The impact of platelet function or C-reactive protein, on cardiovascular events after an acute myocardial infarction

<p>Abstract</p> <p>Background</p> <p>Recurrent cardiovascular events following acute myocardial infarction (AMI) are common. The purpose of this study was to evaluate the impact of platelet aggregation, PFA-100 closure times and peak C-reactive protein (CRP), respectively, on the occurrence of death, myocardial infarction and ischemic cerebral events after an AMI. Furthermore, to examine the relationship between the platelet function tests and peak CRP.</p> <p>Methods</p> <p>Three hundred and thirty-four patients with AMI were included in the study. Platelet aggregation was analyzed by an aggregometer using laser light (PA-200). The state of high residual platelet reactivity was defined as normal closure times (PFA-100) during treatment with aspirin.</p> <p>Results</p> <p>The fourth quartile of peak CRP was associated with poorer outcome as compared to the first quartile in a multivariate Cox-regression analysis, with a hazard ratio of 2.0 (95% CI 1.1–3.7) for the occurrence of death, myocardial infarction and ischemic cerebral events. The fourth quartile of peak CRP (>64.6 mg/l) was associated with platelet aggregation (p < 0.001, adjusted R²= 0.13) and high residual platelet reactivity, in a multivariate model, with an odds ratio of 2.9 (CI 95% 1.3–6.8), as compared to the first quartile. Neither the highest quartile of platelet aggregation nor the state of high residual platelet reactivity predicted new cardiovascular events.</p> <p>Conclusion</p> <p>In patients with myocardial infarction, measured peak CRP is associated with new cardiovascular events. Despite an association with peak CRP neither more pronounced platelet aggregation nor PFA-100 closure times independently predict new cardiovascular events.</p

«Io giungo all’essere e a me stesso». Le prime opere di Francesco Lo Savio, 1957-1959

The main aim of the article is to explain the beginning of the Roman painter Francesco Lo Savio’s career from 1957 to 1959. This part of his production has long been unknown because it was considered too distant from the mature works. During those years Lo Savio is still tied to his training in Informal Art. Moreover, the work of this period also show influences coming from American art, in particular, from the pictorial research of Mark Rothko. This essay illustrates why these works should be considered an important step, although germinal, in Lo Savio’s painting career. Just by analyzing the origins of his painting, it is possible to understand the next steps of his work. The works at the end of 1958 and early 1959 are, in fact, the start of his artistic path that will result in Space-Light paintings a few months later.The main aim of the article is to explain the beginning of the Roman painter Francesco Lo Savio’s career from 1957 to 1959. This part of his production has long been unknown because it was considered too distant from the mature works. During those years Lo Savio is still tied to his training in Informal Art. Moreover, the work of this period also show influences coming from American art, in particular, from the pictorial research of Mark Rothko. This essay illustrates why these works should be considered an important step, although germinal, in Lo Savio’s painting career. Just by analyzing the origins of his painting, it is possible to understand the next steps of his work. The works at the end of 1958 and early 1959 are, in fact, the start of his artistic path that will result in Space-Light paintings a few months later

Origini russe del monocromo

Talking about monochrome painting is a complex issue, due to the impossibility of considering it as a pictorial genre with unique characteristics, and due to the difficulty of framing the variety of artists who can be ascribed, in different ways, to this movement. This essay is intended to be a historical-critical reflection on the initial phase of monochrome painting, in order to clarify how the pictorial roots of modern monochrome are to be found in the context of the experiences relating to abstraction in the early 1900s, in particular, in Malevič and Rodčenko. Although this genesis is well-known, highlighting the ambivalences of the beginnings can contribute to enrich our perception of the “tradition of the new” in many of its dualisms.Talking about monochrome painting is a complex issue, due to the impossibility of considering it as a pictorial genre with unique characteristics, and due to the difficulty of framing the variety of artists who can be ascribed, in different ways, to this movement. This essay is intended to be a historical-critical reflection on the initial phase of monochrome painting, in order to clarify how the pictorial roots of modern monochrome are to be found in the context of the experiences relating to abstraction in the early 1900s, in particular, in Malevič and Rodčenko. Although this genesis is well-known, highlighting the ambivalences of the beginnings can contribute to enrich our perception of the “tradition of the new” in many of its dualisms

COVID-19 atypical Parsonage-Turner syndrome: a case report

Background Neurological manifestations of Sars-CoV-2 infection have been described since March 2020 and include both central and peripheral nervous system manifestations. Neurological symptoms, such as headache or persistent loss of smell and taste, have also been documented in COVID-19 long-haulers. Moreover, long lasting fatigue, mild cognitive impairment and sleep disorders appear to be frequent long term neurological manifestations after hospitalization due to COVID-19. Less is known in relation to peripheral nerve injury related to Sars-CoV-2 infection. Case presentation We report the case of a 47-year-old female presenting with a unilateral chest pain radiating to the left arm lasting for more than two months after recovery from Sars-CoV-2 infection. After referral to our post-acute outpatient service for COVID-19 long haulers, she was diagnosed with a unilateral, atypical, pure sensory brachial plexus neuritis potentially related to COVID-19, which occurred during the acute phase of a mild Sars-CoV-2 infection and persisted for months after resolution of the infection. Conclusions We presented a case of atypical Parsonage-Turner syndrome potentially triggered by Sars-CoV-2 infection, with symptoms and repercussion lasting after viral clearance. A direct involvement of the virus remains uncertain, and the physiopathology is unclear. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach to following-up COVID-19 survivors is strongly advised

Inflammation, platelet aggregation and prognosis in acute myocardial infarction

The incidence of stroke and re-infarction is noticeably high in the first few days following acute myocardial infarction. This finding has raised questions whether the systemic inflammatory reaction secondary to myocardial necrosis is involved. The inflammation might affect the activation of platelets leading to insufficient effect of the antiplatelet treatment given. Furthermore, the importance of platelet reactivity and inflammation in terms of long-term prognosis is not fully understood. The prognostic importance of C-reactive protein (CRP) in relation to clinical variables also needs to be clarified. The present studies are aimed at describing the dynamics of platelet function during the first days of an acute myocardial infarction, in relation to diabetes and inflammation. We also investigated whether increased platelet reactivity or the increased concentration of CRP in blood were related to a worse outcome. Finally, we examined if CRP levels contributed to a predictive model using clinical variables known to affect outcome in patients with AMI.  We used two novel platelet function tests to measure platelet reactivity; the PA-200 (a laser light aggregometer) and the PFA-100 (measures primary haemostasis in whole blood). Platelet aggregation increased during the initial course of an acute myocardial infarction. The increase in platelet aggregation was most pronounced in diabetics and in patients showing higher systemic inflammatory reaction, assessed by measuring the concentration of CRP in blood. The pronounced platelet aggregation occurred despite ongoing antiplatelet and antithrombotic treatment. There was a significant association between the levels of CRP and the degree of platelet reactivity. However, while the CRP levels were associated with a worse outcome (AMI, stroke and death), the results of the platelet function tests were not. The importance of CRP in predicting prognosis depended on which adjustments were made for confounding factors. CRP and prognostic variables in a statistical model predicting death, however, showed that CRP was excluded. Thus CRP did not predict outcome beyond clinical prognostic variables. The results of these studies reinforce the importance of clinical variables such as heart failure, age, atrial fibrillation, smoking status, diabetes and impaired kidney function - all of which were associated with worse prognosis in multivariable analysis

Territorial dissimilarities in energy and climate change

The ‘Europe 2020 Strategy’ was issued in 2010 by the European Commission. This document constitutes a growth scheme for the decade 2010-2020 that aims to help the European Union to emerge from the current crisis through the so-called smart, sustainable and inclusive dimensions of growth. In this context, the basic aim of the SIESTA (“Spatial Indicators for a ‘Europe 2020 Strategy’ Territorial Analysis”) Project has been to illustrate the territorial dimension of the ‘Europe 2020 Strategy’. In other words, to show how this document acts territorially, particularly at the regional scale, but, when possible, also at the urban level. The SIESTA Project has been funded by ESPON (“European Observation Network for Territorial Development and Cohesion”), a European Commission Programme whose mission is to support policy development in relation to the aim of territorial cohesion and a harmonious development of the European territory. This book includes most of the main findings and conclusions obtained through research of the SIESTA Project. The contents were presented and discussed as keynote addresses or communications at the SIESTA Final Conference held in Santiago de Compostela, Galicia, on 4-5 April 2013

An index for the assessment of degraded Mediterranean forest ecosystems

Aim of study: Diagnosing the degradation degree of forest ecosystems is the basis for restoration strategies. However, there is no literature documenting how to quantify the forest degradation degree by using synthetic indicators, also because there is not a widely accepted definition for "forest degradation" and "degraded forest". Although there are many definitions of forest degradation that converge on the loss of ecosystem services, still today there are no largely accepted methods that give operational guidance to help in defining it. In the present research, with the aim to assess the degree of forest degradation, an integrated index - FDI, Forest Degradation Index - was developed.Area of study: In this first application, the FDI was applied and validated at stand level in two different Mediterranean forest types in two different case studies: Madonie and Nedrodi regional Parks (Sicily, Italy). The first dominated by sessile oak [Quercus petraea (Matt.) Liebl. subsp. austrotyrrhenica Brullo, Guarino & Siracusa], the second dominated by cork oak (Quercus suber L.).Material and methods: FDI is a synthetic index structured starting from representative and relatively easily detectable parameters. Here, we propose a set of six indicators that should be assessed to determine the forest degradation: Structural Index (SI), Canopy Cover (CC), Natural Regeneration Density (NRD), Focal Species of Degradation (FSD), Coarse Woody Debris (CWD), and Soil Depth (SD). FDI, here proposed and discussed, has been based on a MCDA (Multi-Criteria Decision Analysis) approach using the Analytic Hierarchy Process (AHP) technique, and implemented in order to contribute in finding simple indicators useful for forest restoration purposes that have an eco-functional basis.Main results: An integrated index of forest degradation has been defined. FDI values are comprised in the closed interval [0, 10], ranging from class I (Higher ecological functionality) to class IV (Lower ecological functionality). A forest fallen in the FDI-IV class can be defined degraded. In this first application, degradation occurs in SA-4 and in SB-4 where the lowest values (qualitative and quantitative) of the indicators were recorded and the FDI reach the minimum value.Research highlights: FDI has proved to be a useful tool at stand level in identifying a threshold value below which a forest can be termed as ‘degraded’. In turn, FDI assumes the meaning of descriptor of the ecological functionality. Future development of the FDI will provide an extension of the application at landscape scale exploiting the potential advantages in coupling MCDA and GIS (Geographical Information Systems) techniques.Keywords: Forest Degradation Index (FDI); Sustainable Forest Management (SFM); Mediterranean Forest Landscape; Multi-Criteria Decision Analysis (MCDA) approach; Analytic Hierarchy Process (AHP).

An index for the assessment of degraded Mediterranean forest ecosystems

<p><em>Aim of study</em>: Diagnosing the degradation degree of forest ecosystems is the basis for restoration strategies. However, there is no literature documenting how to quantify the forest degradation degree by using synthetic indicators, also because there is not a widely accepted definition for "forest degradation" and "degraded forest". Although there are many definitions of forest degradation that converge on the loss of ecosystem services, still today there are no largely accepted methods that give operational guidance to help in defining it. In the present research, with the aim to assess the degree of forest degradation, an integrated index - FDI, Forest Degradation Index - was developed.</p><p><em>Area of study</em>: In this first application, the FDI was applied and validated at stand level in two different Mediterranean forest types in two different case studies: Madonie and Nedrodi regional Parks (Sicily, Italy). The first dominated by sessile oak [<em>Quercus petraea</em> (Matt.) Liebl. subsp. austrotyrrhenica Brullo, Guarino &amp; Siracusa], the second dominated by cork oak (<em>Quercus suber</em> L.).</p><p><em>Material and methods</em>: FDI is a synthetic index structured starting from representative and relatively easily detectable parameters. Here, we propose a set of six indicators that should be assessed to determine the forest degradation: Structural Index (SI), Canopy Cover (CC), Natural Regeneration Density (NRD), Focal Species of Degradation (FSD), Coarse Woody Debris (CWD), and Soil Depth (SD). FDI, here proposed and discussed, has been based on a MCDA (Multi-Criteria Decision Analysis) approach using the Analytic Hierarchy Process (AHP) technique, and implemented in order to contribute in finding simple indicators useful for forest restoration purposes that have an eco-functional basis.</p><p><em>Main results</em>: An integrated index of forest degradation has been defined. FDI values are comprised in the closed interval [0, 10], ranging from class I (Higher ecological functionality) to class IV (Lower ecological functionality). A forest fallen in the FDI-IV class can be defined degraded. In this first application, degradation occurs in SA-4 and in SB-4 where the lowest values (qualitative and quantitative) of the indicators were recorded and the FDI reach the minimum value.</p><p><em>Research highlights</em>: FDI has proved to be a useful tool at stand level in identifying a threshold value below which a forest can be termed as ‘degraded’. In turn, FDI assumes the meaning of descriptor of the ecological functionality. Future development of the FDI will provide an extension of the application at landscape scale exploiting the potential advantages in coupling MCDA and GIS (Geographical Information Systems) techniques.</p><p align="left"><strong>Keywords</strong>: Forest Degradation Index (FDI); Sustainable Forest Management (SFM); Mediterranean Forest Landscape; Multi-Criteria Decision Analysis (MCDA) approach; Analytic Hierarchy Process (AHP). </p