VP50.10: Predicting fetal and maternal complications with sFlt1/PlGF ratio in hypertensive disorders of pregnancy

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Developing biodiversity assessment on a stand forest type management level in north-eastern Italy

This paper discusses a simple operative proposal, elaborated by a team of advisers to the Forestry Service of the Veneto administrative region (north-eastern Italy), concerning the definition of stand-level forest type biodiversity indicators and biodiversity oriented management provisions. Such tools are conceived to transfer biodiversity conservation understanding in current forest stand management practices. The developed assessment system is targeted to: maintenance and increase of the variability of forest landscape mosaic; conservation of species variability; creation of resource reservoirs. The following criteria and indicators are taken into consideration: spatial pattern (widespreadness, connectedness, species contagion potential), forest structure (uneven aged stands: percent of trees in three broad diameter classes; even aged stands: number of development stages and surface of each development stage), herbs/shrubs species (average, minimum and maximum number of species; average number of short-lived herb/ shrub species recorded in minimal anthropic disturbance conditions; dynamic trend in the number of herb/shrub species), bird species (average, minimum and maximum number of species); overall naturalistic quality (flora; vegetation; fauna). Such indicators are proposed as biodiversity reference standards for each forest type in the considered region: they provide practical baseline information with which forest stand management efficiency in achieving biodiversity targets can be compared

Right ventricular dysfunction in right coronary artery infarction: A primary PCI registry analysis

Right ventricular involvement in inferior myocardial infarction (MI) was historically associated with a poor prognosis. However, few studies addressed the impact of right ventricular (RV) dysfunction in the primary percutaneous intervention (pPCI) era. Our aim was to assess the prognostic significance of RV dysfunction in right coronary artery (RCA) related MI treated with pPCI. Methods: A total of 298 patients with a RCA related MI undergone pPCI between January 2011 and June 2015 were included. RV dysfunction was defined by a RV-FAC <35% at echocardiographic examination and further divided into mild (RV-FAC between 35 and 25%) and moderate-severe (RV-FAC <25%). RV function before discharge was reassessed in 95% of the study cohort. The primary endpoint was overall mortality. Median follow-up was 29 months. Results: In RCA related MI, moderate-severe (HR 5.882, p = 0.002, 95% CI 1.882-18.385) but not mild RV dysfunction independently predicted lower survival at follow-up along with age (HR 1.104, p <0.001, CI 1.045-1.167). Importantly, patients recovering RV function at discharge showed a lower mortality (p = 0.001) vs patients with persistent moderate-severe RV dysfunction) that approached the risk of patients without RV dysfunction at presentation. Conclusion: In RCA related MI treated with pPCI, RV dysfunction was one of the strongest independent predictor of lower overall survival. However, patients with only transient RV dysfunction showed a better prognosis compared to patients who had persistent RV dysfunction. The focus on intensive support management of the RV in the first hours after pPCI may be important to overcome the acute phase and to promote RV recovery

Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

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A forest typology for monitoring sustainable forest management: The case of European Forest Types

Sustainable forest management (SFM) is presently widely accepted as the overriding objective for forest policy and practice. Regional processes are in progress all over the world to develop and implement criteria and indicators of SFM. In continental Europe, a set of 35 Pan-European indicators has been endorsed under the Ministerial Conference on the Protection of Forests in Europe (MCPFE) to measure progress towards SFM in the 44 countries of the region. The formulation of seven indicators (forest area, growing stock, age structure/diameter distribution, deadwood, tree species composition, damaging agents, naturalness) requires national data to be reported by forest types. Within the vast European forest area the values taken by these indicators show a considerable range of variation, due to variable natural conditions and anthropogenic influences. Given this variability, it is very difficult to grasp the meaning of these indicators when taken out of their ecological background. The paper discusses the concepts behind, and the requirements of, a classification more soundly ecologically framed and suitable for MCPFE reporting than the three (un-informative) classes adopted so far: broadleaved forest, coniferous forest, mixed broadleaved and coniferous forest. We propose a European Forest Types scheme structured into a reasonably higher number of classes, that would improve the specificity of the indicators reported under the MCPFE process and its understanding.L'articolo è disponibile sul sito dell'editore www.tandf.co.uk/journals

Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors.

BACKGROUND: Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. OBJECTIVES: To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. METHODS AND RESULTS: We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6-18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50% at 1-year, and was observed in 27/48 patients (56.3%). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.04-1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95% CI 1.28-55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95% CI 1.23-124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95% CI 0.82-0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32%±8 vs. 53%±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95% CI 0.89-1.00). CONCLUSIONS: More than half of patients presenting with acute LM and LVEF <50% who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of subacute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point

Sviluppo di modelli innovativi per il monitoraggio multiscala degli indicatori di servizi ecosistemici nelle foreste Mediterranee (Progetto MIMOSE).

Gli ecosistemi, attraverso le loro funzioni, forniscono un ampio range di beni e servizi, che risultano fondamentali per il benessere dell’uomo. Questi vengono complessivamente definiti Servizi Ecosistemici (SE). I SE possono essere intesi come un flusso di valori verso la società, quale risultato dello stato e della quantità del capitale naturale disponibile. Il mantenimento degli stocks del capitale naturale può permettere di prevedere i flussi futuri dei SE, assicurando quindi il benessere dell’uomo per le generazioni future. Il progetto FIRB 2012 MIMOSE è finalizzato allo sviluppo di un approccio multiscala innovativo e all’implementazione di strumenti previsionali volti al monitoraggio dei SE in habitat forestali Mediterranei. Un set di indicatori viene considerato per stimare i SE forniti dalle foreste, sviluppando strumenti integrati per il loro monitoraggio multiscala. Le attività di ricerca vertono allo sviluppo di un metodo statistico innovativo per la stima spaziale degli indicatori di SE, sulla base di dati disponibili a diversi livelli di scala spaziale. Sono realizzate mappe wall-to-wall per la fornitura dei SE, derivate da diversi domini spaziali, dal livello di scala locale sino ad aree forestali di grande estensione. I dati sugli indicatori dei SE sono forniti nel contesto di attività di campionamento già stabilite (raccolta dati a livello di aree di saggio e di popolamento), per poi applicare tecniche di spazializzazione per aggregare i dati raccolti su scala locale a livelli di scala più ampia (paesaggio, scala regionale); l’approccio utilizzato viene valutato attraverso l’applicazione di strumenti di monitoraggio in un set di aree test. Si procede quindi alla valutazione dei cambiamenti spazio-temporali nella previsione dei SE, considerando indicatori sensibili alla gestione forestale, ovvero capaci di evidenziare cambiamenti nella previsione di fornitura di beni e servizi ad opera dei sistemi forestali, in relazione a differenti scenari gestionali, con l’obiettivo di fornire indicazioni ai gestori forestali ed alle comunità locali per l’applicazione di pratiche di gestione che possano mantenere o incrementare la fornitura dei SE in un preciso contesto territoriale. Questo progetto permette di realizzare un’attenta analisi dei gaps esistenti negli attuali schemi di inventariazione in relazione alla fornitura dei SE, con l’obiettivo di dare indicazioni utili all’implementazione ed integrazione degli stessi mediante individuazione di nuovi indicatori, nell’ottica di una gestione forestale sostenibile. Le attività di ricerca in corso possono concretamente contribuire all’incorporazione dei SE nei processi decisionali connessi alla gestione dei paesaggi forestali, fornendo un’opportunità per comprendere la congruenza tra i diversi SE negli ambienti forestali

Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

BACKGROUND: Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis. METHODS: Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium. RESULTS: Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040). CONCLUSION: Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial propertie