Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery

The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognostic role of RDW in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. The study included 1.031 patients with available RDW levels, prospectively followed for a mean of 4.5 +/- 3.5 years. The mean age was 68 +/- 12 years, the mean RDW was 14.7 +/- 1.8%; 492 patients (48%) underwent cardiac rehabilitation after myocardial revascularization, 371 (36%) after cardiac valve surgery, 102 (10%) after valve-plus-coronary artery by-pass graft surgery, 66 (6%) for other indications. Kaplan-Meier analysis and Cox hazard analysis were used to associate RDW with mortality. Kaplan-Meier analysis demonstrated worse survival curves free from overall (log-rank p<0.0001) and cardiovascular (log-rank p<0.0001) mortality in the highest RDW tertile. Cox analysis showed RDW levels correlated significantly with the probability of overall (HR 1.26; 95% CI 1.19-1.32; p<0.001) and cardiovascular (HR 1.31; 95% CI 1.23-1.40; p<0.001) mortality. After multiple adjustments for cardiovascular risk factors, hemoglobin, hematocrit, C-reactive protein, microalbuminuria, atrial fibrillation, glomerular filtration rate,left ventricular ejection fraction and number of exercise training sessions attended, the increased risk of overall (HR 1.10; 95% CI 1.01-1.27; p=0.039) and cardiovascular (HR 1.13; 95% CI 1.01-1.34; p=0.036)mortality with increasing RDW values remained significant. The RDW represents an independent predictor of overall and cardiovascular mortality in secondary cardiovascular prevention patients undergoing cardiac rehabilitation

Influence of laser treatment parameters on the mode I strain energy release rate of aluminum double cantilever beam joints

Surface texturing produced by laser ablation is an efficient and effective technology for treating substrates to improve adhesive bond strength. In the literature, its effect has been extensively studied for different adherends materials, adhesives and laser sources. Laser ablation produces both morphological and chemical modifications of the surfaces, promoting mechanical interlocking and chemical bonding between the adhesive and the substrates. In this work, the effect of pulsed Yb-fiber laser ablation over the quasi-static mode I fracture energy of Double Cantilever Beam (DCB) aluminum bonded joints has been assessed for different combinations of processing parameters, with the aim of optimizing the treatment for industrial purposes. The mechanical tests show that the treatment becomes effective when a laser energy density threshold is overcome. On the other hand, a further increase in the energy density leads to a slight reduction of the joints fracture energy. This is related to the viscosity of the adhesive and to the high roughness produced by high energy treatments, resulting in the presence of air bubbles in the adhesive layer. In order to understand this phenomenon, the treated surfaces are characterized from the morphological point of view using a 3D optical profiler and SEM analysis

Benefit of prostaglandin infusion in severe heart failure Preliminary clinical experience of repetitive administration.

BACKGROUND: Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatment of primary pulmonary hypertension. However intravenous PGE1 infusion may be of benefit and also has been proposed as a therapeutic tool in patients with end-stage heart failure. The aim of this prospective not randomized study was to assess the clinical and instrumental effects of this agent in patients with severe heart failure and pulmonary hypertension. METHODS: To investigate the effects of PGE1 in congestive heart failure we selected 22 consecutive patients (16 males, 6 females, mean age 63+/-2 years) in the mean NYHA class III, because they had pulmonary hypertension (PAPs>3 m/s and left ventricular ejection fraction (LVEF) 25 mm/Hg) was 25\%. During a mean follow-up of 36+/-6 months, 16 patients died (10 in the control group and 6 in the PGE1 group). The Kaplan-Meier 3-years survival analysis was not statistically significant (Log-rank test), but at 2 months survival rates began to diverge; 36 months survival: 72.7\% in the PGE1 group and 56\% in the control group. The mean LVEF increased from 25.78\% to 32.1\% in the PGE1 group and from 23.38\% to 26.15 in the control group (p<0.001); the NYHA mean class improved from 3.18 to 2.24 in the PGE1 group and from 3.46 to 3.38 in the control group (p<0.05). The PAP decreased from 57.65 to 40.82 mm/Hg (p<0.001). An AICD was implanted in 3 patients in the first group and in 5 patients in the control group. Two patients were added to the heart transplantation list. CONCLUSION: These preliminary data suggest that intermittent PGE1 infusion in patients with advanced congestive heart failure and high pulmonary pressure is able to improve NYHA mean class (p<0.05), ventricular contractility (LVEF p<0.001), pulmonary pressure and clinical data. It hasn't been associated to morbid events or increased risk of death