Three vessel optical coherence tomography assessment of macrophages accumulation in first non ST-segment acute coronary sindrome: differences between culprit and non culprit coronary plaques

Background: To investigate in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS) the prevalence and the features of optical coherence tomography (OCT)-detected macrophages accumulation (MA) in culprit plaques (CP) as compared to non culprit plaques (NCP). Methods: The study is a post-hoc analysis of a prospective study aimed at evaluating the relationship between aortic inflammation as assessed by 18F-Fluorodeoxyglucose-positron emission tomography and features of coronary plaque vulnerability as assessed by OCT. We enrolled 32 patients with first NSTE-ACS that successfully underwent 3-vessel OCT. Results: The median age was 65 (54-72) years and 27 patients (84%) were male. CPs were clinically defined. MAs were defined as signal-rich, distinct, or confluent punctuate regions that exceed the intensity of background speckle noise. Their prevalence was 4.2 per patients and MAs were more likely found in CP than NCP (84% vs. 61%, p=0.015). MA had also a higher circumferential extension in CP and the risk for CP associated with macrophages extension was higher (OR = 4.42; 95CI;2.54-9.15, p<0.001) than that associated with the mere presence of MA (OR=3.36; 95%CI;1.30-8.66, p=0.012). CP with thrombus had a lower distance between MA and the luminal surface than CP with no thrombus (0.06 vs. 0.1 mm; p=0.04). Conclusions: In patients with NSTE-ACS, MAs are more likely present in CP where they disclose also a greater extension compared to those observed in NCP. The distance between MA and the luminal surface is lower in thrombotic CP than that in non thrombotic CP

Idiopathic thrombocytopenic purpura and coronary artery disease: comparison between coronary artery bypass grafting and percutaneous coronary intervention.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. Although relatively rare, the association of ITP and coronary artery disease represents a complex therapeutic challenge. In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved

Prodromal angina and risk of 2-year cardiac mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention

We sought to investigate the prognostic significance of prodromal angina (PA) in unselected patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and its additive predictive value to the GRACE score.We prospectively enrolled 3015 consecutive STEMI patients undergoing PPCI. Patients were divided in 2 groups according to the presence or absence of PA. Multivariable Cox regression was used to establish the relation to 2-year cardiac mortality of PA.The mean age of the study population was 68 (±14) years; 2178 patients (72%) were male. During follow-up, 395 (13%) patients died with 278 of these (9.2%) suffering from cardiac mortality. Kaplan-Meier estimates showed a survival rate of 95% and 87% for patients with PA and no PA, respectively (log rank test &lt; 0.001). After multivariable analysis, patients with PA had still a lower risk of 2 years' cardiac mortality compared with patients without PA (adjusted hazard ratio = 0.50; 95% confidence interval [CI] 1.06-1.81, P = .001). Evaluation of net reclassification improvement showed that reclassification improved by 0.16% in case patients, whereas classification worsened in control patients by 1.08% leading to a net reclassification improvement of -0.93% (95% CI: -0.98, -0.88).In patients with STEMI undergoing PPCI the presence of PA is independently associated with a lower risk of 2-year cardiac mortality. However, the incorporation of this variable to the GRACE score slightly worsened the classification of risk. Accordingly, it seems unlikely that the evaluation of PA may be useful in clinical practice

Reduced Mortality With Antiplatelet Therapy Deescalation After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis

Background:Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. Methods:We performed a pairwise meta-analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. Results:The meta-analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P=0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P<0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P=0.14). Conclusions:In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events

Genome sequencing analysis identifies new loci associated with Lewy body dementia and provides insights into its genetic architecture

The genetic basis of Lewy body dementia (LBD) is not well understood. Here, we performed whole-genome sequencing in large cohorts of LBD cases and neurologically healthy controls to study the genetic architecture of this understudied form of dementia and to generate a resource for the scientific community. Genome-wide association analysis identified five independent risk loci, whereas genome-wide gene-aggregation tests implicated mutations in the gene GBA. Genetic risk scores demonstrate that LBD shares risk profiles and pathways with Alzheimer’s and Parkinson’s disease, providing a deeper molecular understanding of the complex genetic architecture of this age-related neurodegenerative condition

Genome-wide structural variant analysis identifies risk loci for non-Alzheimer’s dementias

We characterized the role of structural variants, a largely unexplored type of genetic variation, in two non-Alzheimer’s dementias, namely Lewy body dementia (LBD) and frontotemporal dementia (FTD)/amyotrophic lateral sclerosis (ALS). To do this, we applied an advanced structural variant calling pipeline (GATK-SV) to short-read whole-genome sequence data from 5,213 European-ancestry cases and 4,132 controls. We discovered, replicated, and validated a deletion in TPCN1 as a novel risk locus for LBD and detected the known structural variants at the C9orf72 and MAPT loci as associated with FTD/ALS. We also identified rare pathogenic structural variants in both LBD and FTD/ALS. Finally, we assembled a catalog of structural variants that can be mined for new insights into the pathogenesis of these understudied forms of dementia

Genome sequencing analysis identifies new loci associated with Lewy body dementia and provides insights into its genetic architecture

The genetic basis of Lewy body dementia (LBD) is not well understood. Here, we performed whole-genome sequencing in large cohorts of LBD cases and neurologically healthy controls to study the genetic architecture of this understudied form of dementia, and to generate a resource for the scientific community. Genome-wide association analysis identified five independent risk loci, whereas genome-wide gene-aggregation tests implicated mutations in the gene GBA. Genetic risk scores demonstrate that LBD shares risk profiles and pathways with Alzheimer's disease and Parkinson's disease, providing a deeper molecular understanding of the complex genetic architecture of this age-related neurodegenerative condition

Studio Sperimentale delle Prestazioni di un Radar FMCW per Applicazioni Indoor e Outdoor

La crescente domanda relativa ai sistemi di localizzazione e tracking a partire dal settore automotive fino a quello della difesa, ha aperto la strada verso una rivoluzione nelle tecnologie di detection e ranging. Tra i vari dispositivi sviluppati in tale ambito vi sono i sistemi radar, i quali possiedono alcuni vantaggi che li contraddistinguono da tutti gli altri tipi di sensori. Grazie al loro principio di funzionamento infatti, possono operare in qualsiasi condizione di luce, tempo atmosferico ed in ambienti con scarsa sicurezza operativa. Queste caratteristiche collocano i sistemi radar al centro di numerosi studi, laddove vi sia l’obbiettivo di implementare tecnologie di localizzazione accurate e sempre più economiche. Sono state proposte nel corso del tempo diverse categorie di sistemi radar, ognuna con i suoi pregi e difetti; nello specifico in questo elaborato si concentra l’attenzione sui sistemi radar FMCW, i quali utilizzano una particolare modulazione in frequenza del segnale. Nonostante tale tecnologia sia stata studiata ed implementata decine di anni fa, il radar FMCW ` e tutt’ora oggetto di studio, dal momento che in passato lo sviluppo delle tecnologie digitali non permetteva la rapida esecuzione di algoritmi con una determinata complessità computazionale. Si ricordano inoltre i notevoli progressi nel design di circuiti a radiofrequenza che hanno portato alla costruzione di radar ad onde millimetriche, che posso offrire un’accuratezza notevole rispetto ad altri tipi di radar. In questo lavoro di tesi si illustra innanzitutto una visione di principio dei sistemi radar FMCW. Successivamente viene descritta una teoria generale per l’analisi del segnale utilizzato dal radar. Infine si illustrano le campagne di misura e l'elaborazione dei dati

Localizzazione di tag passivi non lineari

In questo lavoro di tesi è stato realizzato un software di elaborazione dei segnali ricevuti da una etichetta (tag) RFID chipless con l’obiettivo di stimare la distanza del tag rispetto alla posizione dei ricevitori. Questo progetto trova importanti applicazioni legate alla localizzazione sia in ambito hi-tech che di largo consumo, come ad esempio la logistica, l’automotive e i sistemi di automazione. In questo progetto è stato curato specificamente il processo di acquisizione ed elaborazione dati, processando al calcolatore con l’ausilio del software MATLAB® i risultati provenienti da un simulatore circuitale del tag. In particolare, i dati da elaborare sono stati forniti da un progetto di ricerca correlato a questo dove è stato studiato e realizzato un tag RFID chipless passivo di tipo armonico non lineare