Resistant arterial hypertension in a patient with adrenal incidentaloma multiple steno-obstructive vascular lesions and antiphospholipid syndrome

Resistant hypertension is defined as above of blood pressure (≤ 140/90 mmHg) despite therapy with three or more antihypertensive drugs of different classes at maximum tolerable doses with one bling a diuretic. An important consideration in defining a patient with resistant hypertension is the mislabeling of secondary hypertension as resistant hypertension. Here, we report a patients with resistant hypertension caused by multiple stenoocclusive arteries due to antiphospholipid syndrome and coexisting with subclinical Cushing’s syndrome

Should I stay or should I go? Carbon leakage and ETS in an evolutionary model

Emissions trading is gaining increasing importance around the world as a suitable instrument to address climate change. In the absence of a global carbon market, however, unilateral carbon policies may end up causing carbon leakage effects, the more so if carbon prices are to increase in the future to achieve more ambitious emissions abatement targets. This paper intends to explore the possible delocalization effects of an Emissions Trading System (ETS) by proposing an evolutionary theoretical model in which regulated firms decide whether to stay (keep their production activities in the domestic country) or leave (move production abroad where no ETS is in place) imitating what other firms do. We investigate how this decision is affected by some key ETS design features, such as the emissions cap, the number of allowances granted for free to ETS firms, the level of a floor price for allowances. Numerical simulations show that the firms' decision on whether to abate emissions or relocate abroad are more sensitive to policies that reduce the cost of green technologies than to changes in specific features of the ETS design such as the emissions cap, the floor price and the number of permits granted for free.Web of Science103art. no. 10556

Efectos de la maduración y el procesamiento sobre la calidad nutricional y sensorial de las aceitunas de mesa Itrana

In the present study, we evaluated the nutritional and sensory characteristics of table olives of the Italian doubleaptitude olive cultivar (Olea europaea L. cv. Itrana) processed as green (Oliva bianca di Itri) and black (Oliva di Gaeta) table olives with modified Greek methods of preparation. One method provides an initial step of immersion in water to stimulate the growth of specific microflora which contributes to the debittering of the fruits. After 15-45 days, salt is added to the liquid in quantities not exceeding 8 kg per 100 kg of fresh olives. Another method entails the immersion of fruits directly in brine utilizing double-salting (half the amount of NaCl was added immediately and the remaining part after 15 days). All the information derived from chemico-physical, nutritional and sensory data have separated the samples into four groups according to techno-processings, ripening stage and storage. Double-salting is the method which assures the best results.En el presente estudio se evalúan las características nutricionales y sensoriales de la variedad Itrana de aceituna (Olea europaea L.) de doble uso, elaborada en verde (Oliva Bianca di Itri) y en negro (Oliva di Gaeta), utilizando métodos griegos modificados al efecto. Un método consiste en una etapa inicial de inmersión en agua para favorecer el crecimiento de una flora específica que contribuye al endulzado de los frutos. Después de 15-45 días se añade sal a la solución en una cantidad que no exceda 8 kg por 100 g de fruto fresco. Otro procedimiento consiste en colocar directamente las aceitunas en salmuera utilizando un sistema de adición de la sal en dos etapas (la mitad de la sal se añade inmediatamente y el resto a los 15 días). Toda la información derivada de los análisis fisico-químicos, nutricionales y sensoriales ha permitido la separación de las muestras en cuatro grupos según la tecnología de elaboración, el estado de madurez y el almacenamiento. El proceso de adición de sal en dos etapas (“double salting”) fue el procedimiento que dio mejores resultados

Analysis of short-term blood pressure variability in pheochromocytoma/paraganglioma patients

Data on short-term blood pressure variability (BPV), which is a well-established cardiovascular prognostic tool, in pheochromocytoma and paraganglioma (PPGL) patients is still lack and conflicting. We retrospectively evaluated 23 PPGL patients referred to our unit from 2010 to 2019 to analyze 24 h ambulatory blood pressure monitoring (24-h ABPM)-derived markers of short-term BPV, before and after surgical treatment. PPGL diagnosis was assessed according to guidelines and confirmed by histologic examination. The 24-h ABPM-derived markers of short-term BPV included: circadian pressure rhythm; standard deviation (SD) and weighted SD (wSD) of 24-h, daytime, and night-time systolic and diastolic blood pressure (BP); average real variability (ARV) of 24-h, daytime, and night-time systolic and diastolic BP. 7 males and 16 females of 53 ± 18 years old were evaluated. After surgical resection of PPGL we found a significant decrease in 24-h systolic BP ARV (8.8 ± 1.6 vs. 7.6 ± 1.3 mmHg, p < 0.001), in 24-h diastolic BP ARV (7.5 ± 1.6 vs. 6.9 ± 1.4 mmHg, p = 0.031), and in wSD of 24-h diastolic BP (9.7 ± 2.0 vs 8.8 ± 2.1 mmHg, p = 0.050) comparing to baseline measurements. Moreover, baseline 24-h urinary metanephrines significantly correlated with wSD of both 24-h systolic and diastolic BP. Our study highlights as PPGL patients, after proper treatment, show a significant decrease in some short-term BPV markers, which might represent a further cardiovascular risk factor

Net shape HIPping of a Ni-superalloy: A study of the influence of an as-leached surface on mechanical properties

Hot Isostatic Pressing (HIP) is a net-shape powder metallurgy technique where powders densification is achieved through the application of high temperature and pressure at the same time. Powders are allocated into a hollow steel mold called capsule or canister which gives the final shape to the particles. This technique is particularly useful for manufacturing complex components made of materials which are extremely difficult to process via forging or casting. Thus, HIP is particularly indicated to handle superalloy powders such as Astroloy, which is the object of the following study. One of the most attractive peculiarities of HIP is the low material waste obtained since the overstock is limited to the layers immediately beneath the steel capsule. At the end of the HIP cycle, the canister is typically removed using an acid leaching bath which is responsible for the alteration of the outermost layers of the final product. Only a little number of research papers deal with the optimization of the removal of these layers; Consequently, manufacturers often apply a very conservative approach by eliminating more material than is actually needed with a final machining procedure. This paper aims to optimize this procedure by systematically assessing the total thickness of the altered layer of material deriving from the HIPping and leaching process together. To achieve this goal, a set of samples were prepared by removing progressively thicker layers of material and then they were bend tested. Finally, the recorded mechanical properties were compared with those obtained with the samples machined from the core material. One of the main findings is that the removal of 500 μm of material is enough to recover mechanical properties which are comparable with those observed in samples coming from the core. More specifically, by eliminating the first 100 μm material, all the corroded layer is removed, which results in an overall increase of all the mechanical properties except for ductility. This property strongly depends on the number of prior particle boundaries arising from the HIPping process itself. Thus, the correct amount of overstock material must include both these layers

Mitochondrial communication in the context of aging

Mitochondria constantly contribute to the cell homeostasis and this, during the lifespan of a cell, takes its toll. Indeed, the functional decline of mitochondria appears correlated to the aging of the cell. The initial idea was that excessive production of reactive oxygen species (ROS) by functionally compromised mitochondria was the causal link between the decline of the organelle functions and cellular aging. However, in recent years accumulating evidence suggests that the contribution of mitochondria to cellular aging goes beyond ROS production. In this short review, we discuss how intracellular signalling, specifically the cAMP-signalling cascade, is involved in the regulation of mitochondrial functions and potentially in the processes that link mitochondrial status to cellular aging

Amino acids and hypertension in adults

Accumulating evidence suggests a potential role of dietary protein among nutritional factors interfering with the regulation of blood pressure. Dietary protein source (plant versus animal protein), and especially, protein composition in terms of amino acids has been postulated to interfere with mechanisms underlying the development of hypertension. Recently, mounting interest has been directed at amino acids in hypertension focusing on habitual dietary intake and their circulating levels regardless of single amino acid dietary supplementation. The aim of the present review was to summarize epidemiological evidence concerning the connection between amino acids and hypertension. Due to the large variability in methodologies used for assessing amino acid levels and heterogeneity in the results obtained, it was not possible to draw robust conclusions. Indeed, some classes of amino acids or individual amino acids showed non-causative association with blood pressure as well as the incidence of hypertension, but the evidence was far from being conclusive. Further research should be prompted for a thorough understanding of amino acid effects and synergistic actions of different amino acid classes on blood pressure regulation

Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis

Background: Direct oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established. Objective: We performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF. Methods: An online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users. Results: The use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52–0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74–0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52–0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50–0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47–0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78–1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78–1.06; p 0.24). Conclusions: In comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results