Contractile reserve in systemic sclerosis patients as a major predictor of global cardiac impairment and exercise tolerance

Several studies have evidenced high prevalence of myocardial systolic and diastolic dysfunction among patients with systemic sclerosis (SSc). Exercise echocardiography has shown a diagnostic and prognostic role in identifying early left ventricular (LV) dysfunction in several myocardial pathological settings. The aim of our study was to evaluate early signs of LV impairment under exercise and their correlation to patient's exercise tolerance. Forty-five patients (age 60.4 ± 10.3 years) with SSc and 20 age and sex comparable controls were enrolled in the study. All patients underwent clinical evaluation, 2D echocardiography associated with Tissue Doppler and speckle tracking to evaluate LV deformation indexes, and an exercise echocardiography to evaluate left ventricle contractile reserve (LVCR) and exercise pulmonary pressures. Finally, a 6-minute walking test (6MWT) to evaluate exercise tolerance was also performed. Compared to controls, SSc patients showed an impaired diastolic function (E/E' 10.9 ± 3.7 vs 8.36 ± 2.01; p < 0.01) associated with larger left atrial dimensions (LAVI 28.4 ± 8.7 vs 19.3 ± 4.6 mL/m2; p < 0.01). During exercise echocardiography, a reduced global longitudinal strain at peak exercise (S-GLS) was highlighted compared to controls (15.7 ± 3.6 vs 18.2 ± 2.2; p = 0.001). A S-GLS cutoff <18 %, identified by ROC analysis, identified SSc patients with a reduced diastolic function, exercise tolerance at the 6MWT and higher pulmonary pressures. Our data show that in SSc patients a reduced LVCR characterizes the patients with a more extensive cardiovascular impairment in terms of LV diastolic function, pulmonary pressures and exercise tolerance. These data underline the importance of exercise echocardiography for the preclinical screening of the LV impairment in this population

Il restauro e la riconversione del Palazzo della Luce

Il progetto di EXiT architetti associati recupera la spazialità originaria di un palazzo cinquecentesco nel centro di Treviso al servizio di usi e attività contemporanee

La cantina Clos Pachem a Gratallops

La realizzazione della cantina Clos Pachem a Gratallops rappresenta un notevole intervento di riqualificazione urbana attraverso un edificio che sfrutta i principi della sostenibilità ambientale per generare le condizioni ottimali per la produzione del vino

Consolidamento e Restauro del Castello Morella

Morella, monumento di rilevanza artistica e storica, è un’antica città fortificata situata su una collina nella provincia di Castellón, nella Comunità Valenciana in Spagna. Presenta tracce di insediamenti di Iberi, Greci, Romani, Visigoti e Mori. Vista la sua posizione strategica tra l’Ebro e la pianura costiera di Valencia, dal XVII secolo fino alla guerra civile spagnola, la città fu spesso contesa

Il complesso residenziale di Hirtenweg in Basilea

I nuovi edifici di Hirtenweg integrano le condizioni esistenti – scala residenzale, ambiente naturale, servizi di quartiere – per creare un quartiere residenziale rinnovato e densificato. L'impostazione dei tre edifici è derivata dalla sovrapposizione di arretramenti, dal riutilizzo delle fondazioni esistenti, dalla conservazione di gruppi di alberi significativi, dalla disposizione razionale dei piani e degli alloggi e dalle fasi necessarie per la realizzazione. Utilizzando un sistema costruttivo che sfrutta tutti i vantaggi della prefabbricazione, si è riuscito ad ottenere un’architettura performante in modo sostenibile e vantaggioso in termini di costi e tempi di esecuzione

Reconstructive surgery for complex aortoiliac occlusive disease in ypoung adults

Background: Although aortoiliofemoral bypass grafting is the optimal revascularization method for patients with severe aortoiliac occlusive disease (AIOD), previous studies have documented poor patency rates in young adults. This study investigated whether young patients with AIOD have worse outcomes in patency, limb salvage, and long-term survival rates after reconstructive surgery than their older counterparts. Methods: Patients aged <50 years undergoing reconstructive surgery at our institution for AIOD between 1995 and 2010 were compared with a cohort of randomly selected patients aged >60 years (two for each of the young patients, matched for year of operation), analyzing demographics, risk factors, indications for surgery, operative details, and outcomes. Results: Among 927 consecutive patients undergoing primary surgery for AIOD, 78 (8.4%) aged <50 years (mean age, 48.4 years) and 156 older control patients (mean age, 71.2 years) were identified. The younger patients were mainly men (81%) and 59% had surgery for limb salvage and 41% for disabling claudication (P .02). Compared with older patients, they were significantly more likely to be smokers (90% vs 72%; P .002) and had previously needed significantly more inflow procedures (28% vs 16%; P .03). Only one death occurred perioperatively (30-day) among the control patients, and no major amputations or graft infections occurred in either group. The need for subsequent infrainguinal reconstructions was greater in the younger patients (18% vs 7%; P .01). The primary patency rates were inferior in the younger patients at 5 years (82% and 75%) and 10 years (95% and 90%; P .01), whereas assisted secondary patency (89% and 82% vs 96% and 91%; P .08), secondary patency (93% and 86% vs 98% and 92%; P .19), limb salvage (88% and 83% vs 95% and 91%; P .13), and survival rates (87% and 76% vs 91% and 84%; P .32) were comparable in the two groups. Conclusions: This study shows that despite a higher primary graft failure rate than that in older patients, aortoiliofemoral revascularization for complex AIOD is a safe procedure for younger patients with disabling claudication or limbthreatening ischemia, providing they are willing to follow a regular protocol to complete their postoperative surveillance and to undergo graft revision as necessary

Levantamiento digital integrado de la Casa de Vidro de Lina Bo Bardi en São Paulo, Brasil [The integrated digital survey of Lina Bo Bardi’s Casa de Vidro in São Paulo, Brazil]

The Lina Bo and P.M. Bardi Foundation’s archive-museum, Casa de Vidro, designed and built between 1950 and 1951 was the subject of a digital documentation activity which allowed the verification of the viability of a comprehensive assessment on the building in preparation for restoration and the potential placement of new structures into the garden. Besideo the significant findings, analyses, and studies resulting from the processing of the point cloud database, the Casa de Vidro 3D survey was helpful for testing a number of awareness-raising initiatives in collaboration with regional stakeholders. A complete 3D integrated survey and diagnostic analysis were performed in order to complete the digital documentation of the home, which was sponsored by the Getty Foundation (Los Angeles)’s Keeping it Modern initiative.El museo-archivo de la Fundación Casa de Vidro de Lina Bo y P.M. Bardi, una residencia diseñada y construida entre 1950 y 1951, fue objeto de una campaña de documentación digital que permitió comprobar la viabilidad de una valoración global del edificio con miras a su restauración y a la posible introducción de nuevas estructuras en su jardín. Además de los descubrimientos importantes, los análisis y estudios que resultaron del tratamiento de la base de datos de nubes de puntos, es decir, del levantamiento en 3D de la Casa de Vidrio, el levantamiento fue de gran provecho para poner a prueba una serie de iniciativas de sensibilización en colaboración con los actores regionales. Es así que, para completar la documentación digital de la casa, patrocinada por la iniciativa ‘Keeping it Modern’ de la Fundación Getty de Los Ángeles, California, se llevó a cabo un completo e integrado levantamiento en 3D junto a su análisis diagnóstico