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Simplistic models can aid in discovering what is important in the context of normal and pathological behavior. First recognized as a genetic model more than 100 years ago, to date, fruit flies (

L’area archeologica di Noto Antica costituisce un’area di grande interesse dove i resti della città medievale distrutta dal terribile terremoto del 1693 insistono sulle fasi di vita precedenti creando una stratigrafia molto complessa. Nel XVIII secolo numerosi eruditi e storici locali iniziano a occuparsi di Noto, sia della città antica su Monte Alveria che di quella nuova che stava crescendo a pochi chilometri di distanza. La ricerca archeologica ha il via con Paolo Orsi, arrivato a Siracusa nel 1888 grazie alla nomina ministeriale. Tra il 1984 e il 1986 inizia l’esplorazione del sito che porterà alla luce oltre 500 sepolture lungo i costoni rocciosi, il ginnasio e gli heroa ellenistici. È del 1897 la prima e più ampia relazione dedicata interamente a Noto, in cui l’Orsi raccoglie tutto il lavoro svolto sia nelle ricognizioni nel territorio che nelle brevi campagne di scavo. Su questa relazione si baseranno tutte le analisi e le notizie su Noto nel corso del primo Novecento, ma bisognerà attendere più di 70 anni, per assistere a una vera e propria ripresa della ricerca archeologica. Il gruppo di ricerca dell’Università degli Studi di Napoli Federico II inizia lo scavo archeologico a Noto Antica nel 2017 con l’obiettivo di definire le modalità del popolamento antico nel territorio in un arco cronologico che va dalle prime attestazioni sicule fino al periodo romano. I risultati ottenuti sono molto interessanti: la continuità di insediamento nella vallata che giunge fino quasi alla fine del IX sec. d.C., testimonia l’importanza strategica del sito, a controllo della via naturale di comunicazione tra costa e interno.

Dal 1987 l'Università degli Studi di Napoli Federico II conduce scavi sistematici presso l'Heraion presso il fiume Sele, il grande santuario extraurbano situato ai margini della chora settentrionale di Poseidonia/Paestum, scoperto da Paola Zancani Montuoro e Umberto Zanotti Bianco nel 1933. Negli ultimi anni la ricerca del gruppo federiciano si è concentrata sulla Zona C, un'area esterna allo spazio sacro e situata a 530 m a sud/est di quest'ultimo, dove si conservano due edifici monumentali, caratterizzati da orientamento e planimetria diversi. La campagna di scavo del 2021 ha indagato i settori settentrionale e orientale di queste strutture, allo scopo di chiarirne la sequenza stratigrafica e definirne le cronologie.

Iatrogenic superior vena cava syndrome (SVCs) represents an emergent diagnostic entity and its correlation with deep vein thrombosis is extremely rare. Recently, the increased use of indwelling lines, pacemakers and intracardiac devices has led to more cases of SVC syndrome also associated with a higher frequency of DVT. We report an unusual complication in a 74-year-old female, who has been undergoing hemodialysis via CVC for 14 years, who referred at our Emergency Department complaining of shortness of breath, headache, face and neck swelling. She underwent chest Computed Tomography Angiography (CTA), that showed a thrombus extending from the superior vena cava to the azygos and hemiazygos veins. Acute SVCs should be suspected in emergency settings in symptomatic patients with indwelling central lines, catheters and pacemakers. CTA represents an accurate and quick imaging modality for the diagnosis and the assessment of the extension of the thrombus.

Lipomas are the most common form of benign soft tissue tumors in humans, occurring infrequently in visceral organs. Pulmonary lipomas are seen rarely and can occur such as an endobronchial (80%) or peripheral parenchymal (20%) lesion. Less than 10 cases of lung peripheral lipoma are described in literature, none cavitated. We report the clinical case of a 51-year-old emphysematous smoker man with a peripheral intrapulmonary middle-lobe cavitating lipoma, revealed during a routine chest X-ray for emphysema, subsequently confirmed by high-resolution computed tomography (HRCT) and positron emission tomography (PET)–CT. Some hypotheses are made about the origin of cavitation. Biopsy and surgery were not done due to the fully benign nodular features at imaging. The nodule was unchanged till 2 years, last follow-up with low-dose HRCT. It is probably useful to choose a conservative approach with a follow-up, if there is a high suspicion of benignity.

The high morbidity and poor survival rates associated with chronic heart failure still represent a big challenge, despite improvements in treatments and the development of new therapeutic opportunities. The prediction of outcome in heart failure is gradually moving towards a multiparametric approach in order to obtain more accurate models and to tailor the prognostic evaluation to the individual characteristics of a single subject. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was developed 10 years ago from 2715 patients and subsequently validated in a different population. The score allows an accurate evaluation of the risk of heart failure patients using only six variables that include the evaluation of the exercise capacity (peak oxygen uptake and ventilation/CO2 production slope), blood samples (haemoglobin, Na+, Modification of Diet in Renal Disease) and echocardiography (left ventricular ejection fraction). Over the following years, the MECKI score was tested taking into account therapies and specific markers of heart failure, and it proved to be a simple, useful tool for risk stratification and for therapeutic strategies in heart failure patients. The close connection between the centres involved and the continuous updating of the data allow the participating sites to propose substudies on specific subpopulations based on a common dataset and to put together and develop new ideas and perspectives.

Background: In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing. Research question: What is the prognostic power of these different ways to report AT? Study design and methods: In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (< 40%) recruited between 1998 and 2020 and enrolled in the Metabolic Exercise Combined With Cardiac and Kidney Indexes register. All patients underwent a maximum cardiopulmonary exercise test, executed using a ramp protocol on an electronically braked cycle ergometer. Results: This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.O2ATabs (mean ± SD, 823 ± 305 mL/min) and V.O2AT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.O2AT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.O2ATabs (0.680) and V.O2AT%peak_pred (0.688) performed similarly, whereas V.O2AT%peak_obs (0.538) was significantly weaker (P < .001). Moreover, the V.O2AT%peak_pred AUC value was the only one performing as well as the AUC based on peak V.O2 (0.710), with an even a higher AUC (0.637 vs 0.618, respectively) in the group with severe HF (peak V.O2 < 12 mL/min/kg). Finally, the combination of V.O2AT%peak_pred with peak V.O2 and V. per CO2 production shows the highest prognostic power. Interpretation: In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF.

Olive is a widespread crop within Mediterranean area and Italy is one of the biggest producer of olives and oil in the world. From an environmental point of view, centered on carbon (C) sequestration, managing olive orchards sustainably is an urgent and actual issue.This trial was done in a 2-ha olive orchard (Olea europaea L., cv. ‘Maiatica’; 70-year-old plants, with a distance of 8 × 8 m and NE orientation) located in Ferrandina (Southern Italy, Basilicata region; N 40°29’; E 16°28’). The soil is a sandy loam (Haplic Calcisol - WRB), with a mean bulk density of 1.30 g cm–3 and sediment as parental material. The major landform is plain, the slope form is classified as convex-straight and the gradient class as gently sloping (2-5%). Half of the orchard has been managed using sustainable agricultural practices (sustainable management, Sung) for 20 years (2000-2020). Trees were drip-irrigated from March to October with urban wastewater. A light pruning was carried out every year during winter. The soil was permanently covered by spontaneous self-seeding weeds, mowed twice a year. Cover crop residues and prunings were shredded and left along the row as mulch.The other half of the orchard was kept as ‘control’ plot. It was rainfed and conducted with a locally conventional management (Cmng), according to the practices usually adopted by farmers. The Cmng was managed by tillage performed 2-3 times per year to control weeds. Intensive pruning was carried out every two years, but pruned residues were removed from the orchard. A mineral fertilization was carried out once per year, during the fruit set and pit hardening phase (early spring).The average value (n = 5; 0-100 cm soil depth) of baseline soil organic carbon (SOC) stock (related to the Cmng) in the 20-year period was 4.79 t SOC ha–1, with an average additional SOC storage potential because of the adoption of the Smng of 0.15 t SOC ha–1 yr–1, and a SOC stock after 20 years of Smng of 7.75 t SOC ha–1 yr–1.In the Smng system, soil acted as a significant sink for C, especially due to the supplies of the organic resources internal to the system. The Smng system, made up of mature olive trees, was also able to fix in its aboveground and belowground components, a > 2-times higher total amount of C than the Cmng. Spontaneous vegetation was the most important pool, sequestering about 35% of the total fixed C. Also pruning material had a substantial importance in C fixation. Emissions of CO2 eq per kg of olives, calculated according to the Life Cycle Assessment (LCA), were 0.08 kg in the Smng system and 0.11 kg in the Cmng system. Besides C sequestration, the application of the Smng markedly improved physical, chemical, and biological soil fertility, with benefits on plants and production.The application of a sustainable soil and plant management makes olive growing a multifunctional rural activity, not only aimed at production, but including many other objectives, such as environmental, landscaping cultural, social and recreational.

The Historic Center of Florence, a UNESCO World Heritage Site, includes many examples of architecture characterized by rough-hewn rusticated block facades—a very common masonry technique in the Florentine Renaissance—made in Pietraforte sandstone. The latter features numerous criticalities related to its intrinsic characteristics and to decay phenomena that are due to weathering and pollution. A multidisciplinary methodology has been developed starting from historic analysis and architectural survey to a complete optometric, mechanical, physical, mineralogical, and petrographic characterization of rough-hewn rusticated blocks, applied to the case study of the Palazzo Medici Riccardi facades. The studies performed in this work cover several research fields, from architecture to geology, going through material diagnostics, and aim at improving knowledge and designing new restoration solutions for Pietraforte building-material criticalities. The research proposes an operative protocol aimed at supporting restoration projects and monitoring plans, with the aim to protect historical, architectural, and artistic cultural heritage and to safeguard the people who visit the city of Florence every year.

Background Anderson Fabry (AF) disease is a X-linked lysosomal storage disorder with multiorgan involvement. Cardiac disease, mainly represented by left ventricular hypertrophy (LVH) and arrhythmias, is the most frequent cause of premature death. It is well know that specific therapy is less effective after the development of LVH and myocardial fibrosis, therefore early cardiac detection (before LVH) is important. New cardiac magnetic resonance (CMR) parametric imaging techniques (T1 and T2 maps) enable myocardial tissue changes associated with AF disease. Purpose To evaluate the relationship between CMR tissue characterization and clinical and instrumental manifestations of AF disease to find early markers of cardiac involvement. Methods 31 AF patients (9 males, mean age 49±16 years) underwent ECG, echocardiogram and contrast CMR. TnI, BNP, pro-BNP and serum lyso-Gb3 were dosed. T1 mapping was performed in a pre-contrast acquisition with the modified Look-Locker inversion recovery (MOLLI) sequences. CMR results were compared with those of 43 healthy age and gender-matched controls. Results In AF patients native septal T1 values were significantly lower compared to healthy controls (median 949 vs 991 msec, p=0.0137) and were inversely related to Lyso-Gb3 serum levels (p=0.003). Patients with LVH had lower T1 septal values in comparison with patients without LVH (892 vs 981 msec; p=0.0012). Patients with classic form had abnormal low T1 values more frequently than pts with late onset variant (78 vs 23%; p=0.038). In AF patients native septal T2 values were significantly higher compared to the control group (53 vs 49 msec; p=0.0004) and correlated with troponin I (p=0.008) and NT-pro BNP (p=0.006) serum levels. No difference was found between pts with and without LVH (53.5 vs 52.5 ms; p=0.797) and the prevalence of abnormal high T2 values was similar between patients with late onset AF and pts with classical form (53% vs 50%; p=1.000). All patients with late onset AF and high T2 values were females. Conclusions CMR T1 (low values) and T2 (high values) mapping are useful tools to detect early cardiac involvement before LVH and to better understand the pathophysiology of cardiac disease in AF patients. Subclinical tissue inflammation, detectable through T2 maps, seems to be an additional pathogenetic mechanism related to the Gb3 storage that contributes to organ damage and precedes LVH, particularly in females patients with late onset phenotype. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Sant'Orsola-Malpighi Hospital

Platypnea-orthodeoxia syndrome is a rare disorder characterized by dyspnea and oxygen desaturation in upright position, with improvement of symptoms and blood oxygenation in supine position. Basically a right-to-left shunt (intracardiac or pulmonary) or a ventilation/perfusion mismatch are necessary to develop platypnea-orthodeoxia syndrome. Atrial septal defects, including patent foramen ovale (PFO), are known to be a frequent cause of platypnea-orthodeoxia syndrome. We describe herein the case of a 79-year-old woman with platypnea-orthodeoxia syndrome and PFO who developed a refractory worsening respiratory failure. Only the "rescue" emergency closure of PFO allowed the patient a clinical turning point with immediate and sustained respiratory improvement.

Iron deficiency (ID) is recognized as an important comorbidity in patients undergoing cardiac surgery; however, it still remains under-diagnosed and under-treated in clinical practice. This study aims at comparing efficacy and the effects on exercise capacity of intravenous ferric carboxymaltose (FCM) versus ferric gluconate (FG) in patients with ID anemia (IDA) resulting from cardiac surgery. We retrospectively analyzed data from our records of in-hospital patients with IDA after cardiac surgery undergoing cardiac rehabilitation. Group I was treated with FG, group II with FCM. Efficacy measures included changes (baseline vs discharge) in hemoglobin (Hb) and in distance traveled at six-minutes walking test (6MWT). Data from 74 in-patients (mean age 67.5±10.4 years, 43% women) were analyzed. At discharge, patients treated with FCM showed higher levels of Hb (11.1±1.2g/dl vs 10.2±1.1 g/dl; p=0.001), greater distance traveled at 6MWT (279.2±108.8 meters vs 236.3±72.7 meters; p=0.048), and lower in-hospital rehabilitation length of stay (20.3±7 vs 25.3±11.7 days; p=0.043) as compared to FG group. At multivariate analysis, the most powerful predictors of Hb increase >1 g/dl at discharge were transferrin levels (p=0.019) and treatment with FCM (p100 meters) at discharge (p=0.13 and p=0.003, respectively). In patients with IDA following cardiac surgery, intravenous FCM is effective in restoring Hb levels and in improving exercise capacity after cardiac surgery.

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However the effect on cardiac performance remains unknown. We sought to evaluate the effects of sacubitril/valsartan on clinical, bioumoral and echocardiographic parameters in patients with HFrEF. Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 ± 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow–up of 10.49 (2.93±18.44) months, the percentage of patients in NYHA class III changed from 40% to 17% (p

Aim To look for differences in cardiac phenotype and natural history of patients affected by laminopathy, according to the presence or less of neuromuscular involvement at clinical presentation. Methods We prospectively analyzed 47 consecutive pts with a genetic diagnosis of laminopathy followed at a single centre between 1994 and 2017. Additionally, reports of clinical and instrumental evaluations before referral at our centre were retrospectively evaluated. Results Neuromuscular presentation, mainly as Emery-Dreifuss muscular dystrophy (EDMD), was present in 21 (46%) cases (14 LMNA and 7 EMD gene mutations). These pts had symptoms earlier (9 vs 39 years, p Conclusions In pts affected by laminopathy neuromuscular involvement, when present, was most often the first clinical manifestation and preceded cardiological involvement, with a long time frame in some cases. Except for sinus node dysfunction, much more frequent in patients with EDMD, a similar prevalence of rhythm disturbances was reported, although pts with neuromuscular clinical onset were younger at diagnosis of AF and at PM implantation. Pts without neuromuscular presentation had a higher prevalence of CMP and ventricular arrhythmias, albeit a similar rate of heart transplantation. In pts with neuromuscular onset, cardiac involvement was characterized by a stepwise progression from rhythm disturbances to CMP, where a strict temporal progression from rhythm disturbances to CMP was not observed in the group of pts without neuromuscular clinical onset.

Background Previous studies showed that troponin blood levels may increase after exercise. In this study we assessed whether, among patients admitted with suspected unstable angina, the increase in high-sensitive troponin T (hs-TnT) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and predict symptom recurrence during short term follow-up. Methods Maximal treadmill EST was performed in 69 consecutive patients admitted to the emergency room with a suspicion of unstable angina (acute chest pain but confirmed normal serum levels of cardiac troponins) was measured before and 4 hours after EST. Coronary angiography was performed in 22 patients (32.8%). Results hs-TnT increased after EST compared to baseline in the whole population (from 0.84±0.65 to 1.17±0.87 ng/dL, p

Background. Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF. Methods. We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy. Results. At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3&ndash, 14.9 months) systolic blood pressure decreased from 117 &plusmn, 14 to 101 &plusmn, 12 mmHg (p &lt, 0.0001), left ventricular ejection fraction (LVEF) increased from 27 &plusmn, 6 to 29.7 &plusmn, 7% (p &lt, 0.0001), peak oxygen consumption (VO2) improved from 14.6 &plusmn, 3.3 (% of predicted = 53.8 &plusmn, 14.1) to 17.2 &plusmn, 4.7 mL/kg/min (% of predicted = 64.7 &plusmn, 17.8) (p &lt, 0.0001), minute ventilation/carbon dioxide production relationship (VE/VCO2 Slope) decreased from 34.1 &plusmn, 6.3 to 31.7 &plusmn, 6.1 (p = 0.006), VO2 at anaerobic threshold increased from 11.3 &plusmn, 2.6 to 12.6 &plusmn, 3.5 mL/kg/min (p = 0.007), oxygen pulse increased from 11.5 &plusmn, 3.0 to 13.4 &plusmn, 4.3 mL/kg/min (p &lt, 0.0001), and ∆VO2/∆Work increased from 9.2 &plusmn, 1.5 to 10.1 &plusmn, 1.8 mL/min/watt (p = 0.0002). Conclusion. Sacubitril/valsartan improved exercise tolerance, LVEF, peak VO2, and ventilatory efficiency at 6.2 months follow-up. Further studies are necessary to better clarify underlying mechanisms of this functional improvement.

Background Heart transplantation (HTx) improves the quality of life and survival in patients affected by end-stage heart failure. The purpose of the current study is to present the patients' clinical data and results of HTx in a single Center of Sicily. Focus on survival after pre and post HTx mechanical circulatory support use will be performed. Methods. 133 HTx were done from 2004 to the end of 2015.The average donor age was 34±13.5years and the proportion of male donors was 67%. Percentage of use of mechanical circulatory support to bridge patients to HTx was 18%. Results. Overall pre-transplant mechanical circulatory support was not correlated to worse post-transplant prognosis, p=0.757. Severe primary early graft failure requiring extra corporeal membrane oxygenator support strongly impact the early mortality after heart transplantation (p Conclusions. The results of HTx at ISMETT are comparable to those reported in high volume Italian transplant centers as well as in the ISHLT registry. The favorable outcome can be related to focus on multidisciplinary approach, strict recipients' selection and young donor population. Post HTx mechanical circulatory support use in general remains associated with worse post-transplant outcomes. This does not apply to pre-op mechanical circulatory support population.

Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient’s cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation.

Background: atherosclerotic process inexorably advances in patients reaching low-density lipoprotein cholesterol (LDL-C) targets. An attractive hypothesis is that lipoprotein particles (very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL)), could contribute to residual risk. The present study aims to investigate the relationship between carotid intima-media thickness (IMT) and different lipoprotein subfractions in a cohort of healthy postmenopausal women. Methods: 75 postmenopausal women, at LDL-C target levels without overt cardiovascular disease, underwent biochemical analyses (including subfraction assay of plasma lipoproteins) and carotid ultrasound examination. Results: a statistically significant correlation between VLDL and carotid IMT (p &lt, 0.001) was found. No significant correlation was found between carotid IMT and LDL-C (p = 0.179), IDL-C (p = 0.815), high-density lipoprotein (HDL) (p = 0.855), and LDL score (p = 0.240). Moreover, IMT is significantly correlated to LDL particle diameter (p = 0.044). After adjusting for age, systolic blood pressure, body mass index, smoking habits, glucose plasma concentration, and Lipoprotein(a) (Lpa) levels, multivariate analysis showed that women in the third tertile of VLDL-C, compared with those in the first tertile, were significantly associated to the highest IMT (p = 0.04). Conclusions: in this cohort of postmenopausal women, VLDL-C was significantly associated to carotid IMT, independent of main cardiovascular risk factors. These findings pave the way for targeting circulating concentrations of VLDL-C to reduce cardiovascular events in patients with target LDL-C levels.

Oxidative stress and mitochondrial dysfunction are hallmarks of heart failure (HF). Coenzyme Q10 (CoQ10) is a vitamin-like organic compound widely expressed in humans as ubiquinol (reduced form) and ubiquinone (oxidized form). CoQ10 plays a key role in electron transport in oxidative phosphorylation of mitochondria. CoQ10 acts as a potent antioxidant, membrane stabilizer and cofactor in the production of adenosine triphosphate by oxidative phosphorylation, inhibiting the oxidation of proteins and DNA. Patients with HF showed CoQ10 deficiency; therefore, a number of clinical trials investigating the effects of CoQ10 supplementation in HF have been conducted. CoQ10 supplementation may confer potential prognostic advantages in HF patients with no adverse hemodynamic profile or safety issues. The latest evidence on the clinical effects of CoQ10 supplementation in HF was reviewed.

Hormonal abnormalities are quite common in chronic heart failure (CHF). The most studied hormonal axis in CHF is the impairment of Growth Hormone (GH)/Insulin Growth Factor-1(IGF-1), which in turn is defined either by a blunted response to GH stimulation test or low serum IGF-1 values. Â Several independent groups reported that the presence of an abnormal GH/IGF-1 status in CHF is associated with a more severe disease, impaired functional capacity and reduced Survival rates. After the first encouraging results, double -blind controlled trials showed a neutral effect of the GH administration in patients. However, further studies reported positive results, when a GH-therapy is implemented only in those patients presenting a GH deficiency (replacement therapy).

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 &plusmn, 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow-up of 10.49 (2.93 &plusmn, 18.44) months, the percentage of patients in New York Heart Association (NYHA) class III changed from 40% to 17% (p &lt, 0.001). Median N&ndash, Type natriuretic peptide (Nt-proBNP) decreased from 1865 &plusmn, 2318 to 1514 &plusmn, 2205 pg/mL, (p = 0.01). Furosemide dose reduced from 131.3 &plusmn, 154.5 to 120 &plusmn, 142.5 (p = 0.047). Ejection fraction (from 27&plusmn, 5.9% to 30 &plusmn, 7.7% (p &lt, 0.001) and E/A ratio (from 1.67 &plusmn, 1.21 to 1.42 &plusmn, 1.12 (p = 0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%, p = 0.002) and tricuspid velocity decreased from 2.8 &plusmn, 0.55 m/sec to 2.64 &plusmn, 0.59 m/sec (p &lt, 0.014). Conclusions: Sacubitril/valsartan induce &ldquo, hemodynamic recovery&rdquo, and, consistently with reduction in Nt-proBNP concentrations, improve NYHA class despite diuretic dose reduction.

Mounting evidence suggests that hormonal deficiencies (HD) have an important role in chronic heart failure (CHF). In particular, androgen depletion is common in men with CHF and is associated with increased morbidity and mortality. This review summarizes the current understanding of the complex relationship between CHF and testosterone, focusing on evidence derived from clinical trials that have investigated the role of testosterone in the treatment of CHF. A greater comprehension of this area will allow researchers and clinicians to plan future studies that improve current strategies to reduce mortality in this high-risk population. Online databases PubMed (Medline), Web of Science, and Scopus were searched for manuscripts published prior to June 2018 using key words "heart failure" AND "testosterone" OR "anabolism" OR "hormone" OR "replacement treatment”. Manuscripts were collated, studied and carried forward for discussion where appropriate. In summary, findings from the literature demonstrate that testosterone treatment in CHF is a promising topic that requires further investigation.  Â

PURPOSE: This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery. METHODS: One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT. RESULTS: After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively. CONCLUSIONS: In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events.

Infective endocarditis is a disease associated with high mortality and severe complications. We report a case of a young shepherd affected by valvular endocarditis on a bicuspid aortic valve, complicated by a pseudoaneurysm with periaortic abscess. Thanks to the use of multimodality diagnostic imaging (particular echocardiogram, Magnetic Risonance Imaging, Computed tomography-scan and coronary angiography), it was possible to make a correct diagnosis, in order to plan a tailored surgical strategy and to reduce the perioperative risks. The operation consisted of myocardial revascularization, closure of the annular pseudoaneurysm and aortic valve replacement with mechanical prosthesis. The patient maintained normal inflammation indices and was discharged at home in the absence of relevant clinical events. Infective endocarditis is a deadly disease. Multimodality imaging is crucial to clarify anatomical distorsions that can occur in complicated cases.

Aim of this work is to investigate the feasibility of using a natural and inexpensive filler obtained by grinding the culms of Arundo Donax as reinforcement of epoxy resins. The effect of the content and size of Arundo Donax fillers on static and dynamic mechanical properties was evaluated showing that the composites exhibit higher tensile moduli, comparable flexural moduli and lower strength properties in comparison to the neat resin. Moreover, changes in the storage and the loss moduli only above the glass transition temperature (i.e. in the rubbery region) were found while neither significant shifts of tan δ peaks to higher temperatures nor reductions in the peak height of the composites were also observed. To better understand the influence of Arundo Donax filler on the morphology of the composites, the analysis of the fractured surfaces using a scanning electron microscope and the assessment of void content were carried out. The results of this study shown that a new natural filler may be considered as possible reinforcement of epoxy composites useful in semi-structural applications.

Background Primary graft dysfunction (P-GD) is the leading cause of early mortality after heart transplantation (HT). In this 2-center study we analyze outcomes and risk factors of P-GD according to the recent consensus conference classification endorsed by International Society for Heart and Lung Transplantation. Methods We included all adult HTs performed between 1999 and 2013. P-GD was graded as mild, moderate, and severe, according to International Society for Heart and Lung Transplantation recommendations, and analyzed separately from secondary GD. The primary end point was the combined occurrence of in-hospital death or emergency retransplantation. Results Early GD was found in 118 of 518 patients (23%), and 72 (13.9%) met the criteria for P-GD. Of these, 4 (5%) were mild, 33 (46%) moderate, and 35 (49%) severe and mostly characterized by biventricular involvement (78%). The end point occurred in 53 patients (10.2%). Overall, GD was a strong predictor of death-graft loss (odds ratio, 15.9; 95% confidence interval, 7.9–33.5; p < 0.01), with non-significant worse outcomes in P-GD (37%) vs secondary GD (27%) patients (p = 0.2). The study end point was more frequent in severe P-GD patients (65%) than in moderate (12%) or mild (0%; p < 0.01). Several known risk factors influenced the risk for P-GD, and the combination of specific donor and recipient risk factors accounted for approximately 22-times increased odds for P-GD. Donor age, recipient diabetes, ischemic time, and post-operative dialysis predicted non-recovery from P-GD. Conclusions Consensus-defined P-GD identifies patients at major risk for early death and graft loss after HT, although the “mild” grade appeared under-represented and clinically irrelevant. The amplified negative effect of donor and recipient factors on P-GD risk underscores the need for appropriate donor-recipient match.

Several researchers have shown how sisal fibres possess remarkable tensile properties that yield them good candidates as reinforcement in biocomposite materials. This work aims to evaluate the effect of an eco-friendly and cost effective surface treatment method based on the use of commercial sodium bicarbonate (i.e. baking soda) on properties of sisal fibre and its epoxy composites. In particular, raw sisal fibres were treated with a 10%w/w of sodium bicarbonate solution for different periods (24, 120 and 240 h), at room temperature. Changes occurring in sisal fibres were characterized through scanning electron microscope, Fourier transform infrared spectroscopy, thermogravimetric analysis and helium pycnometer analysis. The mechanical characterization of sisal fibre was carried out through single fibre tensile tests and a reliability analysis of the experimental data was performed. A mathematical model was also applied to investigate the relation between the transverse dimension of the fibres and their tensile properties. Interfacial adhesion of sisal fibre with an epoxy matrix was investigated using single fibre pull out technique. Moreover, to deeper investigate the effect of the proposed treatment, epoxy based composites reinforced with short randomly oriented sisal fibres were manufactured and characterized by means of quasi-static flexural tests. The experimental results showed that 120 h is the optimum time for treating sisal fibre to achieve highest interfacial adhesion and mechanical properties with epoxy matrix.

Background: There are several new strategies proposed to improve the outcome of patients with ST-elevation myocardial infarction (STEMI). One approach is the resurgent use of facilitated percutaneous coronary interventions (PCI). Until recently, deciding whether immediate PCI after combined treatment (facilitated PCI) is more appropriate than delayed PCI (short time) has not been investigated. The aim of this study, therefore, was to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 hr, and in patients initially successfully treated with pharmacological therapy and with delayed PCI (12–72 h). Methods: 451 reperfused STEMI patients, aged 18 to 75 years, class I–II Killip, with an acceptable echocardiographic window and admitted within 12 hs of the onset of symptoms were randomized into two groups. All patients had to have successful reperfusion, to receive the combination of a standard tirofiban infusion or abciximab plus half dose rtPA. Thereafter, patients were sub-grouped as follows:group 1 (immediate PCI) patients had PCI within 2 h; and group 2 (delayed PCI) patients in which PCI was performed after 12 hs and within 72 hs. Results: The 225 reperfused (immediate-PCI) and 226 reperfused (delayed-PCI) patients (time from randomization to PCI 165 ± 37 min in immediate PCI versus 45.1 ± 20.2 h in delayed PCI group) showed similar results in ejection fraction, CK release and patency of the IRA. In addition, the delayed PCI group showed a significant reduction in ischemic events, restenosis and bleedings (P = 0.005, 0.01, 0.01 respectively) and significant reduced angiographic evidence of thrombus formation in the infarction-related artery (IRA) (p = 0.001). Conclusion: Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI, and that delayed PCI in patients treated with combined lytic and IIb/IIIa inhibitors appears to be as effective and possibly superior (reduced ischemic events and repeat PCI) as immediate PCI. The patients in this study were successfully reperfused, with TIMI-3 flow and our data may not apply to patients with TIMI 0–2 flow. This strategy could allow transferring the reperfused patients and performing PCI after hours < 72 hours and not immediately, thereby reducing the number of urgent PCI and costs, obtaining similar results, but mostly causing less discomfort to the patient. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies. The study was aimed to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 h, and in patients initially successfully treated with pharmacological therapy and delayed PCI (12–72 h). All patients had to have successful reperfusion, to receive the combination of a standard abciximab or tirofiban infusion plus half dose rtPA. Similar results were observed in both groups. Delayed PCI group showed a significant lower incidence in restenosis (0.01), minor bleedings (0.005), ischemic events (0.01) and a reduced angiographic evidence of thrombus formation in IRA (0.001). Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies.

Background: Chemotherapy cardiotoxicity is an emerging problem and it is very important to prevent cardiac dysfunction caused by anticancer drugs. The aim of this study was to assess the alterations of the cardiac function induced by chemotherapy in a follow-up of 2 years and to evaluate the cardioprotective role of angiotensin-converting enzyme inhibitors (ACEIs) in the prevention of cardiac dysfunction. Methods: A prospective study was carried out using patients with breast cancer (85 women; median age 57W12years) and other inclusion and exclusion criteria. On the basis of treatment, patients were divided into six groups: fluorouracil-epirubicincyclophosphamide, FEC (group A); FEC and trastuzumab (B); trastuzumab (C); FEC and taxotere (D); FEC, paclitaxel and trastuzumab (E); and chemotherapy and cardioprotective drugs (F). Cardiological evaluation including electrocardiogram and conventional echocardiogram with tissue Doppler imaging (TDI) was carried out at T0 (before starting chemotherapy), T1 (after 6months from the start of chemotherapy) and T2 (2 years after the end of chemotherapy). Results: Significant changes in the TDI parameters of systolic and diastolic function were observed at T1 and T2 in all patients. A significant reduction of left ventricular ejection fraction (LVEF) was observed only at T2. In the patients treated with ACEI (F), these changes were less significant than in other groups and they do not have significant changes in the indices of diastolic function. Conclusion: TDI is more sensitive than conventional echocardiogram in the early diagnosis of cardiac dysfunction and ACEIs seem to have an important role in the prevention of cardiotoxicity.

An increasing number of studies with conflicting results regarding the association between angiotensin-converting enzyme (ACE) gene deletion polymorphism and cardiovascular disease has recently been published. The present prospective long-term study was conducted to evaluate whether the DD genotype could also be associated with a higher prevalence of hypertension in healthy subjects over 6 years of follow-up. We also investigated the effects of the ACE-I/D genotypes on diastolic function by echocardiography in healthy subjects without any risk factors and any events after 6 years of follow-up.684 healthy volunteers (aged 25-55 years) normotensive and free of cardiovascular diseases, with acceptable echocardiographic window were enrolled. All subjects had to have a normal electrocardiogram (ECG) and echocardiogram (ECHO) at entry. All subjects have undergone a complete physical examination, 12-lead ECG and ECHO; DNA analysis and serum cholesterol have been performed on venous blood samples. All subjects underwent a clinical evaluation each year for the 6-year duration of the study. In addition, 275 subjects without any risk factors underwent an ECHO every year of the follow-up, to check the influence of genotypes on myocardial diastolic performances.All 684 subjects completed 6 years of follow-up. We obtained 3 genetically distinct groups: I) the ACE-DD group (n = 225, 80 F/ 145 M, mean age 43.4 +/- 7.6 years) with 42 hypertensive subjects (18.3%), 5 heart failure (HF) subjects and 6 subjects with acute coronary syndromes (ACS). There was no association between family history, smoking habit, hypercholesterolaemia and events. 2) the ACE-ID group (n = 335, 116 F/2 19 M, mean age 43.6 +/- 7 years) with 16 hypertensive subjects (4.7%) and 3 subjects with ACS. 3) the ACE-II group (n = 124, 45 F/79 M, mean age 42.5 +/- 6.9 years) with 2 hypertensive subjects (1.6%) and I HF subject. The incidence of hypertension and cardiovascular events, was significantly higher in the ACE-DD (53 cases, 23%) than in the ACE-ID and ACE-II groups (20 and 3 cases, 5.9% and 2.4%, respectively), p = 0.0001. The higher incidence of hypertension was observed in the older age groups (36-45 and 46-55 years) with ACE-DD and ACE-ID genotypes. Moreover, ACE-DD significantly and early affected myocardial diastolic properties in the total group examined, also when stratified for age. There was a reduction of E/A ratio and it was more evident in subjects aged 36-45 and 46-55 years, p = 0.0001.Our data suggest that ACE-DD polymorphism is associated with a higher incidence of hypertension in baseline healthy subjects, irrespective of other risk factors, and appears to affect the diastolic function. These effects were apparent predominantly in the older age groups.

Background Nemaline myopathy (NM) is a rare congenital myopathy characterized by muscle weakness, hypotonia and the presence in muscle fibers of inclusions known as nemaline bodies and a wide spectrum of clinical phenotypes, ranging from severe forms with neonatal onset to asymptomatic forms. The adult-onset form is heterogeneous in terms of clinical presentation and disease progression. Cardiac involvement occurs in the minority of cases and little is known about medical management in this subgroup of NM patients. We report a rare case of heart failure (HF) in a patient with adult-onset NM in whom ivabradine proved to be able to dramatically improve the clinical picture. Case presentation We report a case of a 37-year-old man with adult-onset NM, presenting with weakness and hypotonia of the proximal limb muscles and shoulder girdle, severely limiting daily activities. He developed progressive HF over a period of 6 months while attending a rehabilitation program, with reduced left ventricular ejection fraction (LVEF = 20%), manifested by dyspnea and signs of systemic congestion. The patient was started HF therapy with enalapril, carvedilol, spironolactone and loop diuretics. Target HF doses of these drugs (including carvedilol) were not reached because of symptomatic hypotension causing a high resting heart rate (HR) ≥70 beats per minute (bpm). Further deterioration of the clinical picture occurred with several life-threatening arrhythmic episodes requiring external defibrillation. An implantable cardioverter defibrillator (ICD) was then implanted. Persistent high resting HR was successfully treated with ivabradine with HR lowering from 90 bpm to 55 bpm at 1 month follow up, LVEF rising to 50% at 3 month follow up and to 54% at 2,5 year follow up. To date no more hospitalizations for heart failure occurred. A single hospitalization due to aspiration pneumonia required insertion of a tracheostomy tube to protect airways from further aspiration. At present, the patient is attending a regular rehabilitation program with net improvement in neuromotor control and less limitations in daily activities. Conclusions HF is a rare feature of NM, but it can negatively influence prognosis. Conventional HF therapy and/or heart transplant are the only reasonable strategy in these patients. Ivabradine is a useful, effective and safe drug for therapy in NM patients with HF and should be considered when resting HR remains high despite beta-blockers’ full titration or beta-blockers’ underdosing due to intolerance or side effects.