Impact of myocardial injury on regional left ventricular function in the course of acute myocarditis with preserved ejection fraction: insights from segmental feature tracking strain analysis using cine cardiac MRI

The aim of this study was to provide insights into myocardial adaptation over time in myocyte injury caused by acute myocarditis with preserved ejection fraction. The effect of myocardial injury, as defined by the presence of late gadolinium enhancement (LGE), on the change of left ventricular (LV) segmental strain parameters was evaluated in a longitudinal analysis. Patients with a first episode of acute myocarditis were enrolled retrospectively. Peak radial (PRS), longitudinal (PLS) and circumferential (PCS) LV segmental strain values at baseline and at follow-up were computed using feature tracking cine cardiac magnetic resonance imaging. The change of segmental strain values in LGE positive (LGE+) and LGE negative (LGE−) segments was compared over a course of 89 ± 20 days. In 24 patients, 100 LGE+ segments and 284 LGE− segments were analysed. Between LGE+ and LGE− segments, significant differences were found for the change of segmental PCS (p < 0.001) and segmental PRS (p = 0.006). LGE + segments showed an increase in contractility, indicating recovery, and LGE− segments showed a decrease in contractility, indicating normalisation after a hypercontractile state or impairment of an initially normal contracting segment. No significant difference between LGE+ and LGE− segments was found for the change in segmental PLS. In the course of acute myocarditis with preserved ejection fraction, regional myocardial function adapts inversely in segments with and without LGE. As these effects seem to counterbalance each other, global functional parameters might be of limited use in monitoring functional recovery of these patients

Stability in and Correlation between Factors Influencing Genetic Quality of Seed Lots in Seed Orchard of Pinus tabuliformis Carr. over a 12-Year Span

Coniferous seed orchards require a long period from initial seed harvest to stable seed production. Differential reproductive success and asynchrony are among the main factors for orchard crops year-to-year variation in terms of parental gametic contribution and ultimately the genetic gain. It is fundamental in both making predictions about the genetic composition of the seed crop and decisions about orchard roguing and improved seed orchard establishment. In this paper, a primary Chinese pine seed orchard with 49 clones is investigated for stability, variation and correlation analysis of factors which influence genetic quality of the seed lots from initial seed harvest to the stable seed production over a 12 years span. Results indicated that the reproductive synchrony index of pollen shedding has shown to be higher than that of the strobili receptivity, and both can be drastically influenced by the ambient climate factors. Reproductive synchrony index of the clones has certain relative stability and it could be used as an indication of the seed orchard status during maturity stage; clones in the studied orchard have shown extreme differences in terms of the gametic and genetic contribution to the seed crop at the orchard's early production phase specifically when they severe as either female or male parents. Those differences are closely related to clonal sex tendency at the time of orchard's initial reproduction. Clonal gamete contribution as male and female parent often has a negative correlation. Clone utilization as pollen, seed or both pollen and seed donors should consider the role it would play in the seed crop; due to numerous factors influencing on the mating system in seed orchards, clonal genetic contribution as male parent is uncertain, and it has major influence on the genetic composition in the seed orchard during the initial reproductive and seed production phase

Heritability of seed weight in Maritime pine, a relevant trait in the transmission of environmental maternal effects

Quantitative seed provisioning is an important life-history trait with strong effects on offspring phenotype and fitness. As for any other trait, heritability estimates are vital for understanding its evolutionary dynamics. However, being a trait in between two generations, estimating additive genetic variation of seed provisioning requires complex quantitative genetic approaches for distinguishing between true genetic and environmental maternal effects. Here, using Maritime pine as a long-lived plant model, we quantified additive genetic variation of cone and seed weight (SW) mean and SW within-individual variation. We used a powerful approach combining both half-sib analysis and parent-offspring regression using several common garden tests established in contrasting environments to separate G, E and G x E effects. Both cone weight and SW mean showed significant genetic variation but were also influenced by the maternal environment. Most of the large variation in SW mean was attributable to additive genetic effects (h(2) = 0.55-0.74). SW showed no apparent G x E interaction, particularly when accounting for cone weight covariation, suggesting that the maternal genotypes actively control the SW mean irrespective of the amount of resources allocated to cones. Within-individual variation in SW was low (12%) relative to between-individual variation (88%), and showed no genetic variation but was largely affected by the maternal environment, with greater variation in the less favourable sites for pine growth. In summary, results were very consistent between the parental and the offspring common garden tests, and clearly indicated heritable genetic variation for SW mean but not for within-individual variation in SW.This study was financed by the Spanish National Research Grants RTA2007-100 and AGL2012-40151 (FENOPIN), both co-financed by EU-FEDER. The progeny trials and the clonal seed orchards are part of the experimental set up of the Maritime pine breeding programme developed by the Centro de Investigacion Forestal de Lourizan, Xunta de Galicia.Spanish National Research Grant RTA2007-100Spanish National Research Grant AGL2012-40151 (FENOPIN)EU-FEDERPeer reviewe

Implementation of Guidelines for the Management of Arterial Hypertension. The Impulsion Study

This study assessed the effects of a pilot best practice implementation enhancement program on the control of hypertension. We enrolled 697 consecutive known hypertensive patients with other vascular risk factors but free from overt vascular disease. There was no “control” group because it was considered unethical to deprive high-risk patients from “best medical treatment”. Following a baseline visit, previously trained physicians aimed to improve adherence to lifestyle measures and drug treatment for hypertension and other vascular risk factors. Both at baseline and at study completion (after 6 months), a 1-page form was completed showing if patients achieved treatment targets. If not, the reasons why were recorded. This program enhanced compliance with lifestyle measures and increased the use of evidence-based medication. There was a substantial increase in the number of patients who achieved treatment targets for blood pressure (p<0.0001) and other vascular risk factors. In non-diabetic patients (n=585), estimated vascular risk (PROCAM risk engine) was significantly reduced by 41% (p<0.0001). There was also a 12% reduction in vascular risk according to the Framingham risk engine but this did not achieve significance (p=0.07). In conclusion, this is the first study to increase adherence to multiple interventions in hypertensive patients on an outpatient basis, both in primary care and teaching hospitals. Simple, relatively low cost measures (e.g. educating physicians and patients, distributing printed guidelines/brochures and completing a 1-page form) motivated both physicians and patients to achieve multiple treatment goals. Further work is needed to establish if the improvement observed is sustained. [ClinicalTrials.gov NCT00416611]

Characteristics of soils of Thessaloniki and their assessment as medium of urban greenery growth

Urban parks are an important part of urban landscape and they have a vital role in the development and sustainability of towns and cities. The use of trees within towns and the importance of the beneficial effects, which they and other vegetation produce in and around cities has long been recognized. The urban greenery nowadays, under the pressure of urbanization process improves the quality of urban life in many ways with social and economic benefits and environmental services. Today urban parks and plantation were incorporated in the urban extension plans. Soil is a crucial component of rural and urban environments and soil conditions influence the growth and vigor of trees and vegetation. Some soil scientists estimate that 80% of urban vegetation problems can be traced to poor soil. Consequently there is a clear need for collection of information on soil and its capabilities and limitations for landscape design and planting in the urban environment. During urban development, most natural soil would have been damaged and modified. Foreign soil of inferior quality frequently finds its way into city areas, including those designated as green space. Many activities in urban areas change the soil’s physical, chemical, or biological characteristics. Soil conditions in urban areas influence the growth and vigor of trees and vegetation. In the present research soil conditions and characteristics of five urban parks of the city of Thessaloniki was studied through field and laboratory analysis (park of N. Helvetia, park of Y.M.C.A, park of Pasha gardens, park of Pedion Areos and park of Voulgari). Soil profiles show unnatural stratification with sharp layers and property differences between layers that suggest an artificial origin due to filling process. The lack of aggregating agents, particularly organic matter and soil fauna as soil compaction limits the formation of a strong soil structure. Chemically the samples have an atypical alkaline reaction and inadequate organic matter. The heavy metal concentrations are far from the safety limits, but these should be monitored and controlled. Consequently, it is necessary to adopt rigorous preventing management measures to forestall the multiple problems associated with urban soils. Understanding the basic physical, chemical, and biological properties of soil and their interaction helps to identify and correct problems that effect vegetation growth. Much of the information can be used to develop specifications or preliminary criteria for a design application.Κάτω από τις πιέσεις της έντονης αστικοποίησης, το πράσινο αποκτά σήμερα μια σειρά από περιβαλλοντικούς, κοινωνικούς και οικονομικούς ρόλους και λειτουργίες. Τα εδάφη των αστικών περιοχών λόγω της χρήσης και της διαχείρισης τους αποκτούν ιδιαίτερα χαρακτηριστικά που τα διαφοροποιούν από τα γεωργικά και δασικά εδάφη. Τα χαρακτηριστικά αυτά επιδρούν άμεσα ή έμμεσα στην ανάπτυξη, επέκταση και βελτίωση των δένδρων και της βλάστησης γενικότερα που υπάρχει στις πόλεις. Η εργασία που έγινε στην περιοχή της Θεσσαλονίκης είχε ως σκοπό τη μελέτη των εδαφικών συνθηκών των πάρκων της πόλης και τη διαχείριση του εδάφους ως μέσου ανάπτυξης του αστικού πρασίνου. Για τις ανάγκες της έρευνας επιλέχθηκαν πέντε πάρκα του Δήμου Θεσσαλονίκης. Τα πάρκα αυτά είναι: Το πάρκο της «Χ.Α.Ν.Θ», που βρίσκεται στο κέντρο της πόλης, το πάρκο του πεδίου του Άρεως έναντι του 3ου Σώματος Στρατού, το πάρκο «κήποι του πασά», στην περιοχή της Άνω πόλης, το άλσος-πάρκο « Νέας Ελβετίας», στην ανατολική Θεσσαλονίκη και τέλος το πάρκο Βούλγαρη, που βρίσκεται στην ανατολική είσοδο της πόλης. Για τις ανάγκες της έρευνας ανοίχτηκαν και περιγράφηκαν δώδεκα εδαφοτομές από τις οποίες ελήφθησαν σαράντα επτά δείγματα από τους εδαφικούς ορίζοντες – στρώσεις που σχηματιζόταν, ενώ με εδαφοτρυπάνη έγιναν δειγματοληψίες σε είκοσι έξη σημεία απ’ όπου ελήφθησαν ενενήντα τρία δείγματα. Από τα αποτελέσματα της μελέτης προέκυψε ότι τα εδάφη μας, που είναι αποτέλεσμα τεχνητών διαδικασιών(εκχωματώσεις, επιχωματώσεις), μπορούν να χαρακτηριστούν ανώριμα αφού καμιά πεδογενετική εξέλιξη δεν παρατηρείται σ’ αυτά. Τα περισσότερα εδάφη της μελέτης μας ανήκουν στην κατηγορία των εδαφών με βαριά προς μέτρια μηχανική σύσταση. Η αντίδραση των εδαφών της περιοχής μελέτης μας είναι αλκαλική, καθώς η αντίδραση των περισσοτέρων από αυτά υπερβαίνει το 7,5. Οι συγκεντρώσεις οργανικής ουσίας που παρατηρούμε στα εδάφη της περιοχής μελέτης μας είναι σε χαμηλά επίπεδα, ενώ η ηλεκτρική αγωγιμότητα θα πρέπει να ελέγχεται στα πάρκα που βρίσκονται κοντά στην παραλιακή ζώνη. Η εδαφική συμπίεση εμφανίζεται να αποτελεί παράγοντα που μπορεί να επηρεάσει την ανάπτυξη των δασικών δένδρων και γενικότερα του φυτευτικού υλικού των πάρκων. Οι συγκεντρώσεις βαρέων μετάλλων απέχουν πολύ από τα όρια ασφάλειας, παρόλα αυτά θα πρέπει αυτές να παρακολουθούνται και να ελέγχονται. Συνολικά μπορούμε να πούμε ότι τα προβλήματα που εμφανίζονται στα εδάφη της περιοχής μελέτης εστιάζονται κυρίως στα φυσικά χαρακτηριστικά τους, όπως είναι η υφή και η δομή καθώς και οι παράγοντες που μπορούν να επιδράσουν σε αυτά τα χαρακτηριστικά όπως είναι η οργανική ουσία και η συμπίεση. Συνεπώς για την βελτίωση των εδαφικών συνθηκών των πάρκων θα πρέπει να αναπτυχθούν εκείνες οι διαχειριστικές επεμβάσεις, οι οποίες θα οδηγούν στη δημιουργία πεδογενετικών διεργασιών για την εξέλιξη και την σταδιακή ωρίμανση των εδαφών μας. Η μελέτη των εδαφικών συνθηκών είναι απαραίτητη προϋπόθεση για τον σωστό σχεδιασμό, τη δημιουργία και τη διαχείριση αστικού πρασίνου που θα ανταποκρίνεται στα ιδιαίτερα χαρακτηριστικά και τις ανάγκες των σύγχρονων αστικών κέντρων

Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography

Objectives To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia. Methods We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography. Results 7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5 mm (interquartile range: 3.0-4.0 mm). The circumferential extent of MAD comprised 34 ± 15 % of the posterior and 26 ± 12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa: 0.90 ± 0.02 and 0.92 ± 0.02). Mitral regurgitation (p = 1.00) and severe mitral annular calcification (p = 0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; p  0.05). Conclusions Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR

Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences

BACKGROUND The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. METHODS 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. RESULTS Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). CONCLUSION Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available