 1.9, p

Objectives This study sought to investigate the incidence of phrenic nerve (PN) limitation and the utility of displacing the PN with a balloon. Background The PN can limit the epicardial ablation of ventricular tachycardia (VT). Methods From 2010 to 2017, 363 patients undergoing VT epicardial ablation at a single center were studied. Before the ablation, we used high output (20-mA) pacing maneuvers to verify the course of the PN. When we observed its capture, we used 1 of 3 different approaches to protect it: 1) non-balloon strategy (nerve-sparing ablation), 2) PN displacement with a small balloon (6 mm × 20 mm), or 3) PN displacement with a large balloon (20 mm × 45 mm). Results PN capture occurred in 25 patients (7%) at the target ablation site. The most common cause was myocarditis (12 patients [48%]), and the incidence of the PN limitation was significantly higher in myocarditis than in other causes (19% vs. 4%, respectively; p = 0.0002). PN displacement was attempted in 7 patients by using large balloons and in 6 patients with small balloons, resulting in successful PN displacements and complete late potential (LP) abolition in 6 patients (86%) and 3 patients (50%), respectively. Among the 12 patients in whom the non-balloon strategy was used, only 1 patient (8%) achieved LP abolition (compared with the large balloon group; p = 0.002), whereas 3 patients experienced PN paralysis. Conclusions The PN limited the epicardial ablation in 7% of patients. Because nerve-sparing ablations often resulted in PN injuries, a possible solution could be to displace the PN with a large balloon, leading to a safer procedure and completion of LP abolition.

Background and aims Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques. Methods and methods This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography. Results Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal. Conclusions Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.

INTRODUCTION: Many patients requiring radiotherapy for malignancies have an already implanted cardiac rhythm device. Previous studies reported a variety of device dysfunctions related to high dose radiation. Aim of this study was to assess the impact of current optimal radiotherapy treatment guided by computed tomography on current generation implantable devices. METHODS: Consecutive patients with implanted pacemakers (PMK) and implantable cardioverter defibrillators (ICD) referred for radiotherapy treatment in any district were enrolled at our Centre and followed prospectively with device interrogation before and just after each radiotherapy cycle. A magnet was positioned on the device in patients with implanted defibrillators or pacemaker-dependency. RESULTS: Overall, 48 patients (74.8 years (9.3), 39 males (81.3)) with implantable devices underwent radiotherapy (29 pacemakers and 19 ICDs). Interval between device implant and start of radiation therapy was 2.9 (1.6) years. Radiotherapy was performed under computed tomography guidance, and a mean of 73.5 (45.0) Gy were administered with a mean of 24.8 (14.6) fractionated doses. About half of the patients underwent thoracic radiotherapy, and 9 were treated for a left thoracic malignancy ipsilateral to the implanted device. No device failures were observed at post-treatment device interrogation, nor changes in electrical parameters, inappropriate shocks, device reprogramming or memory reset. None of the patients experienced premature battery failure or other unexpected anomalous findings at the end of the radiation therapy cycle. CONCLUSION: Radiation therapy for malignancies is safe among patients with implanted current generation cardiac rhythm devices.

Graphene nanoribbons (GNRs) physisorbed on a Au(111) surface can be picked up, lifted at one end, and made to slide by means of the tip of an atomic-force microscope. The dynamic transition from smooth sliding to multiple stick-slip regimes, the pushing/pulling force asymmetry, the presence of pinning, and its origin are real frictional processes in a nutshell, in need of a theoretical description. To this purpose, we conduct classical simulations of frictional manipulations of a 30 nm-long GNR, one end of which is pushed or pulled horizontally while held at different heights above the Au surface. These simulations allow us to clarify theoretically the emergence of stick-slip originating from the short 1D edges rather than the 2D "bulk", the role of adhesion, of lifting, and of graphene bending elasticity in determining the GNR sliding friction. The understanding obtained in this simple context is of additional value for more general cases.

Background Mutations in the LMNA (lamin A/C) gene have been associated with neuromuscular and cardiac manifestations, but the clinical implications of these signs are not well understood. Objective To learn more about the natural history of LMNA-related disease. Design Observational study. Setting 13 clinical centers in Italy from 2000 through 2018. Patients 164 carriers of an LMNA mutation. Measurements Detailed cardiologic and neurologic evaluation at study enrollment and for a median of 10 years of follow-up. Results The median age at enrollment was 38 years, and 51% of participants were female. Neuromuscular manifestations preceded cardiac signs by a median of 11 years, but by the end of follow-up, 90% of the patients had electrical heart disease followed by structural heart disease. Overall, 10 patients (6%) died, 14 (9%) received a heart transplant, and 32 (20%) had malignant ventricular arrhythmias. Fifteen patients had gait loss, and 6 had respiratory failure. Atrial fibrillation and second- and third-degree atrioventricular block were observed, respectively, in 56% and 51% of patients with combined cardiac and neuromuscular manifestations and 37% and 33% of those with heart disease only. Limitations Some of the data were collected retrospectively. Neuromuscular manifestations were more frequent in this analysis than in previous studies. Conclusion Many patients with an LMNA mutation have neurologic symptoms by their 30s and develop progressive cardiac manifestations during the next decade. A substantial proportion of these patients will have life-threatening neurologic or cardiologic conditions. Primary funding source None.

AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation (AF) in chronic heart failure (CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers (BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB. RESULTS A total of 903 patients were evaluated (mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms (New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia (23% vs 37%), coronary artery disease (28% vs 52%) and left bundle branch block (9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology (50% vs 24%), a history of valve surgery (13% vs 4%) and received overall more devices implantation (31% vs 21%). The use of disease-modifying medications (i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF (72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics (87% vs 69%) and digoxin (51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm (SR) (45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of all-cause mortality, the univariate relationship between AF and death (HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant (HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy. CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.

©2012 Wiley Periodicals, Inc. Heart failure (HF) is a leading cause of morbidity and mortality. The detection of patients at high risk for death is a major challenge in HF management. The authors compared the prognostic value of 23 clinical Doppler echocardiography and cardiopulmonary exercise indexes in a stable, moderately symptomatic, systolic HF outpatient population receiving optimal medical therapy. The end point was the incidence of overall mortality. Between January 2002 and December 2008, a total of 146 patients with left ventricular (LV) ejection fraction 0.31±0.8 and New York Heart Association functional class II or III were enrolled. The prognostic power of single variables was assessed using chi-square test for categoric variables and t test for continuous variables. Variables associated with the prespecified end point were included as predictors in a binary logistic regression multivariate model. At multivariate analysis, “restrictive” LV filling pattern (P=.004), ischemic etiology (P=.022), pulmonary artery systolic pressure (PASP) ≥50 mm Hg (P=.027), and peak oxygen uptake (VO2)

Background Heart failure is one of the main causes of hospitalization in Italy. In some industrialized countries since the second half of 1990s a halt in the grow rate of hospitalization for this pathology has been observed, and in some cases a reversal. The aim of this study was to evaluate the trend of hospitalization for heart failure in Italy in the years 2001, 2002 and 2003. Materials and methods National hospital discharge data for years 2001, 2002 and 2003 were analysed. Results Heart failure hospitalization increased from 193 042 in 2001 to 205 043 in 2002 (+6.2%) and to 211 183 in 2003 (+3% with respect to 2002). In 2003 heart failure was the primary medical cause of hospitalization (1.6%). Hospitalization for heart failure accounted in 2003 for 2% of global hospitalization costs. Conclusions Heart failure is the primary cause of hospitalization in Italy and the rate of hospital admission from 2001 to 2003 continued to increase, as well as related costs. These data indicate the urgent need for implementation of new models for the management of heart failure, based on a healthcare network, including hospital, ambulatory and home care, potentially capable of ameliorating both quality of life and costs of assistance.

We address the atomistic nature of the longitudinal static friction against sliding of graphene nanoribbons (GNRs) deposited on gold, a system whose structural and mechanical properties have been recently the subject of intense experimental investigation. By means of numerical simulations and modeling we show that the GNR interior is structurally lubric ('superlubric') so that the static friction is dominated by the front/tail regions of the GNR, where the residual uncompensated lateral forces arising from the interaction with the underneath gold surface opposes the free sliding. As a result of this edge pinning the static friction does not grow with the GNR length, but oscillates around a fairly constant mean value. These friction oscillations are explained in terms of the GNRAu( 111) lattice mismatch: at certain GNR lengths close to an integer number of the beat (or moiré) length there is good force compensation and superlubric sliding; whereas close to half odd-integer periods there is significant pinning of the edge with larger friction. These results make qualitative contact with recent state-of-the-art atomic force microscopy experiment, as well as with the sliding of other different incommensurate systems.

Heart failure (HF) is a leading cause of morbidity and mortality. The detection of patients at high risk for death is a major challenge in HF management. The authors compared the prognostic value of 23 clinical Doppler echocardiography and cardiopulmonary exercise indexes in a stable, moderately symptomatic, systolic HF outpatient population receiving optimal medical therapy. The end point was the incidence of overall mortality. Between January 2002 and December 2008, a total of 146 patients with left ventricular (LV) ejection fraction 0.31±0.8 and New York Heart Association functional class II or III were enrolled. The prognostic power of single variables was assessed using chi-square test for categoric variables and t test for continuous variables. Variables associated with the prespecified end point were included as predictors in a binary logistic regression multivariate model. At multivariate analysis, "restrictive" LV filling pattern (P=.004), ischemic etiology (P=.022), pulmonary artery systolic pressure (PASP) ≥50 mm Hg (P=.027), and peak oxygen uptake (VO(2) )15.9 mL/kg/min (P=.046) resulted independent predictors of the outcome. A simple risk score was then obtained using these significant independent variables, excluding peak VO(2) because of only borderline significance. Patients with ischemic etiology, restrictive LV filling pattern, and PASP ≥50 mm Hg have a very high risk of death (odds ratio, 33.77; 95% confidence interval, 5.74-198.8; P.001, compared with patients with no risk factors). In this high-risk group, evaluation of peak VO(2) could be superfluous. A very simple clinical echocardiographic model based on etiology-LV filling and pulmonary pressure is a powerful tool for risk stratification of systolic HF in ambulatory patients.

We describe the effects of spin–orbit (SO) coupling on the collective properties of a two-dimensional (2D) ultracold Fermi gas with Rashba and Dresselhaus SO couplings of equal strength. We first analyse the thermodynamics of the Fermi gas in the absence of repulsive interaction between the atoms (non-interacting system) showing that SO coupling determines one or more second-order phase transitions in the equation of state of the system; we subsequently suggest an experimental strategy that can make these transitions visible. We then study the interacting system using Feynman's path integral formulation. The aim of this analysis is to describe the collective properties of the system in the paramagnetic phase and in weak non-equilibrium conditions. Particular emphasis is given to the numerical analysis of the collective modes of the system, in particular to the zero sound mode and to the spin modes.

INTRODUCTION Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple re-entering wavelets, high frequency activity, and rotor sources. EVIDENCE ACQUISITION This narrative review was based on papers found on PubMed and MEDLINE up to May 2016. The search terms were "atrial fibrillation" in combination with "catheter ablation, pathophysiology, antiarrhythmic drugs". EVIDENCE SYNTHESIS Antiarrhythmic drugs are the cornerstone of therapy in AF, but their efficacy and safety might have to be improved. In case of failure of pharmacologic therapies, other treatments can be considered. A better understanding of the important role of the pulmonary veins has led to new approaches, such as ablation procedures, which were initially only surgical, while percutaneous options were later added. However, these strategies may present various technical complications also when performed by skilled operators. A promising field of investigation is the genetics of AF, as highlighted by studies on the role of micro-RNA. CONCLUSIONS Relevant improvement on the knowledge of the electrophysiological basis of genesis and maintenance of AF has been done in order to treat a very common arrhythmia, but further studies, as those in the genetics field, can open new challenging therapeutic horizons.

Modeling ferroelectric materials from first principles is one of the successes of density-functional theory, and the driver of much development effort, requiring an accurate description of the electronic processes and the thermodynamic equilibrium that drive the spontaneous symmetry breaking and the emergence of macroscopic polarization. We demonstrate the development and application of an integrated machine learning model that describes on the same footing structural, energetic and functional properties of barium titanate ($\text{BaTiO}_3$), a prototypical ferroelectric. The model uses ab initio calculations as reference and achieves accurate yet inexpensive predictions of energy and polarization on time and length scales that are not accessible to direct ab initio modeling. These predictions allow us to assess the microscopic mechanism of the ferroelectric transition. The presence of an order-disorder transition for the Ti off-centered states is the main driver of the ferroelectric transition, even though the coupling between symmetry breaking and cell distortions determines the presence of intermediate, partly-ordered phases. Moreover, we thoroughly probe the static and dynamical behavior of $\text{BaTiO}_3$ across its phase diagram, without the need to introduce a coarse-grained description of the ferroelectric transition. Finally, we apply the polarization model to calculate dielectric response properties of the material in a fully ab initio manner, again reproducing the correct qualitative experimental behaviour., 26 pages, 14 figures