Long term effects of mesoglycan on brachial arterial stiffness and MMP-9/TIMP-1 system in patients with metabolic syndrome

Objectives: The aim of this study was to evaluate the chronic effects of mesoglycan on the vascular remodeling in patients with metabolic syndrome (Mets). Background: MetS is defined by a clustering of vascular risk factors that require both pharmacologic and non-pharmacologic interventions, including body weight reductions and physical activity. The correction of vascular remodeling associated with MetS has lately received increasing interest. Methods: Thirty consecutive ambulatory patients affected by MetS were 2:1 randomized in a doubleblind fashion to receive mesoglycan or placebo, respectively. At the beginning and after 90 days of oral treatment we appraised the effects of mesoglycan (50 mg per os bid) or placebo on vascular remodeling, as assessed by the measurement of arterial wall elastic properties. Moreover, the matrix metalloproteinase’s (MMPs) type 9 and tissue inhibitor of metalloproteinase (TIMP) type 1 were analyzed by enzyme-linked immune sorbent assay (ELISA) and gelatin substrate zymography at the beginning of the study and after 90 days of treatment. Results: After 90 days of treatment, a marked improvement of arterial distensibility and compliance was detected in Mesoglycan group, with associated significant reduction of arterial stiffness, and a significant reduction of serum levels of MMP-9 and TIMP-1 and significant reduction of enzyme activity of MMPs. Conclusions: This small, preliminary study shows that mesoglycan exerts relevant effects on vascular remodeling after three-month treatment, in patients affected by metabolic syndrome

Cardiac sympathetic dysfunction in pulmonary arterial hypertension: Lesson from left-sided heart failure

Sympathetic nervous system hyperactivity has a well-recognized role in the pathophysiology of heart failure with reduced left ventricular ejection fraction. Alterations in sympathetic nervous system have been related to the pathophysiology of pulmonary arterial hypertension, but it is unclear whether cardiac sympathetic nervous system is impaired and how sympathetic dysfunction correlates with hemodynamics and clinical status in pulmonary arterial hypertension patients. The aim of this study was to evaluate the cardiac sympathetic nervous system activity by means of 123Iodine-metaiodobenzylguanidine nuclear imaging in pulmonary arterial hypertension patients and to explore its possible correlation with markers of disease severity. Twelve consecutive pulmonary arterial hypertension patients (nine women, median age 56.5 (17.8), eight idiopathic and four connective tissue-associated pulmonary arterial hypertension) underwent cardiac 123Iodine-metaiodobenzylguanidine scintigraphy. The results were compared with those of 12 subjects with a negative history of cardiovascular or pulmonary disease who underwent the same nuclear imaging test because of a suspected paraganglioma or pheochromocytoma, with a negative result (controls), and 12 patients with heart failure with reduced left ventricular ejection fraction. Hemodynamics, echocardiography, six-minute walking distance, cardiopulmonary exercise testing, and N-terminal pro brain natriuretic peptide were collected in pulmonary arterial hypertension patients within one week from 123Iodine-metaiodobenzylguanidine scintigraphy. Cardiac 123Iodine-metaiodobenzylguanidine uptake, assessed as early and late heart-to-mediastinum ratio, was significantly lower in pulmonary arterial hypertension compared to controls (p = 0.001), but similar to heart failure with reduced left ventricular ejection fraction. Myocardial 123Iodine-metaiodobenzylguanidine turnover, expressed as washout rate, was similar in pulmonary arterial hypertension and heart failure with reduced left ventricular ejection fraction and significantly higher compared to controls (p = 0.016). In the pulmonary arterial hypertension group, both early and late heart-to-mediastinum ratios and washout rate correlated with parameters of pulmonary arterial hypertension severity including pulmonary vascular resistance, right atrial pressure, tricuspid annular plane systolic excursion, N-terminal pro brain natriuretic peptide, and peak VO2. Although we evaluated a small number of subjects, our study showed a significant impairment in cardiac sympathetic nervous system in pulmonary arterial hypertension, similarly to that observed in heart failure with reduced left ventricular ejection fraction. This impairment correlated with indices of pulmonary arterial hypertension severity. Cardiac sympathetic dysfunction may be a contributing factor to the development of right-sided heart failure in pulmonary arterial hypertension

Time-weighted lactate as a predictor of adverse outcome in acute heart failure

The role of dynamic changes in lactate concentrations on prognosis in acute heart failure has been poorly investigated. The aim of this study was to explore the predictive value of 24 h time-weighted lactate (LACTW ) in patients with acute heart failure

Anatomy of Cerebral Arteries with Clinical Aspects in Patients with Ischemic Stroke

Computed tomography (CT) angiography is the main method for the initial evaluation of cerebral circulation in acute stroke. A comprehensive CT examination that includes a review of the three-dimensional and maximum-intensity projection images of the main intra and extracranial arteries allows the identification of most abnormalities and normal variants. Anatomical knowledge of the presence of any normal variants, such as fenestration, duplications, and persistent fetal arteries, plays a crucial role in the diagnosis and therapeutic management of acute stroke. However, the opposite is also true. In fact, sometimes it is the clinical picture that allows weighing how relevant or not the alteration found is. Therefore, in this review, a concise representation of the clinical picture attributable to a given arterial vessel will be included

Design and Control of a Sensorized Trolley for the Measurement of Industrial Craneways

The measurement of the static position of rails in overhead industrial cranes is crucial to prevent failures and reduce undesired wearing effects due to wheels' contact. The traditional procedure used to verify the rail alignment is based on manual operations, which can be overcome with the automatic methodology described in this paper. Through the design and building of a motorized trolley, the optical target point identifying the rail position is able to move automatically under remote wireless control. The measurement procedure is carried out considering one rail at a time and the data acquired on the two rails are then analyzed together by a specific software. Additional sensors embedded in the trolley allow to provide different parameters about the rail positioning and about the conditions of its surface. The system can be integrated in a laser tracking total station and can be controlled by the operator from the ground assuring a time reduction during installation and maintenance operations and greater safety for the operato

Progettazione di un carrello sensorizzato per misure in linea delle vie di corsa di carriponte industriali

Nel presente lavoro si presenta l'attività di progettazione e simulazione di un sistema di misura per la posa e la verifica funzionale di binari di carriponte industriali. Il principale problema che si presenta durante l'installazione delle vie di corsa di tali impianti è rappresentato dal rispetto di tolleranze dimensionali stringenti in relazione alle dimensioni dell'impianto stesso, che talora può superare alcune centinaia di metri di lunghezza e prevede la possibilità di forti irregolarità geometriche dei supporti in muratura. Un secondo problema è inerente l'analisi dello stato di usura e degrado del binario, inclusi disallineamenti fra tratti adiacenti e variazioni della posizione nominale. Il sistema proposto e sviluppato in collaborazione con partner industriali del settore, consiste in un carrello sensorizzato dotato di riferimento ottico mobile, la cui posizione viene rilevata in tempo reale da una stazione totale laser per applicazioni industriali posto a terra. Il carrello sensorizzato è stato oggetto di brevetto industrial

From Nucleotides to Satellite Imagery: Approaches to Identify and Manage the Invasive Pathogen Xylella fastidiosa and Its Insect Vectors in Europe

Biological invasions represent some of the most severe threats to local communities and ecosystems. Among invasive species, the vector-borne pathogen Xylella fastidiosa is responsible for a wide variety of plant diseases and has profound environmental, social and economic impacts. Once restricted to the Americas, it has recently invaded Europe, where multiple dramatic outbreaks have highlighted critical challenges for its management. Here, we review the most recent advances on the identification, distribution and management of X. fastidiosa and its insect vectors in Europe through genetic and spatial ecology methodologies. We underline the most important theoretical and technological gaps that remain to be bridged. Challenges and future research directions are discussed in the light of improving our understanding of this invasive species, its vectors and host–pathogen interactions. We highlight the need of including different, complimentary outlooks in integrated frameworks to substantially improve our knowledge on invasive processes and optimize resources allocation. We provide an overview of genetic, spatial ecology and integrated approaches that will aid successful and sustainable management of one of the most dangerous threats to European agriculture and ecosystems

Diaphragmatic motility assessment in COPD exacerbation, early detection of Non-Invasive Mechanical Ventilation failure: a pilot study

Background Patients with respiratory failure due to Chronic Obstructive Pulmonary Disease (COPD) have decreased diaphragmatic mobility [1]. Non Invasive Mechanical Ventilation (NIMV) is a cornerstone in COPD exacerbation therapy. The availability of early predictors of NIMV failure may be helpful to guide decision-making. Only pH, respiratory rate and PaO2/FiO2 have been considered predictors of response to NIMV [2]. Ultrasonographic (US) assessment of diaphragmatic kinetic is a fast, reliable and reproducible method [3], but its predictive value on NIMV success is not known.Objective:Primary endpoint was to evaluate if the diaphragmatic excursion measurement was able to predict a longer weaning time. Secondary endpoint was to find out a cut-off value of diaphragmatic excursion and a weaning time interval able to predict worst outcome. Methods: Fifty-two (39 males, aged 71±7 years) Caucasian patients with COPD exacerbation treated with NIMV were enrolled. Diaphragm motility was assessed by ultrasonography before starting ventilation at 6 and 24 hours and at the weaning from NIMV. The diaphragmatic excursion (centimeters); the inspiratory and expiratory times (seconds); the inspiration and expiration velocity (cm/sec), the breathing period (seconds), the diaphragm motion time (seconds) and the diaphragm resting time (seconds) were evaluated. Results: Forty-five patients completed the study. The mean time on NIMV was 4.11 ± 1.07 days, with a total time of ventilation of 32.6 ± 86 hours. All the ultrasound diaphragm motility parameters, except for inspiration and expiration velocity, significantly improved at the weaning. Diaphragm excursion at the baseline was significantly correlated with pH (r=0.458; p=0.002), PaO2/FiO2 (r=0.567; p<0.001), and weaning time (r=0.774; p<0.0001). In a multiple linear regression analysis only diaphragm excursion was significantly associated with longer weaning time (coefficient of estimated model -9.247; Standard Error 3.101; p=0.003). ROC curve with weaning time longer than 36 hours was considered as positive state. The AUC value was 0.912 (Standard Error 0.015, p<0.001). The higher sensitivity rate (100%) was achieved with a specificity rate of 86.7% and a cut-off value of 3.165 cm, therefore patients with an excursion lower than 3.165 cm should be weaned after at least 36 hours, while patients with an excursion higher than 3.165 cm could be weaned within 36 hours. Conclusion: US measurements of diaphragmatic performance may have a role in the early evaluation of exacerbation of COPD and in predicting the response to NIMV therapy, it should be included as a routine test in patients presenting to ED with ECOPD