Normal CMR bi-atrial and biventricular reference values in sickle cell disease patients without heart damage

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The MIOT project receives "no-profit support" from industrial sponsorships (Chiesi Farmaceutici S.p.A., ApoPharma Inc.). Background. Cardiac function indices in patients with hemoglobinopathies are different from those in healthy population, mainly due to chronic anemia. Normal reference values specific for SCD patients are not available by CMR. Aim. We aimed to define the normal cut-off value in SCD patients for bi-atrial and biventricular cardiac magnetic resonance (CMR) parameters. Methods. We considered forty-eight adult SCD patients with no known risk factors or cardiac disease, normal electrocardiogram, no macroscopic myocardial fibrosis, and all cardiac segments with T2*≥20 ms, consecutively enrolled in the MIOT network (Myocardial iron overload in thalassemia). SCD patients were compared with ninety-six healthy controls and 96 thalassemia major (TM) patients without cardiac damage, both matched for age and gender. Nine pediatric SCD patients were also analysed in comparison with 9 TM patients and 9 healthy subjects matched for age and gender. Cine images were acquired to quantify biventricular function parameters: LV and RV end-diastolic volume (EDV), end-systolic volume (ESV) and stroke volume (SV) were normalized for body surface area (EDVI, ESVI, SVI), as well as biventricular mass and atrial areas. Myocardial iron overload was assessed by segmental T2* technique. Late gadolinium enhancement (LGE) images were acquired for evaluation of macroscopic myocardial fibrosis. Results. In all three groups males showed higher biventricular volumes and mass indexes than females. SCD male patients had significantly higher LVEDVI (p < 0.0001), LVESVI (p = 0.010), LVSVI (p = 0.003), cardiac index (p = 0.002), LV and RV mass index (p = 0.008 and p = 0.001, respectively) and left and right atrial areas (p < 0.001 and p = 0.011) than healthy subjects. No significant differences were found in RVEDVI, EVESVI and biventricular EF. Compared to healthy volunteers, females with SCD showed a larger LVEDVI (p = 0.020), LVSVI (p = 0.039), RV mass index (p = 0.002) and left atrial area (p = 0.008). SCD and TM patients showed comparable values of bi-atrial and biventricular volumes and function. When compared to TM, SCD patients showed a larger LV (p < 0.001) and RV mass index (p = 0.001) in male group and a larger RV mass index (p = 0.001) in female group. Table 1 shows the cut-offs for bi-atrial and biventricular MR parameters for adult SCD patients by gender. No significant differences in MR parameters were found among the pediatric groups. Conclusions. Normal reference ranges of bi-atrial and biventricular MR parameters for adult males and females SCD patients were established. The use of these reference values will prevent possible misdiagnosis of cardiomyopathy in patients with SCD

The importance of incorporating soil in the life cycle assessment procedure to improve the sustainability of agricultural management

The formidable ability of soil to store carbon has attracted an increasing number of studies, but few of them included soil organic carbon (SOC) sequestration as part of a carbon balance assessment in the agroecosystem. This raises some interesting questions: 1) how orchards conversion increase soil capacity to mitigate the green–house gases (GHG) emissions by storing C? 2) can it be considered in life cycle assessment (LCA)? 3) can SOC pools and soil biochemical properties determination improve LCA interpretation? To answer these questions, this study selected a ten– and fifteen–years–old peach orchards, a twenty–years–old pear orchard, a thirty–years–old kiwi orchard in south-east part of Emilia–Romagna Region (Italy), and a cereals’ field as reference. Soil samples were collected from 0 to 15 and 15–30 cm depths, and the SOC pool amounts (i.e., labile and recalcitrant) determined. LCA was used to estimate the GHG emissions (CO2eq) from the orchards. Results showed that the conversion from cereals to orchard production increased OC stock (+82 % on average) suggesting that orchards cultivation systems have the capacity to enrich soil organic matter. Fertilization had the greatest impact on CO2eq emission accounting for at least 40 % of total CO2eq emissions. Kiwi cultivation had the highest impact on GHG emissions mainly due to the high water and nutrient demand (0.045 and 0.149 kg CO2eq kg−1 fruit yr−1, respectively). When taking into account the C–CO2eq loss by fruit cultivation and C storage in soils, results would indicate that peach and pear orchard agroecosystems promote C sequestration. Conversely, kiwi cultivation showed large CO2eq emissions only partly counterbalanced by SOC sequestration. This study highlights the importance of including soils in LCA: if made mandatory this would allow a wider, yet more detailed, picture of the impact of agricultural practices on C budget. This simple step could help optimise resource management and at the same time improve agroecosystem sustainability

Infezione da HIV e intestino

Infezione da HIV e Intestin

Movement abnormalities in the left ventricle of thalassemia major patients

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Assessment of human exposure to pesticides in greenhouses and effectiveness of personal protective devices

The exposure to pesticides in a group of workers growing vegetables in greenhouses in farms near Rimini in Italy was evaluated. The pesticides used were organophosphorus compounds, organochlorine compounds, carbamates, pyrethroids, amide and anilide derivatives. Measurements were carried out in seven greenhouses randomly selected. The environment was free of atmospheric agents which could have influenced the pesticide concentrations in the indoor air. Two types of chemical sampling were performed: environmental and personal. The latter was done in the liquid for washing hands and by means of pads applied directly to the worker's skin and to the clothes. The aim of the determination of airborne pesticide concentrations was to evaluate mean environmental exposure to pesticides in the sprayed areas. The sampling went on from a fixed point during the entire spraying period. The aim of individual sampling was to determine the active ingredients as contaminants. The values obtained showed a risk of exposure for the greenhouse personnel working without using personal protective devices (masks, gloves and waterproof clothes), considering that pesticides could be absorbed through the skin in between the spraying intervals

Genotypic groups as risk factors for cardiac magnetic resonance abnormalities and complications in thalassemia major: a large, multicentre study

Background - The causes and effects of genotypic heterogeneity in beta-thalassemia major (β-TM) have not been fully investigated. The aim of this multicentre study was to determine whether different genotype groups could predict the development of cardiovascular magnetic resonance abnormalities and cardiac complications. Materials and methods - We considered 708 β-TM patients (373 females, age 30.05±9.47 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. Data were collected from birth to the first cardiac magnetic resonance scan. Myocardial iron overload was assessed using a T2* technique. Biventricular function was quantified by cine images. Macroscopic myocardial fibrosis was evaluated by a late gadolinium enhancement technique. Results - Three groups of patients were identified: β+ homozygotes (n=158), β+/β° heterozygotes (n=298) and β° homozygotes (n=252). Compared to β+ homozygotes, the other two groups showed a significantly higher risk of myocardial iron overload and left ventricular dysfunction. We recorded 90 (13.0%) cardiac events: 46 episodes of heart failures, 38 arrhythmias (33 supraventricular, 3 ventricular and 2 hypokinetic) and 6 cases of pulmonary hypertensions. β° homozygotes showed a significantly higher risk than β+ homozygotes of arrhythmias and cardiac complications considered globally. Discussion - Different genotype groups predicted the development of myocardial iron overload, left ventricular dysfunction, arrhythmias and cardiac complications in β-TM patients. These data support the importance of genotype knowledge in the management of β-TM patients