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Background During cardiopulmonary exercise test, the isocapnic buffering period ranges between anaerobic threshold (AT) and respiratory compensation point (RCP). We investigated whether oxygen uptake (VO2) increase during the isocapnic buffering period (ΔVO2AT-RCP) is related to heart failure severity and prognosis.Methods We retrospectively analysed reduced ejection fraction heart failure patients who attained RCP at cardiopulmonary exercise test. The study endpoint was the composite of cardiovascular mortality and urgent heart transplantation/left ventricular assist device implantation. Hazard ratio was assessed to identify the increase of risk associated with ΔVO2AT-RCP (below and above the median of ΔVO2AT-RCP).Results AT and RCP were both identified in 782 (39.2%) out of 1995 reduced ejection fraction heart failure cases. Left ventricular ejection fraction and peak VO2were 33 ± 9% and 16.5 ± 4.5 mL/kg per min (61 ± 16% of predicted value), suggesting moderate heart failure. At five years, endpoint did not vary between patients below and above the median ΔVO2AT-RCP (3.85 mL/min per kg (25–75th interquartile range = 2.69–5.46)). ΔVO2AT-RCP correlated with several parameters associated to heart failure prognosis, such as peak VO2, VE/VCO2slope, brain natriuretic peptide and left ventricular ejection fraction. The ΔVO2AT-RCP value was associated with prognosis at univariate but not at multivariable analysis, where only VE/VCO2slope endured.Conclusion ΔVO2AT-RCP correlates with several parameters linked to heart failure severity. Isocapnic buffering period stratifies heart failure patients, but not more than other prognostic indices.

Cultural events are an important driver of socio-cultural-economic transformation. The growth of Information and Communication Technologies (ICTs) has affected the ways in which people can play an active role in cultural event management and urban planning. This work proposes a methodological approach that identifies the key elements for building bottom-up urban e-planning strategies. After a brief theoretical analysis of the impact of cultural activities, tourism and ICTs on urban planning, this paper presents the results of an empirical study carried out in the Puglia region (south of Italy) during the cultural event known as “La Notte della Taranta”, in which the crowd created added-value information via comments posted on social media. Data were collected using a mobile application specifically created for this event as part of the Folkture project, as well as from Facebook and Twitter posts. Using network-analytic and sentiment/semantic algorithms, the work aims to support the event management decisional process and produce results valuable to the field of urban planning.

Early definitive identification of infectious pathogens coupled with antimicrobial stewardship interventions allow for targeted and timely administration of antimicrobials. We investigated the combined impact of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology and an antimicrobial stewardship program (ASP) in pediatric patients with blood stream infections (BSIs).

Aldosterone plays important role in cardiovascular damage. Aim was to evaluate arterial subclinical damage through arterial stiffness parameters in patients with Essential Hypertension (EH) and Primary Aldosteronism (PA).

This paper analyses the innovativeness and competitiveness of the wine sector in a specific local area through the perspective of the sectoral system of innovation. The aim of this paper is to analyse, using a case study approach, the main factors that affect the competition of wine business and the strategic guidelines for enhancing the competitiveness of local wines productions on the global markets. In the first part of the paper, we present the main literature review regarding the most important features and dynamics of the wine business environment and the sectoral systems of innovation framework. In the second part the methodology implied in this research as well as the results of the case studies are presented. Finally, we discuss the implications of sectoral systems of innovation for the novelty and competitiveness of the wine business.

Background/aims Treatment of chronic delta hepatitis is long and difficult and better monitoring is needed.Methods In this study, hepatitis delta virus (HDV) RNA, hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA were retrospectively quantified in 53 patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis delta. Twenty-one had received 28 courses of 3–5 MU interferon-a2b (IFN-a2b) thrice weekly for a median of 12.6 months (interquartile range [IQR]: 7.3–31.6), five had received eight courses of 100 mg lamivudine (LAM) daily for 23.6 months (IQR: 8.4–61.5) and 27 were untreated. The controls were 54 untreated, randomly selected, HBeAg-negative chronic hepatitis B patients without delta infection. Quantification of serum HDV RNA, HBsAg and HBV DNA were performed at baseline, during and at the end of treatment and end of follow up.Results Untreated patients had significantly higher median HBsAg levels than controls (5,872 vs 3,501 IU/ml; P=0.046), but lower median HBV DNA levels (2.933 vs 6.459 log10copies/ml; P<0.001). Median baseline HDV RNA (6.374 log10copies/ml) was similar in IFN-a2b-treated, LAM-treated and untreated patients. At the end of treatment, IFN-a2b significantly suppressed in paired measurements HDV RNA (P=0.012) and HBsAg (P=0.043), but LAM was inefficient. In IFN-a2b-treated patients, HDV RNA became undetectable in five patients within a median of 30 months (IQR: 8–90), followed by a slower decrease in HBsAg.Conclusions In untreated chronic delta hepatitis, suppressed HBV replication is associated with significantly increased HBsAg serum levels. IFN-a2b significantly suppresses both HDV RNA and HBsAg, but LAM has no effect. Long-term IFN-a2b treatment (IQR: 1.5–5.0 years) appears necessary for undetectable serum HDV RNA and further treatment is required for HBsAg loss. Monitoring of HDV RNA and HBsAg serum levels in patients with chronic delta hepatitis provides insight during treatment.

ABSTRACTThe use of hydroxyurea for the prevention of sickle cell crises in patients with homozygous HbS disease is now well established. The beneficial effects of this compound stem from (a) selective enrichment of red cells containing an increased amount of fetal hemoglobin, which inhibits HbS polymerization, and (b) a decrease of leukocytes, platelets, and reticulocytes, which significantly limits their adherence to the vascular wall. We report the results of a clinical trial of hydroxyurea on 55 Greek-origin patients with sickle cell/β-thalassemia and 14 patients with homozygous HbS disease who have been treated with hydroxyurea for several years. Such patients have a higher probability to benefit from hydroxyurea therapy, since in addition to its antisickling effect, the increase of γ-chain synthesis is expected to diminish the deleterious effects of the unbound α-globin chains. Selection of patients and monitoring throughout the whole trial were done by the same clinicians. Quantitative expression of the clinical condition was done using a system scoring several outcome parameters. For a period of 52 months prior to starting treatment, the total score of severity for 59 evaluable patients was 1182 points (3068 patient-weeks), while for the 12,018 patient-weeks of the trial this parameter fell to only 82 points. Other observations of interest include the significant improvement of a group of patients with hepatic cholestasis, the development of leg ulcers possibly related to the treatment, and the dramatic increase of hemoglobin F, often in association with an increase of the total hemoglobin levels as a result of decreased hemolysis.

In treatment of idiopathic central precocious puberty, GnRH analogues (GnRHa) have been accepted as the treatment of choice. Since growth velocity may be impaired with GnRHa treatment growth hormone (GH) treatment has been added in clinical trials. Recently, a study followed adopted girls with early or precocious puberty on GnRHa or combined GnRHa and GH treatment to final height. It was found that final height was significantly higher in the combined treatment group, although the difference was small. It was seen that patients that were extremely short at arrival and short at start of treatment seemed to be candidates for combined treatment.We have now analysed the data in order to define criteria for the subgroup in need of combined GnRHa-GH treatment in order to achieve normal final height, i.e. above -2 SDS. Bone ages of 46 patients at start of treatment, randomized to either GnRHa treatment or GnRHa treatment combined with GH, were examined blindly by the same radiologist and the PAH calculated. The methods according to Greulich-Pyle / Bayley-Pinneau (GP/BP) and Tanner-Whitehouse (TW2) were used. Predictions versus final height data were analysed. The accuracy of FH prediction was greatest for GnRHa treated group using the GP/BP method. The GP/BP method gave useful cut off limits for when combined treatment was necessary to possibly achieve normal height. If pre-treatment GP/PAH was > 157cm, the patients attained normal height with GnRHa treatment only. Ten out of 13 (77) such girls could be correctly identified. Using TW2 with a cut off of 164 cm, 9 out of 13 could be selected. Using a multi regression equation of best fit the number of correctly selected cases for GnRHa treatment only, could not be further increased in this group.We conclude that bone age determination and adult height prediction with the Greulich-Pyle/Bayley-Pinneau method, provides useful criteria for selecting the subgroup of adopted girls with early puberty where combined treatment with GnRHa and GH is not necessary to reach normal final height.

We report the characterization of a soft x-ray plasma source generated by a long-pulse XeCl excimer laser system. The output energy is 4 J at a wavelength of 308 nm in a 100-ns pulse. The intensity of radiation on target is estimated to be 4 × 1012W cm−2. X-ray emission spectra of the plasma have been recorded using a double focusing spatial resolution spectrometer with a spherical mica crystal. From these measurements, the plasma temperature and electron density have been estimated. Various applications of such a plasma source have been investigated. First images of whole intact living cells from our system, imaged using the technique of soft x-ray contact microscopy, utilizing x rays in the “water window” region (280–530 eV), are shown. The suitability of the source for other applications, for example, x-ray lithography and radiation damage studies, to living cells are discussed. Possible improvements to the x-ray source for the various applications are proposed.

AbstractPhosphorylation of calix[4]resorcinarenes with long chain aliphatic radicals (R=C6, C,. C,) (1a,b,c) with a number of P(III) derivatives i.e. triamido- and diamidophosphites, triphenylphosphite, monoand polyhalogenides of P(III) is described. A series of phosphoamide cavitands (2), (3) were obtained. A new three-dimensional “container”- like structures, in which tetraresorcinol fragments are connected by means of phosphite bridges (13,14) were formed in the reaction of (Ib) with (-) bis(N,N-diethylamido)menthylphosphite, phosphorus trichloride and triphenylphosphite. Phosphorylation of calix[4]resorcinarene (1c) with chloroanhydrides of chloromethylphosphonic and bis(chloromethyl) phosphinic acids results in completely or partially posphorylated products depending on the reaction conditions. The synthesis of dimeric “head to head” macrocyclic derivative of chlormethylphosphonic acid (19) is described. Structures and properties of synthesized compounds were discussed on the basis of physical and quantum chemical methods.

A postanginal Sepsis Syndrome with metastatic lung abscess caused byFusobacterium necrophorumin a 25-year-old previously healthy man is described. The incomplete and ineffective antibiotic treatment at onset of angina ended progressively in septicaemia and metastatic infections in a 3-week time period. The early parenteral use of Metronidazole based only on the clinical picture, the Gram stain findings and the strict anaerobic feature of the blood isolate in parallel with the long-term antibiotic treatment were possibly the main reasons for the good outcome of this serious infection.

No relevant conflicts of interest to declare.