When collateral vessels matter: asymptomatic Leriche syndrome

While acute arterial occlusion causes life-threatening ischemia and organ damage requiring urgent revascularization, the incidental identification of arterial occlusions in asymptomatic patients represents a therapeutic dilemma in clinicians. Does chronic asymptomatic artery occlusion require specific treatment

Five carbon- and nitrogen-bearing species in a hot giant planet's atmosphere

The atmospheres of gaseous giant exoplanets orbiting close to their parent stars (hot Jupiters) have been probed for nearly two decades. They allow us to investigate the chemical and physical properties of planetary atmospheres under extreme irradiation conditions. Previous observations of hot Jupiters as they transit in front of their host stars have revealed the frequent presence of water vapour and carbon monoxide in their atmospheres; this has been studied in terms of scaled solar composition under the usual assumption of chemical equilibrium. Both molecules as well as hydrogen cyanide were found in the atmosphere of HD 209458b, a well studied hot Jupiter (with equilibrium temperature around 1,500 kelvin), whereas ammonia was tentatively detected there and subsequently refuted. Here we report observations of HD 209458b that indicate the presence of water (H2O), carbon monoxide (CO), hydrogen cyanide (HCN), methane (CH4), ammonia (NH3) and acetylene (C2H2), with statistical significance of 5.3 to 9.9 standard deviations per molecule. Atmospheric models in radiative and chemical equilibrium that account for the detected species indicate a carbon-rich chemistry with a carbon-to-oxygen ratio close to or greater than 1, higher than the solar value (0.55). According to existing models relating the atmospheric chemistry to planet formation and migration scenarios, this would suggest that HD 209458b formed far from its present location and subsequently migrated inwards. Other hot Jupiters may also show a richer chemistry than has been previously found, which would bring into question the frequently made assumption that they have solar-like and oxygen-rich compositions.Comment: As part of the Springer Nature Content Sharing Initiative, it is possible to access a view-only version of this paper by using the following SharedIt link: https://rdcu.be/cifr

Ground-breaking Exoplanet Science with the ANDES spectrograph at the ELT

In the past decade the study of exoplanet atmospheres at high-spectral resolution, via transmission/emission spectroscopy and cross-correlation techniques for atomic/molecular mapping, has become a powerful and consolidated methodology. The current limitation is the signal-to-noise ratio during a planetary transit. This limitation will be overcome by ANDES, an optical and near-infrared high-resolution spectrograph for the ELT. ANDES will be a powerful transformational instrument for exoplanet science. It will enable the study of giant planet atmospheres, allowing not only an exquisite determination of atmospheric composition, but also the study of isotopic compositions, dynamics and weather patterns, mapping the planetary atmospheres and probing atmospheric formation and evolution models. The unprecedented angular resolution of ANDES, will also allow us to explore the initial conditions in which planets form in proto-planetary disks. The main science case of ANDES, however, is the study of small, rocky exoplanet atmospheres, including the potential for biomarker detections, and the ability to reach this science case is driving its instrumental design. Here we discuss our simulations and the observing strategies to achieve this specific science goal. Since ANDES will be operational at the same time as NASA's JWST and ESA's ARIEL missions, it will provide enormous synergies in the characterization of planetary atmospheres at high and low spectral resolution. Moreover, ANDES will be able to probe for the first time the atmospheres of several giant and small planets in reflected light. In particular, we show how ANDES will be able to unlock the reflected light atmospheric signal of a golden sample of nearby non-transiting habitable zone earth-sized planets within a few tenths of nights, a scientific objective that no other currently approved astronomical facility will be able to reach.Comment: 66 pages (103 with references) 20 figures. Submitted to Experimental Astronom

Spectrum of mutations in Italian patients with familial hypercholesterolemia: New results from the LIPIGEN study

Background Familial hypercholesterolemia (FH) is an autosomal dominant disease characterized by elevated plasma levels of LDL-cholesterol that confers an increased risk of premature atherosclerotic cardiovascular disease. Early identification and treatment of FH patients can improve prognosis and reduce the burden of cardiovascular mortality. Aim of this study was to perform the mutational analysis of FH patients identified through a collaboration of 20 Lipid Clinics in Italy (LIPIGEN Study). Methods We recruited 1592 individuals with a clinical diagnosis of definite or probable FH according to the Dutch Lipid Clinic Network criteria. We performed a parallel sequencing of the major candidate genes for monogenic hypercholesterolemia (LDLR, APOB, PCSK9, APOE, LDLRAP1, STAP1). Results A total of 213 variants were detected in 1076 subjects. About 90% of them had a pathogenic or likely pathogenic variants. More than 94% of patients carried pathogenic variants in LDLR gene, 27 of which were novel. Pathogenic variants in APOB and PCSK9 were exceedingly rare. We found 4 true homozygotes and 5 putative compound heterozygotes for pathogenic variants in LDLR gene, as well as 5 double heterozygotes for LDLR/APOB pathogenic variants. Two patients were homozygous for pathogenic variants in LDLRAP1 gene resulting in autosomal recessive hypercholesterolemia. One patient was found to be heterozygous for the ApoE variant p.(Leu167del), known to confer an FH phenotype. Conclusions This study shows the molecular characteristics of the FH patients identified in Italy over the last two years. Full phenotypic characterization of these patients and cascade screening of family members is now in progress

Contemporary lipid-lowering management and risk of cardiovascular events in homozygous familial hypercholesterolaemia: insights from the Italian LIPIGEN Registry

Aims: The availability of novel lipid-lowering therapies (LLTs) has remarkably changed the clinical management of homozygous familial hypercholesterolaemia (HoFH). The impact of these advances was evaluated in a cohort of 139 HoFH patients followed in a real-world clinical setting. Methods and results: The clinical characteristics of 139 HoFH patients, along with information about LLTs and low-density lipoprotein cholesterol (LDL-C) levels at baseline and after a median follow-up of 5 years, were retrospectively retrieved from the records of patients enrolled in the LIPid transport disorders Italian GEnetic Network-Familial Hypercholesterolaemia (LIPIGEN-FH) Registry. The annual rates of major atherosclerotic cardiovascular events (MACE-plus) during follow-up were compared before and after baseline. Additionally, the lifelong survival free from MACE-plus was compared with that of the historical LIPIGEN HoFH cohort. At baseline, LDL-C level was 332 ± 138 mg/dL. During follow-up, the potency of LLTs was enhanced and, at the last visit, 15.8% of patients were taking quadruple therapy. Consistently, LDL-C decreased to an average value of 124 mg/dL corresponding to a 58.3% reduction (Pt < 0.001), with the lowest value (∼90 mg/dL) reached in patients receiving proprotein convertase subtilisin/kexin type 9 inhibitors and lomitapide and/or evinacumab as add-on therapies. The average annual MACE-plus rate in the 5-year follow-up was significantly lower than that observed during the 5 years before baseline visit (21.7 vs. 56.5 per 1000 patients/year; P = 0.0016). Conclusion: Our findings indicate that the combination of novel and conventional LLTs significantly improved LDL-C control with a signal of better cardiovascular prognosis in HoFH patients. Overall, these results advocate the use of intensive, multidrug LLTs to effectively manage HoFH

The GAPS programme with HARPS-N at TNG. X. Differential abundances in the XO-2 planet-hosting binary

Binary stars hosting exoplanets are a unique laboratory where chemical tagging can be performed to measure the elemental abundances of both stellar components with high accuracy, with the aim to investigate the formation of planets and their subsequent evolution. Here, we present a high-precision differential abundance analysis of the XO-2 wide stellar binary based on high-resolution HARPS-N at TNG spectra. Both components are very similar K-dwarfs and host planets. Since they formed presumably within the same molecular cloud, we expect that they possess the same initial elemental abundances. We investigated whether planets can cause some chemical imprints in the stellar atmospheric abundances. We measure abundances of 25 elements for both stars with a range of condensation temperature TC = 40-1741 K, achieving typical precisions of ~0.07 dex. The northern component shows abundances in all elements higher by +0.067 ± 0.032 dex on average, with a mean difference of +0.078 dex for elements with TC > 800 K. The significance of the XO-2N abundance difference relative to XO-2S is at the 2σ level for almost all elements. We discuss that this result might be interpreted as the signature of the ingestion of material by XO-2N or depletion in XO-2S that is due to locking of heavy elements by the planetary companions. We estimate a mass of several tens of M⊕ in heavy elements. The difference in abundances between XO-2N and XO-2S shows a positive correlation with the condensation temperatures of the elements, with a slope of (4.7 ± 0.9) × 10-5 dex K-1, which could mean that both components have not formed terrestrial planets, but first experienced the accretion of rocky core interior to the subsequent giant planets. Based on observations made with the Italian Telescopio Nazionale Galileo (TNG), operated on the island of La Palma by the INAF - Fundación Galileo Galilei at the Roche de los Muchachos Observatory of the Instituto de Astrofísica de Canarias (IAC) in the framework of the large programme Global Architecture of Planetary Systems (GAPS; P.I. A. Sozzetti).Final reduced spectra (FITS) are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/583/A135</A

The GAPS Programme at TNG XXXIX. Multiple molecular species in the atmosphere of the warm Giant Planet WASP-80 b unveiled at high resolution with GIANO-B*

Detections of molecules in the atmosphere of gas giant exoplanets allow us to investigate the physico-chemical properties of the atmospheres. Their inferred chemical composition is used as tracer of planet formation and evolution mechanisms. Currently, an increasing number of detections is showing a possible rich chemistry of the hotter gaseous planets, but whether this extends to cooler giants is still unknown. We observed four transits of WASP-80 b, a warm transiting giant planet orbiting a late-K dwarf star with the near-infrared GIANO-B spectrograph installed at the Telescopio Nazionale Galileo and performed high-resolution transmission spectroscopy analysis. We report the detection of several molecular species in its atmosphere. Combining the four nights and comparing our transmission spectrum to planetary atmosphere models containing the signature of individual molecules within the cross-correlation framework, we find the presence of H2O, CH4, NH3, and HCN with high significance, tentative detection of CO2, and inconclusive results for C2H2 and CO. A qualitative interpretation of these results, using physically motivated models, suggests an atmosphere consistent with solar composition and the presence of disequilibrium chemistry and we therefore recommend the inclusion of the latter in future modeling of sub-1000 K planets

VizieR Online Data Catalog: XO-2N and XO-2S spectra (Biazzo+, 2015)

Final reduced spectra used for the elemental abundance measurements. We observed both XO-2 components with the high resolution HARPS-N@TNG (R~115000, λ~3900-6900Å) spectrograph between November 20, 2012 and October 4, 2014. Solar spectra were also obtained through observations of the asteroid Vesta. The spectra reduction was obtained using the 2013 November version of the HARPS-N instrument data reduction software (DRS) pipeline. A detailed description of the observations and data reduction is reported in Paper II (Desidera et al., 2013A&A...554A..29D) (2 data files). <P /