How cardiologists can manage excess body weight and related cardiovascular risk. An expert opinion

Obesity is an important independent cardiovascular (CV) risk factor and a chronic inflammatory disease related to the development of insulin resistance, type 2 diabetes, dyslipidaemia, coronary artery disease, hypertension, heart failure, atrial fibrillation and obstructive sleep apnoea. Body Mass Index (BMI) values >27 Kg/m2 are associated with an exponential increase in the risk for Major Adverse Cardiac Events (MACE). On the other hand, weight reduction can significantly reduce metabolic, CV and oncological risk. Orlistat, bupropion/naltrexone, liraglutide and semaglutide, combined with lifestyle changes, have proven to be effective in weight loss; the last two have been tested in randomized clinical trials (RCTs) with CV outcomes only in diabetic patients, and not in obese patients. To fill a fundamental gap of knowledge, the SELECT trial on patients with obesity and CV disease treated with semaglutide is ongoing, aiming at MACE as the primary endpoint. The battle against the social and clinical stigma towards obesity must be counteracted by promoting an awareness that elevates obesity to a complex chronic disease. Several actions should be implemented to improve the management of obesity, and cardiologists have a key role for achieving a global approach to patients with excess weight also through the correct implementation of available treatment strategies

COVID-19 and atrial fibrillation: Intercepting lines

Almost 20% of COVID-19 patients have a history of atrial fibrillation (AF), but also a new-onset AF represents a frequent complication in COVID-19. Clinical evidence demonstrates that COVID-19, by promoting the evolution of a prothrombotic state, increases the susceptibility to arrhythmic events during the infective stages and presumably during post-recovery. AF itself is the most frequent form of arrhythmia and is associated with substantial morbidity and mortality. One of the molecular factors involved in COVID-19-related AF episodes is the angiotensin-converting enzyme (ACE) 2 availability. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses ACE2 to enter and infect multiple cells. Atrial ACE2 internalization after binding to SARS-CoV-2 results in a raise of angiotensin (Ang) II, and in a suppression of cardioprotective Ang(1–7) formation, and thereby promoting cardiac hypertrophy, fibrosis and oxidative stress. Furthermore, several pharmacological agents used in COVID-19 patients may have a higher risk of inducing electrophysiological changes and cardiac dysfunction. Azithromycin, lopinavir/ritonavir, ibrutinib, and remdesivir, used in the treatment of COVID-19, may predispose to an increased risk of cardiac arrhythmia. In this review, putative mechanisms involved in COVID-19-related AF episodes and the cardiovascular safety profile of drugs used for the treatment of COVID-19 are summarized

Application of X-Band Wave Radar for Coastal Dynamic Analysis: Case Test of Bagnara Calabra (South Tyrrhenian Sea, Italy)

Sea state knowledge has a key role in evaluation of coastal erosion, the assessment of vulnerability and potential in coastal zone utilization, and development of numerical models to predict its evolution. X-band radar measurements were conducted to observe the spatial and temporal variation of the sea-state parameters along a 3 km long sandy-gravelly pocket beaches forming a littoral cell on Bagnara Calabra. We produced a sequence of 1000 images of the sea state extending offshore up to 1 mile. The survey has allowed monitoring the coastline, the directional wave spectra, the sea surface current fields, and the significant wave heights and detecting strong rip currents which cause scours around the open inlets and affect the stability of the submerged reef-type breakwaters. The possibility to validate the data acquired with other datasets (e.g., LaMMA Consortium) demonstrates the potential of the X-band radar technology as a monitoring tool to advance the understanding of the linkages between sea conditions, nearshore sediment dynamics, and coastal change. This work proves the possibility to obtain relevant information (e.g., wave number, period, and direction) for evaluation of local erosion phenomena and of morphological changes in the nearshore and surf zone

Retrospective Investigation of an Influenza A/H1N1pdm Outbreak in an Italian Military Ship Cruising in the Mediterranean Sea, May-September 2009

BACKGROUND: Clinical surveillance may have underestimated the real extent of the spread of the new strain of influenza A/H1N1, which surfaced in April 2009 originating the first influenza pandemic of the 21(st) century. Here we report a serological investigation on an influenza A/H1N1pdm outbreak in an Italian military ship while cruising in the Mediterranean Sea (May 24-September 6, 2009). METHODS: The contemporary presence of HAI and CF antibodies was used to retrospectively estimate the extent of influenza A/H1N1pdm spread across the crew members (median age: 29 years). FINDINGS: During the cruise, 2 crew members fulfilled the surveillance case definition for influenza, but only one was laboratory confirmed by influenza A/H1N1pdm-specific RT-PCR; 52 reported acute respiratory illness (ARI) episodes, and 183 reported no ARI episodes. Overall, among the 211 crew member for whom a valid serological result was available, 39.3% tested seropositive for influenza A/H1N1pdm. The proportion of seropositives was significantly associated with more crowded living quarters and tended to be higher in those aged <40 and in those reporting ARI or suspected/confirmed influenza A/H1N1pdm compared to the asymptomatic individuals. No association was found with previous seasonal influenza vaccination. CONCLUSIONS: These findings underline the risk for rapid spread of novel strains of influenza A in confined environment, such as military ships, where crowding, rigorous working environment, physiologic stress occur. The high proportion of asymptomatic infections in this ship-borne outbreak supports the concept that serological surveillance in such semi-closed communities is essential to appreciate the real extent of influenza A/H1N1pdm spread and can constitute, since the early stage of a pandemic, an useful model to predict the public health impact of pandemic influenza and to establish proportionate and effective countermeasures

Geological, stratigraphic and hydrostratigraphic setting of the lower Crati valley reconstructed by geophysical and well data and relationship with the land subsidence detected

Scuola "Archimede" in Scienze , Comunicazionee e Tecnologie, Dottorato di Ricerca in Scienze della Terra, Ciclo XXVII, a.a. 2014Università della Calabri

New insights into molecular mechanisms of diffuse coronary ectasiae: A possible role for VEGF

BACKGROUND: Diffuse coronary artery ectasiae (DCE) are occasionally found at necropsy or at angiography. Pathogenetic mechanisms of DCE are still poorly known. Matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs) and vascular endothelial growth factor (VEGF) are involved in vascular remodeling and may play a role in DCE. METHODS: A total of 1280 consecutive coronary angiograms performed in a single institution in 1 year were screened. DCE were found in 15 patients. Diagnosis at hospital admission was acute coronary syndromes in all of them. Two patients died during initial admission and 1 refused blood sampling; the remaining 12 patients were enrolled in the study. No patient with DCE exhibited coronary stenoses. Plasma levels of VEGF, MMP-2, TIMP-1, TIMP-2 and C-reactive protein (CRP) were measured in these 12 patients 12 months after discharge during a silent clinical phase, in 12 age- and sex-matched patients with stable angina (SA) and coronary artery disease, and in 12 age- and sex-matched patients with normal coronary arteries (NCA). RESULTS: VEGF levels were higher in patients with DCE than in SA or NCA (151.6 pg/ml [36.2-252.9] vs. 66.6 pg/ml [36.4-93.3] and 54.8 pg/ml [14.5-87.1], respectively, p = 0.012]. TIMP-2 levels were lower in DCE and SA than in NCA (5.9 ng/ml [0-33.6] and 5.0 [0-17.4] vs. 139.3 ng/ml [114.4-237.4], respectively, p < 0.001). TIMP-1 and MMP-2 plasma levels were similar in all groups (p = NS), and CRP levels were within normal limits (< 3 mg/L) in most patients, irrespective of their coronary anatomy (75% for DCE, 66% for SA, and 84% for NCA [p = NS]). CONCLUSIONS: Symptomatic patients with DCE typically present with an acute coronary syndrome and exhibit lack of obstructive stenosis at angiography, decreased plasma levels of TIMP-2 and raised plasma levels of VEGF. The simultaneous occurrence of reduced MMPs inhibition and increased angiogenetic activity suggests an accelerated and persistent extracellular matrix remodeling process favouring arterial remodeling and aneurysms formation which is likely to enhance the risk of thrombosis because of low shear stress

Messinian resedimented gypsum (branching-like facies) from the Catanzaro Basin (Calabria, Southern Italy): petrographic and geochemical evidence for paleoenvironmental reconstruction

A multidisciplinary approach allowed to investigate the formation and evolution of gypsum blocks within the Riato Conglomerate outcropping in the Catanzaro Basin (Calabria, Southern Italy). Macroscopically, the gypsum blocks seem to belong to the branching facies (primary facies) known in literature, however microscopic observations reveal a detrital origin (secondary facies). Indeed, the gypsum blocks show an alternation of laminae made of selenite clasts (100 to 500μm) and of fine matrix engulfing relicts of selenite crystals (<100μm) suggesting a clastic nature for these blocks. Crystal’s remains have sub-euhedral shapes and display a bright epifluorescence core under Ultraviolet (UV) light. The matrix is made of amorphous material that engulfs very fine relict crystals. UV-epifluorescence observations reveal the organic nature of the matrix. Strontium isotope ratio (87Sr/86Sr: 0.70904), obtained on the relict selenite clasts allow to ascribe these facies to the first stage of the Messinian Salinity Crisis (5.97-5.60 Ma). This data enables to prove the presence of a primary selenite deposit (dismantled) in the Catanzaro Basin. The gypsum blocks investigated show very similar features with the branching-like facies recognised in the Ionian Forearc Basin (Benestare, Calabria, Southern Italy). These deposits experienced reworking processes as a consequence of local perturbation of the basin due to the major relative sea level fluctuations that were affecting the whole Mediterranean area

Different Ground Subsidence Contributions Revealed by Integrated Discussion of Sentinel-1 Datasets, Well Discharge, Stratigraphical and Geomorphological Data: The Case of the Gioia Tauro Coastal Plain (Southern Italy)

Groundwater is the main water supply for agricultural and industrial needs in many coastal plains worldwide. Groundwater depletion often triggers land subsidence, which threatens manmade infrastructure and activities and aggravates other geohazards. We applied a multi-temporal interferometric synthetic aperture radar technique to Sentinel-1 datasets to detect ground motion in the Gioia Tauro plain (Calabria, Southern Italy) from 2018 to 2021. The InSAR data were analysed through the integrated use of groundwater head, stratigraphical and geomorphological data, and land use information to distinguish the potential subsidence divers. The results show that subsiding areas, with a mean rate of about 10 mm/yr, are in the middle of the plain, and their location is influenced by the spatial distribution of compressible sediments included in the shallow aquifer. Furthermore, the subsidence arrangement is spatially accordant with the main groundwater depression area, which can be ascribed to the ongoing and increasing water pumping for predominantly agricultural usage. We also observed that subsidence (up to 10 mm/yr) affects the western dock of the Gioia Tauro harbour, in front of which, in very shallow water, are two submarine canyon heads already affected by slides in the past