Prediction of hyperaldosteronism subtypes when adrenal vein sampling is unilaterally successful

Objective: Adrenal venous sampling (AVS) is the gold standard to discriminate patients with unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and in cases of unsuccessful cannulation of adrenal veins, the results may not always be interpreted. The aim of our study was to develop diagnostic models to distinguish UPA from BPA, in cases of unilateral successful AVS and the presence of contralateral suppression of aldosterone secretion.Design: Retrospective evaluation of 158 patients referred to a tertiary hypertension unit who underwent AVS. We randomly assigned 110 patients to a training cohort and 48 patients to a validation cohort to develop and test the diagnostic models.Methods: Supervised machine learning algorithms and regression models were used to develop and validate two prediction models and a simple 19-point score system to stratify patients according to their subtype diagnosis.Results: Aldosterone levels at screening and after confirmatory testing, lowest potassium, ipsilateral and contralateral imaging findings at CT scanning, and contralateral ratio at AVS, were associated with a diagnosis of UPA and were included in the diagnostic models. Machine learning algorithms correctly classified the majority of patients both at training and validation (accuracy: 82.9-95.7%). The score system displayed a sensitivity/specificity of 95.2/96.9%, with an AUC of 0.971. A flow-chart integrating our score correctly managed all patients except 3 (98.1% accuracy), avoiding the potential repetition of 77.2% of AVS procedures.Conclusions: Our score could be integrated in clinical practice and guide surgical decision-making in patients with unilateral successful AVS and contralateral suppression

Restoration in the Mediterranean: Overview of experiences mapped and lessons learnt

Restoration and rehabilitation efforts have been undertaken for decades in the Mediterranean region and with different degrees of success. Nevertheless, they all offer valuable lessons onto which other initiatives can be built, thus improving their success. As part of its effort to compile and analyze data and share lessons learnt on restoration, the Food and Agriculture Organization of the United Nations (FAO) has been collecting data on Mediterranean restoration and rehabilitation, including reforestation and afforestation, projects, programmes and initiatives. Based on an online consultation and desk research, a preliminary mapping allowed to compile and analyze data from a total of 40 restoration and rehabilitation initiatives in 13 Mediterranean countries. These initiatives were analyzed in terms of their objective, scale, type of stakeholders involved, type of land degradation and main measures taken, and sources of funding. The results highlighted some key issues, which were then translated into recommendations to support restoration practitioners and decision-makers. These recommendations focus on the choice of the best restoration strategy, the choice of the most appropriate (native) species and genetic material, as well as some key elements to ensure the long-term sustainability of these initiatives

Restauration en Méditerranée : tour d’horizon des expériences et acquis

Des actions de restauration et de réhabilitation ont été entreprises dans la région méditerranéenne depuis des décennies, avec divers niveaux de réussite. Toutes offrent cependant des enseignements dont peuvent potentiellement bénéficier les projets en cours et futurs pour améliorer leurs résultats. Dans le cadre de son travail de compilation et d’analyse de données et de partage de leçons apprises sur la restauration, l’Organisation des Nations Unies pour l’alimentation et l’agriculture (FAO) a entrepris la collecte de données sur les projets, programmes et autres initiatives de restauration et de réhabilitation en Méditerranée, y compris les programmes de boisement et de reboisement. Sur la base d’une consultation en ligne et d’une recherche documentaire, un recensement préliminaire de 40 initiatives dans 13 pays méditerranéens a été effectué. Celles-ci ont été analysées par rapport à leur objectif, leur ampleur, le type de parties prenantes impliquées, les causes de dégradation des terres, le type de mesures entreprises, et les sources de financement notamment. Les résultats ont permis de mettre en évidence un certain nombre de questions clés qui ont été traduites en directives pour aider les intervenants et les partenaires techniques et financiers concernés par la restauration des terres. Ces recommandations mettent notamment l’accent sur le choix de la meilleure stratégie à adopter pour la restauration, le choix des espèces (locales) et du matériel génétique les plus appropriés, ainsi que sur des éléments essentiels permettant d’assurer la durabilité à long terme de telles initiatives

Sphingolipid composition of circulating extracellular vesicles after myocardial ischemia

none10siSphingolipids are structural components of cell membrane, displaying several functions in cell signalling. Extracellular vesicles (EV) are lipid bilayer membrane nanoparticle and their lipid composition may be different from parental cells, with a significant enrichment in sphingolipid species, especially in pathological conditions. We aimed at optimizing EV isolation from plasma and describing the differential lipid content of EV, as compared to whole plasma. As pilot study, we evaluated the diagnostic potential of lipidomic signature of circulating EV in patients with a diagnosis of ST-segment-elevation myocardial infarction (STEMI). STEMI patients were evaluated before reperfusion and 24-h after primary percutaneous coronary intervention. Twenty sphingolipid species were quantified by liquid-chromatography tandem-mass-spectrometry. EV-ceramides, -dihydroceramides, and -sphingomyelins increased in STEMI vs. matched controls and decreased after reperfusion. Their levels correlated to hs-troponin, leucocyte count, and ejection fraction. Plasma sphingolipids levels were 500-to-700-fold higher as compared to EV content; nevertheless, only sphingomyelins differed in STEMI vs. control patients. Different sphingolipid species were enriched in EV and their linear combination by machine learning algorithms accurately classified STEMI patients at pre-PCI evaluation. In conclusion, EV lipid signature discriminates STEMI patients. These findings may contribute to the identification of novel biomarkers and signaling mechanisms related to cardiac ischemia.openBurrello J.; Biemmi V.; Dei Cas M.; Amongero M.; Bolis S.; Lazzarini E.; Bollini S.; Vassalli G.; Paroni R.; Barile L.Burrello, J.; Biemmi, V.; Dei Cas, M.; Amongero, M.; Bolis, S.; Lazzarini, E.; Bollini, S.; Vassalli, G.; Paroni, R.; Barile, L