Epidemiology of coronary microvascular obstruction

Primary percutaneous coronary intervention (PPCI) is nowadays the preferred reperfusion strategy for treating ST-elevation myocardial infarction (STEMI) patients, aiming at restoring epicardial infarct-related artery patency and achieving microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured myocardium. Yet, in a sizeable proportion of patients, PPCI achieves epicardial coronary artery reperfusion but not myocardial reperfusion due to the occurrence of coronary microvascular obstruction (CMVO), a condition clinically known as no-reflow. Prevalence of CMVO is variable, ranging from 5% up to 50%, according to the methods used to assess the phenomenon and to the population under study. Indeed, CMVO can be assessed using different techniques and at different time points after STEMI. In this chapter, we review the available data regarding the incidence of CMVO in STEMI patients according to different reperfusion strategies (PPCI, effective thrombolysis, and rescue PCI) and according to the different modalities of its detection. Finally, we analyzed data in the literature reporting the incidence of CMVO in different clinical subsets (diabetes, chronic kidney disease, women, and latecomers) and different subset of lesions (saphenous vein graft)

The management of non-culprit coronary lesions in patients with acute coronary syndrome

About 50% of patients diagnosed with ST-segment elevation myocardial infarction have multivessel disease on coronary angiography. Recent evidence has shown that a staged percutaneous coronary intervention (PCI) strategy of non-culprit lesions, achieving complete revascularization, significantly reduces the rate of recurrent cardiovascular events compared with a PCI strategy limited to culprit lesion. Although functional evaluation of intermediate coronary stenoses by functional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is widely used to detect residual myocardial ischaemia, the reliability of the study of non-culprit lesions in the acute phase of heart attack is controversial. On the other hand, the excess of new events in patients with acute coronary syndrome in whom PCI was deferred on the basis of FFR/iFR compared to patients with stable CAD could be due to both an inadequate functional evaluation and an intrinsic higher risk, related to the presence of untreated vulnerable plaques. In this context, intra-coronary imaging has shown that the presence of vulnerability features in non-culprit plaques is associated with an increased rate of ischaemic recurrence

Hydrogen storage in MgH2 matrices: A study of Mg-MgH2 interface using CPMD code on ENEA-GRID

The remarkable ability of magnesium to store significant quantities of hydrogen, in the form (MgH2), has fostered intense research efforts in the last years in view of its future applications where light and safe hydrogen-storage media are needed. However, further research is needed since Mg has a high operation temperature and slow absorption kinetics that prevent for the moment the use in practical applications. To improve and optimize the performances of this material a detailed knowledge of the hydrogen diffusion mechanism at the atomic level is needed. Experiments can only provide indirect evidences of the atomic rearrangement during the desorption process. For these reasons a detailed computational study of MgH2 is invoked to characterize the dynamics of hydrogen during desorption. Further insights are gained by characterizing the Mg-MgH2 interface which is supposed to play a major role in the hydrogen diffusion during absorption and desorption cycles. By means of accurate ab initio molecular dynamics simulations based on the density-functional theory with norm-conserving pseudopotentials and plane-wave expansion (CPMD code) an interface is designed and studied. Extensive electronic structure calculations are used to characterize the equilibrium properties and the behavior of the surfaces in terms of total energy considerations and atomic diffusion

Kratom: The analytical challenge of an emerging herbal drug

Mitragyna speciosa or kratom is emerging worldwide as a “legal” herbal drug of abuse. An increasing number of papers is appearing in the scientific literature regarding its pharmacological profile and the analysis of its chemical constituents, mainly represented by alkaloids. However, its detection and identification are not straightforward as the plant material is not particularly distinctive. Hyphenated techniques are generally preferred for the identification and quantification of these compounds, especially the main purported psychoactive substances, mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG), in raw and commercial products. Considering the vast popularity of this recreational drug and the growing concern about its safety, the analysis of alkaloids in biological specimens is also of great importance for forensic and toxicological laboratories. The review addresses the analytical aspects of kratom spanning the extraction techniques used to isolate the alkaloids, the qualitative and quantitative analytical methods and the strategies for the distinction of the naturally occurring isomers

Myocardial and microvascular injury due to Coronavirus disease 2019

Over the past few months, health systems worldwide have been put to the test with the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though the leading clinical manifestations of the SARS-CoV-2 infection involve the respiratory tract, there is a non-negligible risk of systemic involvement leading to the onset of multi-organ failure with fatal consequences. Since the onset of COVID-19, patients with underlying cardiovascular disease have been at increased risk of poor clinical outcomes with higher death rates. Moreover, the occurrence of new-onset cardiac complications is not uncommon among patients hospitalised for COVID-19. Of importance, a significant portion of COVID-19 patients present with myocardial injury. Herein, the authors discuss the mechanisms leading to myocardial and microvascular injury in SARS-CoV-2 infection and their clinical implications

Transformation products of antibacterial drugs in environmental water: Identification approaches based on liquid chromatography-high resolution mass spectrometry

In recent years, the presence of antibiotics in the aquatic environment has caused increasing concern for the possible consequences on human health and ecosystems, including the development of antibiotic-resistant bacteria. However, once antibiotics enter the environment, mainly through hospital and municipal discharges and the effluents of wastewater treatment plants, they can be subject to transformation reactions, driven by both biotic (e.g. microorganism and mammalian metabolisms) and abiotic factors (e.g. oxidation, photodegradation, and hydrolysis). The resulting transformation products (TPs) can be less or more active than their parent compounds, therefore the inclusion of TPs in monitoring programs should be mandatory. However, only the reference standards of a few known TPs are available, whereas many other TPs are still unknown, due to the high diversity of possible transformation reactions in the environment. Modern high-resolution mass spectrometry (HRMS) instrumentation is now ready to tackle this problem through suspect and untargeted screening approaches. However, for handling the large amount of data typically encountered in the analysis of environmental samples, these approaches also require suitable processing workflows and accurate tandem mass spectra interpretation. The compilation of a suspect list containing the possible monoisotopic masses of TPs retrieved from the literature and/or from laboratory simulated degradation experiments showed unique advantages. However, the employment of in silico prediction tools could improve the identification reliability. In this review, the most recent strategies relying on liquid chromatography-HRMS for the analysis of environmental TPs of the main antibiotic classes were examined, whereas TPs formed during water treatments or disinfection were not included

Randomised trials and meta-analyses of double vs triple antithrombotic therapy for atrial fibrillation-ACS/PCI: A critical appraisal

•The optimal antithrombotic regimen to be used in patients with AF and PCI or ACS is still debated.•Each of the six randomised controlled trials comparing double to triple therapy has limitations.•None was powered to assess differences between treatment arms in ischaemic event rates.•The contrasting results regarding ischaemic events within published meta-analyses can be explained by heterogeneity, incompleteness and varying definitions of stent thrombosis.•The overall reduced bleeding rates, but increased early definite and probable stent thrombosis rates with double versus triple antithrombotic therapy encourage consideration of triple therapy during the first weeks from PCI followed by double therapy