A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

Multifrequency variability of the blazar AO 0235+164 the WEBT campaign in 2004-2005 and long-term SED analysis

A huge multiwavelength campaign targeting the blazar AO 0235+164 was organized by the Whole Earth Blazar Telescope (WEBT) in 2003-2005 to study the variability properties of the source. Monitoring observations were carried out at cm and mm wavelengths, and in the near-IR and optical bands, while three pointings by the XMM-Newton satellite provided information on the X-ray and UV emission. We present the data acquired during the second observing season, 2004-2005, by 27 radio-to-optical telescopes. They reveal an increased near-IR and optical activity with respect to the previous season. Increased variability is also found at the higher radio frequencies, down to 15 GHz, but not at the lower ones. The radio (and optical) outburst predicted to peak around February-March 2004 on the basis of the previously observed 5-6 yr quasi-periodicity did not occur. The analysis of the optical light curves reveals now a longer characteristic time scale of 8 yr, which is also present in the radio data. The spectral energy distributions corresponding to the XMM-Newton observations performed during the WEBT campaign are compared with those pertaining to previous pointings of X-ray satellites. Bright, soft X-ray spectra can be described in terms of an extra component, which appears also when the source is faint through a hard UV spectrum and a curvature of the X-ray spectrum. Finally, there might be a correlation between the X-ray and optical bright states with a long time delay of about 5 yr, which would require a geometrical interpretation

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

Climatic control on deposition of upper Pliocene deepwater gravity-driven strata in the Apennines foredeep (central Italy): correlations to the marine oxygen sea isotope record.

The thick upper Pliocene to lower Pleistocene succession of hemipelagic mudstones of the Marche Apennines foredeep (central Italy) is punctuated by several mostly coarse-grained, cyclic turbidite systems. Integrated and detailed analyses of sedimentary facies, physical stratigraphy, biostratigraphy, and magnetostratigraphy have provided a high-resolution sequence stratigraphic framework for sediments of two of these coarse-grained systems, each resulting from the stack of five deepwater, high-frequency depositional sequences backfilling the mouth and lower reaches of a long-lived submarine canyon. The tight chronostratigraphic control available on these two turbidite systems and encasing hemipelagic sediments allows a precise correlation of the component high-frequency sequences with the Pliocene marine oxygen isotope curve. This reveals that the cyclic arrangement occurred near the Gauss–Matuyama polarity transition and the onset of the Olduvai subchron in response to recurring, obliquity-driven global changes in sea level. Each depositional sequence, 20 to 65 m thick, includes sediments that were deposited by a range of gravity-driven processes, resulting in sedimentary motifs that contain a deep marine record of both glacial and interglacial stages. A typical depositional sequence comprises: (1) a lowstand systems tract composed of cohesionless-debris-flow conglomerates (braided submarine channel complex), which passes down-dip into turbidite sandstones (frontal-splay complex); (2) an overlying transgressive to early falling-stage systems tract composed of a mud-rich masstransport complex of slumped horizons and cohesive-mud-flow pebbly mudstones eventually overlain by a thin interval of hemipelagic mudstones. This stacking pattern records variations in depositional style, and hence, variations in canyon activity during eustatic changes in sea level

The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study

Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique

The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study

Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique