Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques.

Aortic diseases include a wide range of pathological conditions: aortic aneurysms, pseudoaneurysms, acute aortic syndromes, atherosclerotic and inflammatory conditions, genetic diseases and congenital anomalies. Acute aortic syndromes have acute onset and may be life-threatening. They include aortic dissection, intramural haematoma, penetrating aortic ulcer and traumatic aortic injury. Pain is the common denominator to all acute aortic syndromes. Pain occurs regardless of age, gender and other associated clinical conditions. In this review, we deal with the main findings in the clinical setting and the most recent indications for diagnostic imaging, which are aimed to start an appropriate treatment and improve the short- and long-term prognosis of these patients. © The Author(s) 2016

IL PATRIMONIO IMMOBILIARE PUBBLICO IN ITALIA: DALLA DISMISSIONE ALLA VALORIZZAZIONE. EVOLUZIONE DELLA NORMATIVA E PROSPETTIVE FUTURE

The management of the public real estate has represented a relevant issue for the legislator since the unification of Italy. It has been for several years the core of political debates having a direct impact on national economy. This paper intends to collect the legislative proceedings and political guidelines adopted regarding the decommissioning and valorisation of public real estate assets revealing the prevailing characters that guided legislative interventions. Over time, a significant regulatory layering has taken place overloading the bureaucratic procedures leading to a slowdown in the valorisation processes. The paper suggests the adoption of unified and structured protocols capable of rapidly implementing the most suitable valorisation strategies

UNA PRIMA RIFLESSIONE SUGLI ESITI DELLA RICOSTRUZIONE POST-SISMICA ABRUZZESE

The dilapidation of building stock that has come to characterise the hillside and mountainous settlements of the region of Abruzzo in recent decades is a sign of forms of economic decline and negative demographic trends. In this situation, it is difficult to imagine occasions for a turn in events triggered by endogenous forces; instead, there is a sense of the need for public intervention and targeted economic-social policies. Indeed, in settlements lacking important resources for tourism and/or infrastructures for winter sports, it is very difficult to imagine their recovery through interventions entrusted solely to the market: often negligible property values suggest the inconvenience of any building requalification project in relation to asset or income-based objectives of valorisation. The reconstruction process put into place after the 2009 earthquake could have been interpreted and implemented within a vaster programme of interventions based on clear and defined strategic capable of guaranteeing prospects for the long-term relaunching and development of damaged areas. The initial idea behind the Reconstruction Plans appeared to confirm a similar approach. In reality, reconstruction is proceeding as a simple programme of building recovery. The paper develops this thesis by attempting to demonstrate how after a decade later the 2009 earthquake, the funding provided to date has not produced particularly relevant effects on local economics and demographics

Antibacterial activities of peptides from the water-soluble extracts of Italian cheese varieties.

Water-soluble extracts of 9 Italian cheese varieties that differed mainly for type of cheese milk, starter, technology, and time of ripening were fractionated by reversed-phase fast protein liquid chromatography, and the antimicrobial activity of each fraction was first assayed toward Lactobacillus sakei A15 by well-diffusion assay. Active fractions were further analyzed by HPLC coupled to electrospray ionization-ion trap mass spectrometry, and peptide sequences were identified by comparison with a proteomic database. Parmigiano Reggiano, Fossa, and Gorgonzola water-soluble extracts did not show antibacterial peptides. Fractions of Pecorino Romano, Canestrato Pugliese, Crescenza, and Caprino del Piemonte contained a mixture of peptides with a high degree of homology. Pasta filata cheeses (Caciocavallo and Mozzarella) also had antibacterial peptides. Peptides showed high levels of homology with N-terminal, C-terminal, or whole fragments of well known antimicrobial or multifunctional peptides reported in the literature: alphaS1-casokinin (e.g., sheep alphaS1-casein (CN) f22-30 of Pecorino Romano and cow alphaS1-CN f24-33 of Canestrato Pugliese); isracidin (e.g., sheep alphaS1-CN f10-21 of Pecorino Romano); kappacin and casoplatelin (e.g., cow kappa-CN f106-115 of Canestrato Pugliese and Crescenza); and beta-casomorphin-11 (e.g., goat beta-CN f60-68 of Caprino del Piemonte). As shown by the broth microdilution technique, most of the water-soluble fractions had a large spectrum of inhibition (minimal inhibitory concentration of 20 to 200 microg/mL) toward gram-positive and gram-negative bacterial species, including potentially pathogenic bacteria of clinical interest. Cheeses manufactured from different types of cheese milk (cow, sheep, and goat) have the potential to generate similar peptides with antimicrobial activity

Cardiovascular risk evaluation and prevalence of silent myocardial ischemia in subjects with asymptomatic carotid artery disease

Introduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis. Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries. Results: A statistically significant relationship (P = 0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively. Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification.Introduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis. Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries. Results: A statistically significant relationship (P = 0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively. Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification. © 2011 Ciccone et al, publisher and licensee Dove Medical Press Ltd

On driver behavior recognition for increased safety:A roadmap

Advanced Driver-Assistance Systems (ADASs) are used for increasing safety in the automotive domain, yet current ADASs notably operate without taking into account drivers’ states, e.g., whether she/he is emotionally apt to drive. In this paper, we first review the state-of-the-art of emotional and cognitive analysis for ADAS: we consider psychological models, the sensors needed for capturing physiological signals, and the typical algorithms used for human emotion classification. Our investigation highlights a lack of advanced Driver Monitoring Systems (DMSs) for ADASs, which could increase driving quality and security for both drivers and passengers. We then provide our view on a novel perception architecture for driver monitoring, built around the concept of Driver Complex State (DCS). DCS relies on multiple non-obtrusive sensors and Artificial Intelligence (AI) for uncovering the driver state and uses it to implement innovative Human–Machine Interface (HMI) functionalities. This concept will be implemented and validated in the recently EU-funded NextPerception project, which is briefly introduced

Doppler ultrasound venous mapping of the lower limbs

Aldo Innocente Galeandro1, Giovanni Quistelli2, Pietro Scicchitano2, Michele Gesualdo2, Annapaola Zito2, Paola Caputo2, Rosa Carbonara2, Giuseppe Galgano3, Francesco Ciciarello4, Sandro Mandolesi4, Claude Franceschi5, Marco Matteo Ciccone21Centro Diagnostica Globale and ASL-TA, Taranto, Italy; 2Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy; 3Cardiovascular Diseases Section, Ente Ecclesiastico Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Bari, Italy; 4Cardiology Department, Policlinico Umberto I, Sapienza University of Rome, Italy; 5Vascular Laboratories of Hospitals Saint Joseph and Pitié-Salpétrière, Paris, FranceBackground: The study aim was to test the accuracy (intra and interobserver variability), sensitivity, and specificity of a simplified noninvasive ultrasound methodology for mapping superficial and deep veins of the lower limbs.Methods: 62 consecutive patients, aged 62 ± 11 years, were enrolled. All underwent US-examinations, performed by two different investigators, of both legs, four anatomical parts, and 17 veins, to assess the interobserver variability of evaluation of superficial and deep veins of the lower limbs.Results: Overall the agreement between the second versus the first operator was very high in detecting reflux (sensitivity 97.9, specificity 99.7, accuracy 99.5; P = 0.80 at McNemar test). The higher CEAP classification stages were significantly associated with reflux (odds ratio: 1.778, 95% confidence interval: 1.552–2.038; P < 0.001) as well as with thrombosis (odds ratio: 2.765, 95% confidence interval: 1.741–4.389; P < 0.001). Thus, our findings show a strict association between the symptoms of venous disorders and ultrasound evaluation results for thrombosis or reflux.Conclusion: This study demonstrated that our venous mapping protocol is a reliable method showing a very low interobserver variability, which makes it accurate and reproducible for the assessment of the morphofunctional status of the lower limb veins.Keywords: venous mapping, new methodology, sensitivity, specificity, accurac

Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis.

BACKGROUND: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity. METHODS: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity. RESULTS: A total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p < 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p < 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0. CONCLUSIONS: Cerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively.EU 7th Framewor

Growth variability in Atlantic horse mackerel Trachurus trachurus (Linneus, 1758) across the central Mediterranean Sea: contrasting latitudinal gradient and different ecosystems

Data on Atlantic horse mackerel Trachurus trachurus (Linneus, 1758) were collected along 8-year acoustic surveys (2011-2018). Age and growth variability of horse mackerel from the Central Mediterranean Sea were investigated within different, contrasting habitats, from the south of Sicily to the north Tyrrhenian (Ligurian Sea). Data from satellite provided the habitat features along the study period over the whole surveyed area. For comparison purposes, according to the ecosystems difference the study area has been split into four subareas: Strait of Sicily (SoS), North of Sicily (NS), south Tyrrhenian Sea (ST) and north Tyrrhenian Sea (NT). In terms of the FAO Geographical Sub-Area definition the SoS corresponding to GSA15 and 16, NS to GSA 10 south, ST to GSA10 north and NT to GSA 9. Results showed a growth homogeneity in the study area, suggesting a unique stock inhabiting these waters. The only exception was recorded for juveniles (Age 0 class) in the SoS, where a lower size at age was detected compared to other areas. A multiple linear modelling analyses suggested that variability in length at age 0 was mainly linked to the oceanographic differences between an upwelling driven system (Strait of Sicily) and the other ecosystems, where enrichment processes are mainly due to river runoff (relevant in ST and NT). Namely, Absolute Dynamic Topography (ADT) and body condition factor (Kn) were significantly related to differences in length at age 0. Results revealed that currents (and gyres) are among the principal abiotic factors controlling Atlantic horse mackerel growth in its first year of life, suggesting that circulation and food-related processes (i.e., zooplankton concentration) are of major importance for this species. Finally preliminary observations suggest the Strait of Sicily may be the main spawning area among those analyzed

Rethinking neuroprotection in severe traumatic brain injury : toward bedside neuroprotection

Neuroprotection after traumatic brain injury (TBI) is an important goal pursued strenuously in the last 30 years. The acute cerebral injury triggers a cascade of biochemical events that may worsen the integrity, function, and connectivity of the brain cells and decrease the chance of functional recovery. A number of molecules acting against this deleterious cascade have been tested in the experimental setting, often with preliminary encouraging results. Unfortunately, clinical trials using those candidate neuroprotectants molecules have consistently produced disappointing results, highlighting the necessity of improving the research standards. Despite repeated failures in pharmacological neuroprotection, TBI treatment in neurointensive care units has achieved outcome improvement. It is likely that intensive treatment has contributed to this progress offering a different kind of neuroprotection, based on a careful prevention and limitations of intracranial and systemic threats. The natural course of acute brain damage, in fact, is often complicated by additional adverse events, like the development of intracranial hypertension, brain hypoxia, or hypoperfusion. All these events may lead to additional brain damage and worsen outcome. An approach designed for early identification and prompt correction of insults may, therefore, limit brain damage and improve results