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Università degli Studi di Triest

3D CFD Transient Analysis of the Forces Acting on the Spool of a Directional Valve

Abstract In this paper, a study of a hydraulic directional valve using a tridimensional fluid-dynamic approach will be shown. During the valve spool displacement, the fluid-dynamics inside the valve creates forces who could reduce the valve performance. The adopted methodology allowed the valve designer to study the complex fluid-dynamic behavior inside the valve and greatly help them to design the internal geometry with the objective of improving the valve performance. This paper shows how a tridimensional fluid-dynamic approach can help engineers to develop the best valve geometry reducing the prototyping requirement and finally the time-to-market and, consequently, the development cost

259 Incidence, predictors, and prognostic role of complications occurring during intracoronary provocative test with acetylcholine in patients with myocardial ischaemia and non-obstructive coronary arteries

Abstract Aims Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischaemia and non-obstructive coronary arteries. However, data on safety, predictors, and prognostic role of complications during intracoronary provocative testing are scarce. We aimed at assessing the safety of ACh provocative test in patients with myocardial ischaemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test. Methods and results We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-h ECG dynamic Holter monitoring and angina status were assessed at follow-up. We enrolled 310 patients [mean age 60.6 ± 11.9; 169 (54.5%) chronic coronary syndromes (CCS) and 141 (45.5%) with myocardial infarction and non-obstructive coronary arteries (MINOCA)]. The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS [10 (7.1%) vs. 18 (10.7%), P = 0.276, respectively]. At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation [odds ratio (OR): 12.324, confidence interval (CI): 95% (4.641–32.722), P = 0.015] and moderate/severe diastolic dysfunction [OR: 3.827, 95% CI (1.296–11.304), P = 0.015] were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden. Conclusions Intracoronary provocative testing with ACh test is safe in patients with myocardial ischaemia and non-obstructive coronary arteries (including MINOCA patients). History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. However, occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events, and angina burden

Burning Fog: Cognitive Impairment in Burning Mouth Syndrome

Background: Due to its common association with chronic pain experience, cognitive impairment (CI) has never been evaluated in patients with burning mouth syndrome (BMS). The purpose of this study is to assess the prevalence of CI in patients with BMS and to evaluate its relationship with potential predictors such as pain, mood disorders, blood biomarkers, and white matter changes (WMCs). Methods: A case-control study was conducted by enrolling 40 patients with BMS and an equal number of healthy controls matched for age, gender, and education. Neurocognitive assessment [Mini Mental State Examination (MMSE), Digit Cancellation Test (DCT), the Forward and Backward Digit Span task (FDS and BDS), Corsi Block-Tapping Test (CB-TT), Rey Auditory Verbal Learning Test (RAVLT), Copying Geometric Drawings (CGD), Frontal Assessment Battery (FAB), and Trail Making A and B (TMT-A and TMT-B)], psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 36-Item Short Form Health Survey (SF-36)], and pain assessment [Visual Analogic Scale (VAS), Total Pain Rating index (T-PRI), Brief Pain Inventory (BPI), and Pain DETECT Questionnaire (PD-Q)] were performed. In addition, blood biomarkers and MRI of the brain were recorded for the detection of Age-Related WMCs (ARWMCs). Descriptive statistics, the Mann-Whitney U-test, the Pearson Chi-Squared test and Spearman's correlation analysis were used. Results: Patients with BMS had impairments in most cognitive domains compared with controls (p < 0.001**) except in RAVLT and CGD. The HAM-D, HAM-A, PSQI, ESS, SF-36, VAS, T-PRI, BPI and PD-Q scores were statistically different between BMS patients and controls (p < 0.001**) the WMCs frequency and ARWMC scores in the right temporal (RT) and left temporal (LT) lobe were higher in patients with BMS (p = 0.023*). Conclusions: Meanwhile, BMS is associated with a higher decline in cognitive functions, particularly attention, working memory, and executive functions, but other functions such as praxis-constructive skills and verbal memory are preserved. The early identification of CI and associated factors may help clinicians to identify patients at risk of developing time-based neurodegenerative disorders, such as Alzheimer's disease (AD) and vascular dementia (VD), for planning the early, comprehensive, and multidisciplinary assessment and treatment

Extended Adjuvant Endocrine Treatment in Luminal Breast Cancers in the Era of Genomic Tests

In patients with early-stage endocrine receptor-positive (ER+) breast cancer (BC), adjuvant endocrine therapy (ET) for 5 years is the standard of care. However, for some patients, the risk of recurrence remain high for up to 15 years after diagnosis and extended ET beyond 5 years may be a reasonable option. Nevertheless, this strategy significantly increases the occurrence of side effects. Here we summarize the available evidence from randomized clinical trials on the efficacy and safety profile of extended ET and discuss available clinical and genomic tools helpful to select eligible patients in daily clinical practice

ISMuLT Guidelines for muscle injuries

Muscle injuries are frequent in high demand sports. No guidelines are available in the scientific literature. ISMuLT, the "Italian Society of Muscles, Ligaments and Tendons", in line with its multidisciplinary mission, is proud to cover this gap

Change in Eosinophil Count in Patients with Heart Failure Treated with Anakinra

Background: Interleukin-1 blockade with anakinra leads to a transient increase in eosinophil blood count (eosinophils) in patients with acute myocardial infarction. We aimed to investigate the effect of anakinra on changes in eosinophils in patients with heart failure (HF) and their correlation with cardiorespiratory fitness (CRF). Methods: We measured eosinophils in 64 patients with HF (50% females), 55 (51-63) years of age, before and after treatment, and, in a subset of 41 patients, also after treatment cessation. We also evaluated CRF, measuring peak oxygen consumption (VO2) with a treadmill test. Results: Treatment with anakinra significantly and transiently increased eosinophils, from 0.2 [0.1-0.3] to 0.3 [0.1-0.4] x 10(3) cells/mu L (p &lt; 0.001) and from 0.3 [0.2-0.5] to 0.2 [0.1-0.3] x 10(3) cells/mu L, with suspension (p &lt; 0.001). Changes in eosinophils correlated with the changes in peak VO2 (Spearman's Rho = +0.228, p = 0.020). Eosinophils were higher in patients with injection site reactions (ISR) (n = 8, 13%; 0.5 [0.4-0.6] vs. 0.2 [0.1-0.4] x 10(3) cells/mu L, p = 0.023), who also showed a greater increase in peak VO2 (3.0 [0.9-4.3] vs. 0.3 [-0.6-1.8] mLO(2)center dot kg(-1)center dot min(-1), p = 0.015). Conclusion: Patients with HF treated with anakinra experience a transient increase in eosinophils, which is associated with ISR and a greater improvement in peak VO2

Notulae to the Italian alien vascular flora 6

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions of taxa in the genera Acalypha, Acer, Canna, Cardamine, Cedrus, Chlorophytum, Citrus, Cyperus, Epilobium, Eucalyptus, Euphorbia, Gamochaeta, Hesperocyparis, Heteranthera, Lemna, Ligustrum, Lycium, Nassella, Nothoscordum, Oenothera, Osteospermum, Paspalum, Pontederia, Romulea, Rudbeckia, Salvia, Sesbania, Setaria, Sicyos, Styphnolobium, Symphyotrichum, and Tradescantia. Nomenclature and distribution updates, published elsewhere, and corrigenda are provided as supplementary material

C-Reactive Protein and N-Terminal Pro-brain Natriuretic Peptide Levels Correlate With Impaired Cardiorespiratory Fitness in Patients With Heart Failure Across a Wide Range of Ejection Fraction

Background: Impaired cardiorespiratory fitness (CRF) is a hallmark of heart failure (HF). Serum levels of C-reactive protein (CRP), a systemic inflammatory marker, and of N-terminal pro-brain natriuretic peptide (NT-proBNP), a biomarker of myocardial strain, independently predict adverse outcomes in HF patients. Whether CRP and/or NT-proBNP also predict the degree of CRF impairment in HF patients across a wide range of ejection fraction is not yet established.Methods: Using retrospective analysis, 200 patients with symptomatic HF who completed one or more treadmill cardiopulmonary exercise tests (CPX) using a symptom-limited ramp protocol and had paired measurements of serum high-sensitivity CRP and NT-proBNP on the same day were evaluated. Univariate and multivariate correlations were evaluated with linear regression after logarithmic transformation of CRP (log10) and NT-proBNP (logN).Results: Mean age of patients was 57 ± 10 years and 55% were male. Median CRP levels were 3.7 [1.5–9.0] mg/L, and NT-proBNP levels were 377 [106–1,464] pg/ml, respectively. Mean peak oxygen consumption (peak VO2) was 16 ± 4 mlO2•kg−1•min−1. CRP levels significantly correlated with peakVO2 in all patients (R = −0.350, p &lt; 0.001) and also separately in the subgroup of patients with reduced left ventricular ejection fraction (LVEF) (HFrEF, N = 109) (R = −0.282, p &lt; 0.001) and in those with preserved EF (HFpEF, N = 57) (R = −0.459, p &lt; 0.001). NT-proBNP levels also significantly correlated with peak VO2 in all patients (R = −0.330, p &lt; 0.001) and separately in patients with HFrEF (R = −0.342, p &lt; 0.001) and HFpEF (R = −0.275, p = 0.032). CRP and NT-proBNP did not correlate with each other (R = 0.05, p = 0.426), but independently predicted peak VO2 (R = 0.421, p &lt; 0.001 and p &lt; 0.001, respectively).Conclusions: Biomarkers of inflammation and myocardial strain independently predict peak VO2 in HF patients. Anti-inflammatory therapies and therapies alleviating myocardial strain may independently improve CRF in HF patients across a large spectrum of LVEF