Esca symptoms appearance in Vitis vinifera L.: influence of climate, pedo-climatic conditions and rootstock/cultivar combination

This study investigated the appearance of esca symptoms in relation to environmental factors and the rootstock/cultivar combination in an experimental setting between 2004 and 2009. Among the common genotypes showing susceptibility to the esca disease, four cultivars were considered: ‘Cabernet Sauvignon’, ‘Sangiovese’, ‘Trebbiano Toscano’ and ‘Chardonnay’. These cultivars were studied own-rooted and in combination with two rootstocks: Kober 5BB and 1103 Paulsen. The difference in susceptibility of cultivars to esca appeared negatively related to the graft. No clear relation was found between esca appearance and environmental factors. Moreover, an unexpected discordance between esca incidence percentage and mortality rate was observed

The link of biocompatibility to cytokine production

The link of biocompatibility to cytokine production. Recent studies suggest that chronic inflammation plays a role in the pathogenesis of cardiovascular disease. Cytokines released from jeopardized tissues stimulate the liver to synthesize acute phase proteins, including C-reactive protein (CRP). Baseline levels of CRP in apparently healthy persons or in persons with unstable angina constitute an independent risk factor for cardiovascular events. More recently, it has been suggested that CRP is useful not only as a marker of the acute phase response, but is also involved in the pathogenesis of the disease. CRP may, in fact, directly interact with the atherosclerotic vessels or ischemic myocardium by activation of the complement system, thereby promoting inflammation and thrombosis. Several studies in uremic patients have implicated CRP as a marker of malnutrition, resistance to erythropoietin, and chronic stimulation in hemodialysis. An increased cytokine production secondary to blood interaction with bioincompatible dialysis components has been reported by several studies; interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), and mainly IL-6 are the three proinflammatory cytokines involved in the pathogenesis of hemodialysis-related disease. We have provided evidence for the occurrence of high CRP and IL-6 levels in chronic dialytic patients exposed to contaminate dialysate and suggest that backfiltration may induce a chronic, slowly developing inflammatory state that may be abrogated by avoiding backfiltration of contaminate dialysate. Therefore, CRP is implicated as a marker linking bioincompatibility associated with backfiltration and increased cytokine production with a clinical state of chronic inflammation

Predictive value of HDL function in patients with coronary artery disease: relationship with coronary plaque characteristics and clinical events

BACKGROUND: HDL is endowed with several metabolic, vascular, and immunoinflammatory protective functions. Among them, a key property is to promote reverse cholesterol transport from cells back to the liver. The aim of this study was to estimate the association of scavenger receptor class B type I (SR-BI)- and ATP binding cassette transporter A1 (ABCA1)-mediated cholesterol efflux (the two major routes for cholesterol efflux to HDL) with the presence, extent, and severity of coronary artery disease (CAD), vascular wall remodelling processes, coronary plaque characteristics, and the incidence of myocardial infarction in the different subgroups of patients from the CAPIRE study. METHODS: Patients (n = 525) from the CAPIRE study were divided into two groups: low-risk factors (RF), with 0–1 RF (n = 263), and multiple-RF, with ≥2 RFs; within each group, subjects were classified as no-CAD or CAD based on the segment involvement score (SIS) evaluated by coronary computed tomography angiography (SIS = 0 and SIS > 5, respectively). SR-BI- and ABCA1-mediated cholesterol efflux were measured using the plasma of all patients. RESULTS: SR-BI-mediated cholesterol efflux was significantly reduced in patients with CAD in both the low-RF and multiple-RF groups, whereas ABCA1-mediated cholesterol efflux was similar among all groups. In CAD patients, multivariable analysis showed that SR-BI-mediated cholesterol efflux <25(th) percentile predicted cardiovascular outcome (odds ratio 4.1; 95% CI: 1.3–13.7; p = .019), whereas ABCA-1-mediated cholesterol efflux and HDL-C levels significantly did not. Despite this finding, reduced SR-BI-mediated cholesterol efflux was not associated with changes in high-risk plaque features or changes in the prevalence of elevated total, non-calcified, and low-attenuation plaque volume. CONCLUSION: KEY MESSAGES: Increased cholesterol efflux capacity, an estimate of HDL function, is associated with a reduced CVD risk, regardless of HDL-C levels. HDL-C levels are significantly lower in patients with CAD. Lower SR-BI-mediated cholesterol efflux capacity is observed in patients with diffuse coronary atherosclerosis and is associated with the worst clinical outcomes in patients with CAD, independently of atherosclerotic plaque features

Coronary atherosclerosis in outlier subjects at the opposite extremes of traditional risk factors: Rationale and preliminary results of the Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation (CAPIRE) study

Although it is generally accepted that cardiac ischemic events develop when coronary atherosclerosis (coronary artery disease [CAD]) has reached a critical threshold, this is true only to a first approximation. Indeed, there are patients with severe CAD who do not develop ischemic events; conversely, at the other extreme, individuals with minimal CAD may do. Similar exceptions to this paradigm include patients with diffuse CAD with a low risk factor (RF) profile and others with multiple RFs who develop only mild or no CAD. Therefore, the CAPIRE project was designed to investigate whether the specific study of these extreme outlier populations could provide clues for identification of yet unknown risk or protective factors for CAD and ischemic events. In the CAPIRE study, 481 subjects without previous symptoms or history of ischemic heart disease and normal left ventricular systolic function undergoing coronary computed tomography angiography have been selected based on coronary computed tomography angiography findings and cardiovascular RF profile. Therefore, in the whole population, 2 extreme outlier populations have been identified: (1) subjects with no CAD despite multiple RFs, and (2) at the opposite extreme, subjects with diffuse CAD despite a low-risk profile. Each subject has been characterized by clinical, anatomical imaging variables of CAD and baseline circulating biomarkers. Blood samples were collected and stored in a biological bank for further advanced investigations. The project is designed as a prospective, observational, international multicenter study with an initial cross-sectional analysis of clinical, imaging, and biomolecular variables in the selected groups and a longitudinal 5-year follow-up

3D right ventricular endocardium segmentation in cardiac magnetic resonance images by using a new inter-modality statistical shape modelling method

Objective Statistical shape modelling (SSM) has established as a powerful method for segmenting the left ventricle in cardiac magnetic resonance (CMR) images However, applying them to segment the right ventricle (RV) is not straightforward because of the complex structure of this chamber. Our aim was to develop a new inter-modality SSM-based approach to detect the RV endocardium in CMR data. Methods Real-time transthoracic 3D echocardiographic (3DE) images of 219 retrospective patients were used to populate a large database containing 4347 3D RV surfaces and train a model. The initial position, orientation and scale of the model in the CMR stack were semi-automatically derived. The detection process consisted in iteratively deforming the model to match endocardial borders in each CMR plane until convergence was reached. Clinical values obtained with the presented SSM method were compared with gold-standard (GS) corresponding parameters. Results CMR images of 50 patients with different pathologies were used to test the proposed segmentation method. Average processing time was 2 min (including manual initialization) per patient. High correlations (r2 > 0.76) and not significant bias (Bland-Altman analysis) were observed when evaluating clinical parameters. Quantitative analysis showed high values of Dice coefficient (0.87 ± 0.03), acceptable Hausdorff distance (9.35 ± 1.51 mm) and small point-to-surface distance (1.91 ± 0.26 mm). Conclusion A novel SSM-based approach to segment the RV endocardium in CMR scans by using a model trained on 3DE-derived RV endocardial surfaces, was proposed. This inter-modality technique proved to be rapid when segmenting the RV endocardium with an accurate anatomical delineation, in particular in apical and basal regions

Impact of Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients with Multivessel Coronary Artery Disease: Insights from the SYNTAX III REVOLUTION Trial

Background: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFRCT) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFRCT on heart team's treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease. Methods: The trial was an international, multicenter study randomizing 2 heart teams to make a treatment decision between percutaneous coronary interventions and coronary artery bypass grafting using either coronary computed tomography angiography or conventional angiography. The heart teams received the FFRCT and had to make a treatment decision and planning integrating the functional component of the stenoses. Each heart team calculated the anatomic SYNTAX score, the noninvasive functional SYNTAX score and subsequently integrated the clinical information to compute the SYNTAX score III providing a treatment recommendation, that is, coronary artery bypass grafting, percutaneous coronary intervention, or equipoise coronary artery bypass grafting-percutaneous coronary intervention. The primary objective was to determine the proportion of patients in whom FFRCT changed the treatment decision and planning. Results: Overall, 223 patients were included. Coronary computed tomography angiography assessment was feasible in 99% of the patients and FFRCT analysis in 88%. FFRCT was available for 1030 lesions (mean FFRCT value 0.64\ub113). A treatment recommendation of coronary artery bypass grafting was made in 24% of the patients with coronary computed tomography angiography with FFRCT. The addition of FFRCT changed the treatment decision in 7% of the patients and modified selection of vessels for revascularization in 12%. With conventional angiography as reference, FFRCT assessment resulted in reclassification of 14% of patients from intermediate and high to low SYNTAX score tertile. Conclusions: In patients with 3-vessel coronary artery disease, a noninvasive physiology assessment using FFRCT changed heart team's treatment decision-making and procedural planning in one-fifth of the patients

Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE) in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC) in 2008 and simplified PESI score (sPESI).Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC) Curves (AUCs) and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpointsResults: All cause in-hospital mortality was 25% (16.6% PE related) in high risk, 8.7% (4.7%) in intermediate risk and 3.8% (1.2%) in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related) in patients with sPESI score ≥1 and 0% (0%) in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084) and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11). Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI: 0.606-0.707 versus ESC 0.512, 95% CI: 0.459-0.565, difference between AUCs 0.145, p=0.34). In hemodynamically stable patients, the combined endpoint in-hospital PE-related mortality and/or fatal or major bleeding (adverse events) occurred in 0% of patients with low risk ESC model and sPESI score 0, whilst it occurred in 5.5% of patients with low-risk ESC model but sPESI ≥1. In intermediate risk patients according to ESC model, adverse events occurred in 3.6% of patients with sPESI score 0 and 6.65% of patients with sPESI score ≥1.Conclusions: In real world, predictive performance of sPESI and the hemodynamic/biomarkers-based ESC model as prognosticator of in-hospital mortality and bleedings is similar. Combination of sPESI 0 with low risk ESC model may identify patients with very low risk of adverse events and candidate for early hospital discharge or home treatment.

The Performance of Preloaded Bolts in Seismically Prequalified Steel Joints in a Fire Scenario

Seismically pre-qualified beam-to-column joints guarantee large ductility in seismic scenarios thanks to the effectiveness of the design rules and technological requirements that are devoted to avoiding the failure of brittle components (i.e., bolts and welds). However, their performance under different severe actions like those induced by fire has not been properly investigated. Therefore, a parametric study based on finite element simulations has been carried out with the aim to verify the effectiveness of local details of seismically prequalified joints under fire. Finite element analyses were carried out on beam-to-column assemblies sub-structured from a reference archetype building accounting for both material and geometrical imperfections. The bolts&rsquo; internal actions were monitored in all the investigated specimens varying the applied vertical loads. The results show that the seismic design rules adopted to size the bolts are effective to resist the large increase in shear forces in the bolts occurring under fire. Thus, the investigated joints provide satisfactory ductility and rotation capacity at high temperature preventing the failure of bolts; further analysis could be conducted to investigated the fire performance of the investigated joints in a seismic scenario

E-POD investigations of turbulent premixed flame dynamics approaching lean blow-out conditions

Thanks to the continuous computational power increase, the use of high-fidelity computational fluid dynamics (CFD) simulations is nowadays customary, especially in the gas turbines design process. The extraordinary temporal and spatial detail of such analyses generate large datasets, which must be carefully studied to correlate different quantities and gain information to characterize the behavior of combustor designs. Several advanced post-processing tools have been proposed; however, the Extended-POD (E-POD) holds the greatest potential for turbulent combustion applications when the mutual influence of different quantities is the main goal of the investigation. The present work investigates the application of the E-POD to an LES model of a perfectly-premixed, swirl-stabilized, methane-air flame approaching Lean-Blow-Out. Leveraging the validation against the experimental data at two different operating conditions on a laboratory test case, the numerical model has been used to collect several quantities of interest for shedding light on the flow-flame interaction near the blow-out. The post-processing algorithm has been used to highlight the differences between two conditions approaching the extinction at distinct air-flow velocities. It has been found that, when the burner is operated with a higher velocity, the flame is subjected to a cyclic low-frequency breakdown around the internal recirculation zone, leading to an ingestion of cold products from the external parts of the combustor toward the center. Although other local effects acting on the flame brush have been found in both conditions, they are related mainly to higher order coherent structures with a lower energy content. As a result, their impact onto flame stability is found to be of secondary importance since their limited interaction with flame stabilization. The work shows that E-POD represents a powerful tool for investigating the key features of flame dynamics even at near-blow-out conditions, constituting a valid algorithm for interpreting the results of CFD analyses on gas turbines combustors

Osteopontin as Candidate Biomarker of Coronary Disease despite Low Cardiovascular Risk: Insights from CAPIRE Study

Stratification according high cardiovascular (CV) risk categories, still represents a clinical challenge. In this analysis of the CAPIRE study (NCT02157662), we investigate whether inflammation could fit between CV risk factors (RFs) and the presence of coronary artery disease (CAD). In total, 544 patients were included and categorized according with the presence of CAD and CV risk factor burden (low/multiple). The primary endpoint was to verify any independent association of neutrophil-related biomarkers with CAD across CV risk categories. The highest values of osteopontin (OPN) were detected in the low RF group and associated with CAD (23.2 vs. 19.4 ng/mL; p = 0.001), although no correlation with plaque extent and/or composition were observed. Conversely, myeloperoxidase (MPO) and resistin did not differ by CAD presence. Again, OPN was identified as independent variable associated with CAD but only in the low RF group (adjOR 8.42 [95% CI 8.42&ndash;46.83]; p-value = 0.015). As an ancillary finding, a correlation linked OPN with the neutrophil degranulation biomarker MPO (r = 0.085; p = 0.048) and resistin (r = 0.177; p = 3.4 &times; 10&minus;5). In the present study, OPN further strengthens its role as biomarker of CAD, potentially bridging subclinical CV risk with development of atherosclerosis