Cardiovascular Imaging and Theranostics in Cardiovascular Pharmacotherapy

Imaging plays a pivotal role in the diagnostic and prognostic assessment of cardiovascular diseases. During the past two decades, there has been an expansion of the available imaging techniques, some of which are now part of routine clinical practice. Cardiovascular imaging of atherosclerosis is a useful instrument, and it can corroborate and expand pathophysiological evidence on cardiovascular disease, providing proof of concept for medical therapy and can predict its responsiveness, and it may be able to be used as surrogate endpoints for clinical trials. Theranostics is an emerging therapy that combines imaging and therapeutic functions, using imaging-based therapeutic delivery systems. Theranostics could partially overcome current imaging limitations and translate experimental evidence and large-scale trials assessing clinical endpoints, rationalising cardiovascular drug development and paving the way to personalised medicine. The medical community cannot overlook the use of cardiovascular imaging as a complementary and supportive adjunct to trials investigating clinical endpoints, which remain the mainstay for investigating the efficacy and safety of cardiovascular pharmacotherapy

Hydraulic modeling of a segment of the EU DEMO HCPB breeding blanket back supporting structure

The Helium-Cooled Pebble Bed (HCPB) concept for the Breeding Blanket (BB) of the EU DEMO tokamak reactor is under development at KIT within the EUROfusion consortium. Although the coolant distribution inside the blanket manifolds has been investigated in the past using 3D CFD models, such detailed analysis could not be extended to investigate the behavior of all blanket segments as a whole. Thus, for system-level analyses, lumped-parameter models are used, which exploit 0D/1D simplifications of the physics. This work presents the development of a 1D thermal-hydraulic (TH) model for the HCPB Back Supporting Structure (BSS). To validate such model, an experimental campaign is foreseen in 2018 in the HELOKA facility at KIT, in which a scaled-down mock-up of a segment of the BSS, which is dimensioned according to the facility working conditions, will be tested. Using the results of CFD simulations on full-size and mock-up, a first successful comparison between 3D and 1D results is presented. The 1D model is developed in such a way to allow a smooth integration in the GETTHEM code, which is under development at PoliTo, for the TH simulation of the entire tokamak

Modeling the Transport of Activated Corrosion Products in the WCLL PbLi Loop for ITER and the EU DEMO With the GETTHEM Code

This work presents the results of the implementation in the GEneral Tokamak THErmal-hydraulic Model of available models for the generation and transport of any dispersed material in flowing PbLi eutectic mixture. In particular, the focus is on Activated Corrosion Products circulating as solid suspension in the PbLi loop of the Water-Cooled Lithium-Lead Breeding Blanket of the EU DEMO fusion reactor. A simple test case is used to show that the distribution of the concentration of activated corrosion products at any point of the PbLi loop, both in the water-cooled lithium-lead breeding blanket and in the related ITER Test Blanket System, can be determined by the model. Moreover, thanks to the model’s dynamic nature, operational transients can be simulated; for instance, starting from zero impurities in the PbLi alloy, the evolution of the concentration of corrosion products is shown, until the steady-state is reached. The results obtained with this tool can be useful not only for radiological safety purposes, but also because activated corrosion products may affect the PbLi flow itself and the efficiency of the tritium removal system, with consequences on the achievable Tritium Breeding Ratio. A rigorous verification of the model is also performed

Diversidade de Scolytinae, Platypodinae (Curculionidae) e Bostrichidae em Hevea brasiliensis (Willd. ex A.Juss.) no estado de Goiás, Brasil

In Brazil, the rubber tree Hevea brasiliensis (Willd. ex A.Juss.) is heavily planted in the so-called escape areas in order to avoid leaf blight. While there are reports on damage inflicted by insects and mites in the literature, these are sparse. The objective of this study was to survey the community of Scolytinae, Platypodinae (Curculionidae) and Bostrichidae, in a rubber tree plantation in Goianésia, state of Goiás, Brazil, with ethanol-baited flight intercept traps from March 2013 through March 2014. Scolytinae beetles (13 genera, 29 species) were the most abundant group, accounting for over 99% of trapped specimens, while six Bostrichidae, seven Cerambycidae and two Platypodinae species were also caught. Hypothenemus obscurus (Scolytinae) comprised ca. 89% of all trapped specimens. While no attack on live trees was observed during the survey, species with known ability to attack and successfully colonize standing trees were trapped in this study. Perhaps this is an indication that the plantation is well managed, not providing conditions where attacks on live trees may occur.No Brasil, a seringueira Hevea brasiliensis (Willd. ex A.Juss.) é plantada em áreas de escape para evitar a doença do mal-das-folhas. Embora haja relatos de danos ocasionados por insetos e ácaros na literatura, estes são esparsos. O objetivo deste estudo foi realizar um levantamento populacional da comunidade de Scolytinae, Platypodinae (Curculionidae) e Bostrichidae em um plantio de seringueira em Goianésia, estado de Goiás, com armadilhas de impacto de voo iscadas com etanol, de março de 2013 a março de 2014. Scolytinae (13 gêneros, 29 espécies) foi o grupo mais abundante, representando mais de 99% dos espécimes capturados, enquanto que seis espécies de Bostrichidae, sete de Cerambycidae e duas de Platypodinae foram também capturadas. Hypothenemus obscurus (Scolytinae) representou cerca de 89% de todos os exemplares capturados. Embora nenhum ataque a árvores vivas tenha sido observado durante a pesquisa, espécies com capacidade conhecida de atacar e colonizar com sucesso árvores vivas foram capturadas neste estudo. Talvez isso seja uma indicação de que a plantação é bem gerenciada, não fornecendo condições para que isso ocorra

Progression of human carotid and femoral atherosclerosis: a prospective follow-up study by magnetic resonance vessel wall imaging

Aims The time course of atherosclerosis burden in distinct vascular territories remains poorly understood. We longitudinally evaluated the natural history of atherosclerotic progression in two different arterial territories using high spatial resolution magnetic resonance imaging (HR-MRI), a powerful, safe, and non-invasive tool. Methods and results We prospectively studied a cohort of 30 patients (mean age 68.3, n = 9 females) with high Framingham general cardiovascular disease 10-year risk score (29.5%) and standard medical therapy with mild-to-moderate atherosclerosis intra-individually at the level of both carotid and femoral arteries. A total of 178 HR-MRI studies of carotid and femoral arteries performed at baseline and at 1- and 2-year follow-up were evaluated in consensus reading by two experienced readers for lumen area (LA), total vessel area (TVA), vessel wall area (VWA = TVA − LA), and normalized wall area index (NWI = VWA/TVA). At the carotid level, LA decreased (−3.19%/year, P = 0.018), VWA increased (+3.83%/year, P = 0.019), and TVA remained unchanged. At the femoral level, LA remained unchanged, VWA and TVA increased (+5.23%/year and +3.11%/year, both P < 0.01), and NWI increased for both carotid and femoral arteries (+2.28%/year, P = 0.01, and +1.8%/year, P = 0.033). Conclusion The atherosclerotic burden increased significantly in both carotid and femoral arteries. However, carotid plaque progression was associated with negative remodelling, whereas the increase in femoral plaque burden was compensated by positive remodelling. This finding could be related to anatomic and flow differences and/or to the distinct degree of obstruction in the two arterial territorie

The sac evolution imaging follow-up after endovascular aortic repair:An international expert opinion-based Delphi consensus study

Objective: Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Methods: Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts' responses, only those statements reaching a grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement &lt;5%) were included in the final document. Results: One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Conclusions: Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues.</p

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when &gt;70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available