MORPHOLOGICAL ANALYSIS OF ANCIENT GRAPE SEEDS FROM A SINK IN THE MIDDLE-AGE TOWN OF PALERMO

The archaeological excavations in Piazza della Vittoria, in the Roman-Middle Age town of Palermo (Sicily) put in light a sink 3.20 m deep and 1 square m. large, partially filled by thin organic sediments. Grape seeds (grape-stones), fish scales and few vertebrate bones have been found in specific strata sealed under a stratum chronologically attributed to Islamic Middle-Age period (a post-quem limit). The finding of well preserved grape seeds is peculiar and their study opens the opportunity to improve the actual knowledge about evolution, cultivation, use and trade of Vitis L. in the Mediterranean area. This preliminary work focuses on morphologic and morphometric analysis of the ancient grape seeds with two aims: i) systematically describe the remains collection and, ii) define seeds typology and a consequent morphotaxonomic attribution. Over 200 seeds have been carefully dry cleaned (soft brush), photographed and analyzed for total breadth (B), total length (L) and length of stalk (LS) parameters, the most efficient for typological attribution (1, 2); Stummer index has been also calculated (1). Apical notch length (AN) has been for the first time evaluated. Measurements on digital images have been performed using ImageJ 1.31 platform; morphological parameters have been assembled in a dedicated database. Descriptive analysis and linear correlations have been performed using SYSTAT 10. Analysis of variance (ANOVA) and Tukey’s HSD (5% level of significance, α = 0.05) have been applied. All the parameters approximate a normal distribution. Major variation has been observed in LS (c.v. = 35.6%) and AN (c.v. = 35.6%), while B and L showed a c.v. of 9.5% and 12.6% respectively. All the analyzed parameters behave as independent variables with the exception of a significant correlation between Stummer index and L (R2 = 0.45; y = 8.17-0.047x with y = L and x = Stummer index). This correlation reveals that Stummer index depends more from the L and not from the B parameter. On the base of LS measures three subgroups have been arbitrarily created in relationship with the LS: LS1 0.90 mm (35 seeds). Analyzing together the LS groups toward AN, we have found a proportional and significant correlation (p = 0.05) between the extremes LS1 and LS3. In the entire collection, Stummer index varies from 55.76 to 100.86; in the LS groups, the range is 68.38-97.87 in LS1, 61.02-100.86 in LS2 and 55.76-81.70 in LS3. A small group (17) of seeds has been excluded for the impossibility to measure the stalk. The analyzed ancient grape seeds show a wide range of variability for all the considered parameters, revealing a polymorphic collection. In general, the seeds have a rounded heart-like shape, with a noticeable pointy stalk and a very invaginated apical notch. This typical shape is more marked in LS3 group. On the base of LS measures, LS1 is ascribable to wild grapevines, while LS2 and LS3 seem to be ascribable neither to wild nor to cultivated autochthonous Vitis. Furthermore, these seeds differ from those already described in other archaeological horizons in Italy (3) and in France (2). The Stummer index varies highly, exceeding the known range of wild Vitis vinifera (4), although values close to 100 have been already found in wild grapevines in Spain (5) and values above 80 have been also described in Extra-European Vitis species (6). A deep evaluation of the sample, including isotopic analysis and aDNA studies, is in progress. 1) T. T. Korenčič, J. Jakše, Z. Korošec-Koruza (2008) Veget. Hist. Archaeobot., 17(Suppl. 1), S93-S102 2) L. Bouby, I. Figueiral, A. Bouchette, N. Rovina, S. Ivorra, T. Lacombe, T. Pastor, S. Picq, P. Marinval, J. F. Terral (2013) PLoS ONE, 8(5), e63195 3) C. Milanesi, F. Antonucci, P. Menesatti, C. Costa, C. Faleri, M. Cresti (2011) Interdisciplinaria Archaeologica – Natural Sciences in Archaeology, II(2), 95-100 4) A. Stummer (1911) Mitt. Anthropol. Gesellschaft Wien, 41, 283-296 5) F. M. De Toda, J. C. Sancha (1999) Am. J. Enol. Vitic., 50(4), 443-446 6) D. Rivera, B. Miralles, C. Obón, E. Carreño, J. A. Palazón (2007) Vitis, 46(4), 158-16

TAKO-TSUBO CARDIOMYOPATHY AND THYROID DYSFUNCTION

This work provides important information about the correlation between Tako-Tsubo Cardiomyopathy (TTC) and Thyroid dysfunction (TD). The article gives evidence to how doctors may have to refer to when confronted with a patients with such condiction as thyroid dysfunction and TTC, and the diverse methods that can be used to treat these conditions (TTC with TD)

Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation

Background: Ischemic mitral regurgitation (iMR) predisposes to right ventricular (RV) pressure and volume overload, providing a nidus for RV dysfunction (RVDYS) and non-ischemic fibrosis (NIF). Echocardiography (echo) is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown. Methods: iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR) within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S’, fractional area change [FAC]), and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS]) and parasternal long axis orientation (transverse strain). CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI) and septal NIF. Results: 73 iMR patients were studied; 36% had RVDYS (EF<50%) on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05). CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73) and lowest for RV-S’ (r = 0.43; all p<0.001). RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001). Whereas all RV indices were lower among NIF-affected patients (all p≤0.006), percent change was largest for transverse strain (48.3%). CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001) and transverse strain (r = 0.38, p = 0.002) (R = 0.78, p<0.001). Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87–0.99]|0.91[0.84–0.99], both p<0.001), and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively). Conclusion: Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR

Compliance with herpes zoster vaccination in young and adult individuals in two regions of Italy

Background: The purpose of this work was to explore the knowledge and acceptance of Varicella Zoster Virus (VZV)- Herpes Zoster (HZ) vaccination in the general Italian population, where the HZ vaccine has not yet been distributed, using a prevalence study of subjects from two regions in Italy. Methods: A group of 3,173 individuals were interviewed using a questionnaire. The youngest age group (≤ 20 year) was composed of students interviewed at university. The middle age group (21-40 years) and the older age group (≥ 41 years) were interviewed by general practitioners in their office. Results: In both regions, the majority of subjects had been infected with varicella, and only 165 (5.2%) subjects reported receiving the VZV vaccination. Regarding HZ, 2,749 (86.6%) individuals stated that they knew of the virus and 2,233 (70%) were willing to be vaccinated against HZ. The majority of people willing to be vaccinated were in the middle and older age groups (36.6% and 44.7%, respectively). Conclusion: Compliance versus vaccination results were satisfactory and probably, with the upcoming availability of the HZ vaccine in Italy, adults will be favourably disposed towards vaccination

Use rate and outcome in bilateral internal thoracic artery grafting:Insights From a systematic review and meta-analysis

Background This meta‐analysis was designed to assess whether center experience affects the short‐ and long‐term results and the relative benefits of bilateral internal thoracic artery grafting (BITA) for coronary artery bypass grafting. Methods and Results MEDLINE and EMBASE were searched to identify all articles reporting the outcome of BITA in patients undergoing coronary artery bypass grafting. The BITA center experience was gauged according to the percentage use of BITA in the institutional overall coronary artery bypass grafting population (%BITA). The primary outcome was long‐term all‐cause mortality. Secondary outcomes were operative mortality, perioperative myocardial infarction, perioperative stroke, deep sternal wound infections (DSWIs), and major postoperative adverse event. The rates of the primary and secondary outcomes were calculated after adjusting for %BITA. Primary and secondary outcomes were also compared between the BITA and the single internal thoracic artery arms in the adjusted studies. Meta‐regression was used to evaluate the effect of %BITA on the primary and secondary outcomes. Thirty‐four studies (27 894 patients undergoing BITA) were included. In the pooled analysis, the incidence rate for long‐term mortality was 2.83% (95% confidence interval, 2.21%–3.61%). %BITA was significantly and inversely associated with long‐term mortality and the rate of DSWI. In the pairwise comparison, %BITA was significantly and inversely associated with the risk of long‐term mortality and DSWI in the group undergoing BITA. Conclusions BITA series with higher %BITA report significantly lower long‐term mortality and DSWI rate as well as higher long‐term survival advantage and lower relative risk of DSWI in their BITA cohort. These findings suggest that a specific volume‐outcome relationship exists for BITA grafting. </jats:sec

Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery:A Network Meta-Analysis of Clinical Outcomes

Background-There remains uncertainty regarding the second-best conduit after the internal thoracic artery in coronary artery bypass grafting. Few studies directly compared the clinical results of the radial artery (RA), right internal thoracic artery (RITA), and saphenous vein (SV). No network meta-analysis has compared these 3 strategies.Methods and Results-MEDLINE and EMBASE were searched for adjusted observational studies and randomized controlled trials comparing the RA, SV, and/or RITA as the second conduit for coronary artery bypass grafting. The primary end point was all-cause long-term mortality. Secondary end points were operative mortality, perioperative stroke, perioperative myocardial infarction, and deep sternal wound infection (DSWI). Pairwise and network meta-analyses were performed. A total of 149 902 patients (4 randomized, 31 observational studies) were included (RA, 16 201, SV, 112 018, RITA, 21 683). At NMA, the use of SV was associated with higher long-term mortality compared with the RA (incidence rate ratio, 1.23; 95% CI, 1.12-1.34) and RITA (incidence rate ratio, 1.26; 95% CI, 1.17-1.35). The risk of DSWI for SV was similar to RA but lower than RITA (odds ratio, 0.71; 95% CI, 0.55-0.91). There were no differences for any outcome between RITA and RA, although DSWI trended higher with RITA (odds ratio, 1.39; 95% CI, 0.92-2.1). The risk of DSWI in bilateral internal thoracic artery studies was higher when the skeletonization technique was not used.Conclusions-The use of the RA or the RITA is associated with a similar and statistically significant long-term clinical benefit compared with the SV. There are no differences in operative risk or complications between the 2 arterial conduits, but DSWI remains a concern with bilateral ITA when skeletonization is not used.</p

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population