Prognostic role of aldosterone in patients with acute coronary syndrome: short and medium term follow-up.

AIMS: Different studies have shown a correlation between aldosterone, atherosclerosis and ischemia in the past decade. Evidence exists for the relationship between high levels of aldosterone and augmented risk of cardiovascular diseases, such as hypertension, cardiac failure, coronary artery disease and stroke. The objective of this study was to determine the prognostic role of aldosterone in patients with myocardial infarction. METHODS:The study population included 96 consecutive patients admitted to our department for ST-elevated and non-ST-elevated myocardial infarction from June 2009 to March 2012. Plasma aldosterone levels were measured at admission to hospital in all patients. A 2-year prospective follow-up was performed, and fatal events and non-fatal events, such as reinfarction, congestive heart failure and arrhythmias, were recorded. RESULTS:Aldosterone levels at admission were associated with incidence of congestive heart failure (P\u200a=\u200a0.02), ventricular arrhythmias (P\u200a=\u200a0.01) and all complications (P\u200a=\u200a0.003) after 1-month follow-up. Moreover, high aldosterone levels gave important information in the medium term (24\u200a\ub1\u200a6 months). Specifically, aldosterone was a predictive variable of reinfarction (P\u200a<\u200a0.0001), congestive heart failure (P\u200a<\u200a0.0001) and adverse events (P\u200a=\u200a0.0002). The logistic regression analysis confirmed these results and showed that aldosterone may be predictive of adverse events at medium-term follow-up (odds ratio 1.1, 95% confidence interval 1.03-1.15, P\u200a=\u200a0.02). CONCLUSION:These data show a strong and significant correlation between plasma aldosterone levels at admission for myocardial infarction and fatal and nonfatal adverse events. Aldosterone appears to be a main marker of adverse clinical outcome, in accordance with the literature. These data suggest the need to identify whether antialdosteronic drug treatment, applied acutely in patients with aldosterone elevation, can influence favorably the prognosis of patients with myocardial infarction

Ice-bridging frustration by self-ejection of single droplets results in superior anti-frosting surfaces

Surfaces capable of delaying the frosting passively and facilitating its removal are highly desirable in fields where ice introduces inefficiencies and risks. Coalescence jumping, enabled by highly hydrophobic surfaces, is already exploited to slow down the frosting but it is insufficient to completely eliminate the propagation by ice-bridging. We show how the self-ejection of single condensation droplets can frustrate the ice bridges of all the condensation droplets leading to a frost velocity lower than 0.5 um/s thus dropping below the current limits of passive surfaces by a factor of at least 2. Arrays of truncated microcones, covered by uniformly hydrophobic nanostructures, enable individual condensation droplets to growth and self-propel towards the top of the microstructures and to self-eject once a precise volume is reached. The independency of self-ejection on the neighbour droplets allows a precise control on the droplets' size and distance distributions and the ice-bridging frustration. The most performant microstructures tend to cones with a sharp tip on which the percentage of self-ejection is maximum. Looking towards applications, tapered microstructures allow maximising the percentage of self-ejecting drops while maintaining a certain mechanical strength. Further, it is shown that inserted pinning sites are not essential, which greatly facilitates manufacturing

What links BRAF to the heart function? New insights from the cardiotoxicity of BRAF inhibitors in cancer treatment

none11noThe RAS-related signalling cascade has a fundamental role in cell. It activates differentiation and survival. It is particularly important one of its molecules, B-RAF. B-RAF has been a central point for research, especially in melanoma. Indeed, it lacked effective therapeutic weapons since the early years of its study. Molecules targeting B-RAF have been developed. Nowadays, two classes of molecules are approved by FDA. Multi-target molecules, such as Sorafenib and Regorafenib, and selective molecules, such as Vemurafenib and Dabrafenib. Many other molecules are still under investigation. Most of them are studied in phase 1 trials. Clinical studies correlate B-RAF inhibitors and QT prolongation. Though this cardiovascular side effect is not common using these drugs, it must be noticed early and recognize its signals. Indeed, Oncologists and Cardiologists should work in cooperation to prevent lethal events, such as fatal arrhythmias or sudden cardiac death. These events could originate from an uncontrolled QT prolongation.openBronte E.; Bronte G.; Novo G.; Bronte F.; Bavetta M.G.; Re G.L.; Brancatelli G.; Bazan V.; Natoli C.; Novo S.; Russo A.Bronte, E.; Bronte, G.; Novo, G.; Bronte, F.; Bavetta, M. G.; Re, G. L.; Brancatelli, G.; Bazan, V.; Natoli, C.; Novo, S.; Russo, A

Usefulness of regional right ventricular and right atrial strain for prediction of early and late right ventricular failure following a left ventricular assist device implant: A machine learning approach

Background: Identifying candidates for left ventricular assist device surgery at risk of right ventricular failure remains difficult. The aim was to identify the most accurate predictors of right ventricular failure among clinical, biological, and imaging markers, assessed by agreement of different supervised machine learning algorithms. Methods: Seventy-four patients, referred to HeartWare left ventricular assist device since 2010 in two Italian centers, were recruited. Biomarkers, right ventricular standard, and strain echocardiography, as well as cath-lab measures, were compared among patients who did not develop right ventricular failure (N = 56), those with acute–right ventricular failure (N = 8, 11%) or chronic–right ventricular failure (N = 10, 14%). Logistic regression, penalized logistic regression, linear support vector machines, and naïve Bayes algorithms with leave-one-out validation were used to evaluate the efficiency of any combination of three collected variables in an “all-subsets” approach. Results: Michigan risk score combined with central venous pressure assessed invasively and apical longitudinal systolic strain of the right ventricular–free wall were the most significant predictors of acute–right ventricular failure (maximum receiver operating characteristic–area under the curve = 0.95, 95% confidence interval = 0.91–1.00, by the naïve Bayes), while the right ventricular–free wall systolic strain of the middle segment, right atrial strain (QRS-synced), and tricuspid annular plane systolic excursion were the most significant predictors of Chronic-RVF (receiver operating characteristic–area under the curve = 0.97, 95% confidence interval = 0.91–1.00, according to naïve Bayes). Conclusion: Apical right ventricular strain as well as right atrial strain provides complementary information, both critical to predict acute–right ventricular failure and chronic–right ventricular failure, respectively

Management of direct oral anticoagulants in patients with atrial fibrillation undergoing cardioversion

Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real "epidemic phenomenon". Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. This, whether obtained with synchronized shock or with drugs, involves a periprocedural risk of stroke and systemic embolism which is reduced by adequate anticoagulant therapy in the weeks before or by the exclusion of left atrial thrombi. Direct oral anticoagulants are safe, manageable, and provide rapid onset of oral anticoagulation; they are an important alternative to heparin/warfarin from all points of view, with a considerable reduction in bleedings and increase in the safety and quality of life of patients

Ventricular pre-excitation in cats: 17 cases.

OBJECTIVES Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias. ANIMALS Seventeen cats with VPE and 15 healthy matched-control cats. MATERIAL AND METHODS Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated. RESULTS Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]). CONCLUSIONS Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats

Statistical Comparison of Classifiers Applied to the Interferential Tear Film Lipid Layer Automatic Classification

The tear film lipid layer is heterogeneous among the population. Its classification depends on its thickness and can be done using the interference pattern categories proposed by Guillon. The interference phenomena can be characterised as a colour texture pattern, which can be automatically classified into one of these categories. From a photography of the eye, a region of interest is detected and its low-level features are extracted, generating a feature vector that describes it, to be finally classified in one of the target categories. This paper presents an exhaustive study about the problem at hand using different texture analysis methods in three colour spaces and different machine learning algorithms. All these methods and classifiers have been tested on a dataset composed of 105 images from healthy subjects and the results have been statistically analysed. As a result, the manual process done by experts can be automated with the benefits of being faster and unaffected by subjective factors, with maximum accuracy over 95%

Vasospastic angina and scombroid syndrome: a case report

Scombroid syndrome is a fish poisoning characterised by the onset of symptoms compatible with a pseudoallergic reaction; it is rarely also responsible of signs and symptoms of acute coronary syndromes, as demonstrated in this case repor

Sunflower and peanut emergency : initial development under sugarcane mulch.

The research aimed to evaluate the effect of residual sugarcane mulch on sunflower and peanut plant emergence and initial development. Vases of 4.0 L were disposed in a randomized experimental blocks design, with four replications, in a factorial arrangement of five mulch amounts and three cultivars of each crop. The mulch treatments consisted of four increasing amounts (5, 10, 15 e 20 t ha-1) and a tester with no mulch. The sunflower cultivars were the varieties IAC-iarama and Catissol and the hybrid H-358; the peanut cultivars were IAC-Caiapó, Runner 886 and Tatu. The speed emergency index and final percentage, the plant height and shoot dry mass were evaluated. The presence of different levels of sugarcane mulch negatively influences the emergency and initial plant development mainly in peanut but also in sunflower. The negative effects are stronger especially for the runner type of peanut cultivars, while cultivar Tatu was less influenced by the mulch thickness

Ventricular pre-excitation in cats: 17 cases

Objectives: Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias. Animals: Seventeen cats with VPE and 15 healthy matched-control cats. Material and methods: Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated. Results: Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]). Conclusions: Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats