ST2 and Multimarker Testing in Acute Decompensated Heart Failure

Most data on heart failure biomarkers have been derived from patient cohorts with chronic disease. However, risk prediction in patients admitted with acute decompensated heart failure (ADHF) remains a challenge. ADHF is not a single disease: it presents in various manners, and different causes may underlie ADHF, which may be reflected by different biomarkers. Soluble suppression of tumorigenicity 2 (ST2) has been shown to be a strong independent predictor of short-, mid-, and long-term outcome in ADHF. Furthermore, combining biomarkers may help further improve the prognostic power of ST2. The ProBNP Investigation of Dyspnea in the Emergency Department study showed that elevated plasma levels of ST2 together with elevated levels of 4 other biomarkers have clear incremental values to predict outcome in ADHF. The Multinational Observational Cohort on Acute Heart Failure study is an international collaborative network that recruited 5,306 patients hospitalized for ADHF that demonstrated that ST2 and midregional pro-adrenomedulin had independently strong value to predict 30-day and 1-year outcome in patients with ADHF. The Multinational Observational Cohort on Acute Heart Failure study also showed that C-reactive protein plus ST2 better classified risk in patients with ADHFs than ST2 alone. Combining biomarkers for risk prediction or risk stratification might have clinical and more importantly pathophysiological meaning

Obesity and sleep disturbance: the chicken or the egg?

Epidemiological studies suggested an association between obesity and sleep disturbances. Obstructive sleep apnea is the most prevalent type of obesity-related sleep disorder that lead to an increased risk for numerous chronic health conditions. In addition the increased visceral adipose tissue might be responsible for the secretion of inflammatory cytokines that could contribute to alter the sleep-wake rhythm. Unhealthy food characterized by high consumption of fat and carbohydrate seems to negatively influence the quality of sleep while diet rich of fiber is associated to more restorative and deeper sleep. Although obesity could cause through several pathogenetic mechanisms an alteration of sleep, it has been reported that subjects suffering from sleep disorders are more prone to develop obesity. Experimental laboratory studies have demonstrated that decreasing either the amount or quality of sleep increase the risk of developing obesity. Experimental sleep restriction also causes physiological, hormonal and food behavioral changes that promote a positive energy balance and a compensatory disproportionate increase in food intake, decrease in physical activity, and weight gain. Thus, the aim of this review is to provide observational evidence on the association of obesity with sleep disturbances and viceversa with emphasis on possible pathophysiological mechanisms (hormonal and metabolic) that link these two pathological conditions

Stochastic Operation Optimization of the Smart Savona Campus as an Integrated Local Energy Community Considering Energy Costs and Carbon Emissions

Aiming at integrating different energy sectors and exploiting the synergies coming from the interaction of different energy carriers, sector coupling allows for a greater flexibility of the energy system, by increasing renewables’ penetration and reducing carbon emissions. At the local level, sector coupling fits well in the concept of an integrated local energy community (ILEC), where active consumers make common choices for satisfying their energy needs through the optimal management of a set of multi-carrier energy technologies, by achieving better economic and environmental benefits compared to the business-as-usual scenario. This paper discusses the stochastic operation optimization of the smart Savona Campus of the University of Genoa, according to economic and environmental criteria. The campus is treated as an ILEC with two electrically interconnected multienergy hubs involving technologies such as PV, solar thermal, combined heat and power systems, electric and geothermal heat pumps, absorption chillers, electric and thermal storage. Under this prism, the ILEC can participate in the day-ahead market (DAM) with proper bidding strategies. To assess the renewables’ uncertainties, the roulette wheel method is used to generate an initial set of scenarios for solar irradiance, and the fast forward selection algorithm is then applied to preserve the most representative scenarios, while reducing the computational load of the next optimization phase. A stochastic optimization model is thus formulated through mixed-integer linear programming (MILP), with the aim to optimize the operation strategies of the various technologies in the ILEC, as well as the bidding strategies of the ILECs in the DAM, considering both energy costs and carbon emissions through a multi-objective approach. Case study results show how the optimal bidding strategies of the ILEC on the DAM allow minimizing of the users’ net daily cost, and, as in the case of environmental optimization, the ILEC operates in self-consumption mode. Moreover, in comparison to the current operation strategies, the optimized case allows reduction of the daily net energy cost in a range from 5 to 14%, and the net daily carbon emissions in a range from 6 to 18%

Alteration of the growth hormone axis, visceral fat dysfunction, and early cardiometabolic risk in adults: the role of the visceral adiposity index

The aim of the study is to clarify the relationship between adipose tissue dysfunction, metabolic profile and growth hormone (GH)/insulin-like growth factor (IGF)-I secretion in healthy adult subjects. We investigated the metabolic profile in a cohort of 231 consecutive healthy subjects in relation to GH, IGF-I levels, and visceral adiposity index (VAI). Anthropometric measures, lipid profile, and glucose and insulin levels during oral glucose tolerance test, Homa-IR and ISI Matsuda, IGF-I and GH peak after GHRH plus Arginine test were analyzed. The subjects with high VAI showed lower GH peak (22.8 ± 11.1 vs. 42.2 ± 21.3 µg/L; p = 0.049) and lower IGF-I (presented as IGF-I under normal range, UNR) (0.54 ± 0.14 vs. 0.64 ± 0.12; p = 0.005) than group with normal VAI. ROC curve analysis identified the cut-off, able to detect subjects with high VAI, i.e., 31.8 µg/L for GH peak and 0.63 for IGF-1 UNR. The subjects with GH peak and IGF-I UNR under the cut-off showed significantly higher levels of VAI, systolic and diastolic blood pressure, glucose and insulin levels, Homa-IR, and lower ISI Matsuda, with a concomitant worse lipid profile (all p < 0.001). A strong relationship between GH axis, VAI and metabolic risk has been demonstrated. A percentage of apparently healthy subjects show a degree of visceral adipose dysfunction associated with GH and IGF-I levels that do not meet the criteria of overt GH deficiency (GHD). Long-term prospective studies could help to clarify and confirm whether a hypothetical condition of subclinical GHD could be taken into account as a new clinical entity

Management of renewable-based multi-energy microgrids in the presence of electric vehicles

This study proposes a stochastic optimisation programming for scheduling a microgrid (MG) considering multiple energy devices and the uncertain nature of renewable energy resources and parking lot‐based electric vehicles (EVs). Both thermal and electrical features of the multi‐energy system are modelled by considering combined heat and power generation, thermal energy storage, and auxiliary boilers. Also, price‐based and incentive‐based demand response (DR) programs are modelled in the proposed multi‐energy MG to manage a commercial complex including hospital, supermarket, strip mall, hotel and offices. Moreover, a linearised AC power flow is utilised to model the distribution system, including EVs. The feasibility of the proposed model is studied on a system based on real data of a commercial complex, and the integration of DR and EVs with multiple energy devices in an MG is investigated. The numerical studies show the high impact of EVs on the operation of the multi‐energy MGs.©2020 IET. This paper is a postprint of a paper submitted to and accepted for publication in IET Renewable Power Generation and is subject to Institution of Engineering and Technology Copyright. The copy of record is available at the IET Digital Library.fi=vertaisarvioitu|en=peerReviewed

Semi-empirical model for shear strength of RC interior beam-column joints subjected to cyclic loads

This paper proposes an extension to RC interior beam-column joints of a model for the shear strength prediction of exterior joints under seismic actions, already presented in the literature and based, for certain assumptions, on a previous work of Park and Mosalam. The necessary changes, due to the joints\u2019 different physical configurations, only one beam converging in exterior joints and two beams converging in interior ones, are introduced. In the proposed model, on the basis of mechanical considerations, a direct formula for interior joint shear strength accounting for the resisting contributions of three inclined concrete struts and of joint reinforcements, the column horizontal stirrups and intermediate vertical bars, is derived. In comparison to the model for exterior joints, three struts are considered instead of two and the influenced of the upper column axial load on the inclination of the concrete struts is taken into account. The coefficients of the contributions of the struts and reinforcements are calibrated using 69 test data sets available in the literature, selecting only cyclic tests showing joint shear failure. For the validation of the proposed model, the shear strength predictions obtained using the proposed expression are compared with those obtained from Kassem\u2019s model, Wang et al.\u2019s formula and Kim and LaFave\u2019s formula, on a set of 28 specimens. It is also proposed a design formula, whose predictions are compared to those of Eurocode 8 and ACI Code

BEYOND WAIST CIRCUMFERENCE IN AN ADULT MALE POPULATION OF SOUTHERN ITALY: IS THERE ANY ROLE FOR SUBSCAPULAR SKINFOLD THICKNESS IN THE RELATIONSHIP BETWEEN INSULIN-LIKE GROWTH FACTOR-1 SYSTEM AND METABOLIC PARAMETERS ?

ABSTRACT Background: Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The Insulin-like Growth Factor (IGF)-1 system is deregulated in obese subjects in proportion to their degree of visceral adiposity. Aim : To examine the association among IGF-1, IGF-Binding Protein (BP)1 and 3 levels and different measures of adiposity in a sample of adult male population in Southern Italy. Materials and Methods: A complete database for this analysis was available for 229 (age range 50–82 years) participating at 2002-2004 Olivetti Heart Study follow-up. Results: After adjustment for age, IGF-1 was inversely associated with BMI and waist circumference (p<0.05). IGFBP1 was inversely associated with BMI, waist circumference, SST, Homeostasis Model Assessment (HOMA) index, Fat Mass (FM). HOMA index, age and SST significantly predicted the IGFBP1 plasma levels, with 24% of IGFPB-1 variability explained at a linear regression analysis. Conclusions: IGFBP1 inversely correlated to adiposity and HOMA index. Among adiposity indexes, SST was the best predictor of IGFPB-1 levels. The evaluation of some components of the IGFs system, and simple measures of body adiposity, such as SST, may represent a further tool to better evidence phenotype profiles associated to the pathogenetic mechanism of cardiovascular risk factor clustering in male adults