Age of submarine debris avalanches and tephrostratigraphy offshore Ischia Island, Tyrrhenian Sea, Italy

We present an "event stratigraphy" framework built for the last 23 cal ka marine record in the southern offshore of Ischia Island based on AMS (14)C dating and tephrostratigraphic analysis of 11 gravity cores. Two collapse events have been recovered in the record: a) the Ischia submarine debris avalanche/debris flow (DA/DF), dated between similar to 3 ka B.P. and 2.4 ka B.P. and possibly between 2.7 ka B.P. and 2.4 ka B.P. (event DF1); b) a former, pre-Holocene, DA/DF older than 23 cal ka B.P. (event DF2). The Ischia DA, with an estimated volume of 1.5 km(3), incorporates thousands of blocks that are still detectable on the sea-floor until 45-50 km far from the island. Our results indicate an age of emplacement younger than previously thought and support the hypothesis that a major catastrophic event occurred when the island was already inhabited by Greek settlers (i.e. after the 7th century BC). Three ash layers have been recognised in the post-DF1 avalanche sequence and correlated with Ischian eruptions occurred between Middle Ages and Roman times. Two tephras recovered in the pre-DF1 succession have been correlated with explosive activity occurred on Ischia and Procida islands from similar to 23 ka to similar to 17.5 ka B.P. The results presented here improve the chronostratigraphic reconstruction of the main eruptive and collapse events that affected Ischia volcano during Late Pleistocene-Holocene and their dispersal at sea The occurrence of at least two major collapsing events in the past 23 kyr confirms the close genetic relationship between gravity failures and Mt. Epomeo uplift. (C) 2010 Elsevier B.V. All rights reserved

Age of submarine debris avalanches offshore Ischia island, Tyrrhenian Sea, Italy

Further 14C age constraints for the emplacement of historical and pre historical submarine debris avalanche and related to major collapses that affected the southern flank of Ischia island volcano are presented. Results are based on the stratigraphy of 11 gravity cores located in the southern offshore of the island and on new AMS analyses. The two collapsing events are: a) the Ischia submarine debris avalanche/debris flow, dated between ∼2.3 cal ka B.P. and ∼3 cal ka B.P.; b) a debris flow older than 23 cal ka B.P.. The Ischia debris avalanche, previously recognised mostly through marine geophysics, has an estimated volume of 1.5 km 3 and incorporates thousands of blocks that are still detectable over the sea-floor until 45-50 km from the island. Our results indicate an age of emplacement younger than previously held and support the still tentative hypothesis that a major catastrophic event occurred when the island was already inhabited by Greek settlers i.e. after the 7 th century b.C. The occurrence of at least two major collapsing events in the past 23 ka confirms the close genetic relationship between gravity failures and Mt. Epomeo uplift

Observational multicentre registry of patients treated with IMPella mechanical circulatory support device in Italy: The IMP-IT registry

Aims: The aim of this study was to investigate nationwide trends and clinical outcomes of the Impella device for cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). Methods and results: The IMP-IT study was a multicentre observational national registry which enrolled all patients treated with Impella 2.5, Impella CP, Impella 5.0 and Impella RP, both for CS and HR-PCI indications, across 17 Italian centres from 2004 to June 2018. A total of 406 patients were included: 229 had CS (56.4%) and 177 underwent HR-PCI (43.6%). The use of Impella increased significantly during the study period (average annual percent change 39.8%, 95% confidence interval: 30.4 to 49.9; p<0.0001) for both indications. The Impella 2.5 was the most commonly used device (N=242; 59.6%). Rates of in-hospital and one-year all-cause death in patients with CS were 46.9% and 57.0%, respectively; 18.5% underwent left ventricular assist device implantation or heart transplant at one year. Rates of in-hospital and one-year allcause death in patients who underwent HR-PCI were 5.7% and 15.6%, respectively. Rates of device-related complications were 37.1% and 10.7% in the setting of CS and HR-PCI, respectively. Conclusions: Use of the Impella for CS and HR-PCI is increasing substantially in Italy, despite relatively high rates of device-related complications

Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization

Objective: To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella\uae pump) implantation pre-percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high-risk PCI populations. Background: A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods: A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP-IT Registry were included. Through propensity-score weighting (PSW) analysis, 1-year clinical outcomes were assessed separately in CS and HR-PCI patients, stratified by timing of Impella support. Results: Pre-procedural insertion was associated with an improvement in 1-year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p =.04 before PSW, p =.009 after PSW) and HR-PCI (p <.01 both before and after PSW). Among patients undergoing HR-PCI, early Impella support was also associated with a lower rate of the composite of mortality, re-hospitalization for heart failure, and need for left-ventricular assist device/heart transplantation at 1-year (p =.04 before PSW, p =.01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in-hospital life-threatening and severe bleeding among patients with AMI-CS receiving PCI (7 vs. 16%, p =.1) and HR-PCI (1 vs. 9%, p =.02). Conclusions: Our findings suggested a survival benefit and reduced rates of major bleeding when a pre-PCI Impella implantation instead of during-after procedure was used in the setting of HR-PCI and AMI-CS

Differences between familial and sporadic dilated cardiomyopathy: ESC EORP Cardiomyopathy & Myocarditis registry

Aims: Dilated cardiomyopathy (DCM) is a complex disease where genetics interplay with extrinsic factors. This study aims to compare the phenotype, management, and outcome of familial DCM (FDCM) and non-familial (sporadic) DCM (SDCM) across Europe. Methods and results: Patients with DCM that were enrolled in the prospective ESC EORP Cardiomyopathy & Myocarditis Registry were included. Baseline characteristics, genetic testing, genetic yield, and outcome were analysed comparing FDCM and SDCM; 1260 adult patients were studied (238 FDCM, 707 SDCM, and 315 not disclosed). Patients with FDCM were younger (P\ua0<\ua00.01), had less severe disease phenotype at presentation (P\ua0<\ua00.02), more favourable baseline cardiovascular risk profiles (P\ua0 64\ua00.007), and less medication use (P\ua0 64\ua00.042). Outcome at 1\ua0year was similar and predicted by NYHA class (HR 0.45; 95% CI [0.25\u20130.81]) and LVEF per % decrease (HR 1.05; 95% CI [1.02\u20131.08]. Throughout Europe, patients with FDCM received more genetic testing (47% vs. 8%, P\ua0<\ua00.01) and had higher genetic yield (55% vs. 22%, P\ua0<\ua00.01). Conclusions: We observed that FDCM and SDCM have significant differences at baseline but similar short-term prognosis. Whether modification of associated cardiovascular risk factors provide opportunities for treatment remains to be investigated. Our results also show a prevalent role of genetics in FDCM and a non-marginal yield in SDCM although genetic testing is largely neglected in SDCM. Limited genetic testing and heterogeneity in panels provides a scaffold for improvement of guideline adherence

Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

74sireservedObjective: Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. Design: Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). Setting: Tertiary and University hospitals. Interventions: 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). Measurements: The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. Conclusions: The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections.mixedMonti G.; Galbiati C.; Toffoletto F.; Calabro M.G.; Colombo S.; Ferrara B.; Giardina G.; Lembo R.; Marzaroli M.; Moizo E.; Mucci M.; Pasculli N.; Plumari V.P.; Scandroglio A.M.; Tozzi M.; Momesso E.; Boffa N.; Lobreglio R.; Montrucchio G.; Guarracino F.; Benedetto U.; Biondi-Zoccai G.; D'Ascenzo F.; D'Andrea N.; Paternoster G.; Ananiadou S.; Ballestra M.; De Sio A.; Pota V.; Cotoia A.; Della Selva A.; Bruni A.; Iapichino G.; Bradic N.; Corradi F.; Gemma M.; Nogtev P.; Petrova M.; Agro F.E.; Cabrini L.; Forfori F.; Likhvantsev V.; Bove T.; Finco G.; Landoni G.; Zangrillo A.; Ajello S.; Cappelletti A.M.; Fominskiy E.; Nisi F.G.; Pazzanese V.; Pieri M.; Canavosio F.; Palmesino F.; Bernasconi M.; Gallioli G.; Marino G.; Vetrugno L.; Millin C.; Missio D.; Gallicchio F.; Azzali B.; Bozzetti M.; Cristadoro D.; Perone R.; Cantatore L.P.; Curci G.; Pabon I.M.; Garofalo E.; Mainetti M.; Calamai I.; Maraggia D.; Mattei A.; Yavorovskiy A.Monti, G.; Galbiati, C.; Toffoletto, F.; Calabro, M. G.; Colombo, S.; Ferrara, B.; Giardina, G.; Lembo, R.; Marzaroli, M.; Moizo, E.; Mucci, M.; Pasculli, N.; Plumari, V. P.; Scandroglio, A. M.; Tozzi, M.; Momesso, E.; Boffa, N.; Lobreglio, R.; Montrucchio, G.; Guarracino, F.; Benedetto, U.; Biondi-Zoccai, G.; D'Ascenzo, F.; D'Andrea, N.; Paternoster, G.; Ananiadou, S.; Ballestra, M.; De Sio, A.; Pota, V.; Cotoia, A.; Della Selva, A.; Bruni, A.; Iapichino, G.; Bradic, N.; Corradi, F.; Gemma, M.; Nogtev, P.; Petrova, M.; Agro, F. E.; Cabrini, L.; Forfori, F.; Likhvantsev, V.; Bove, T.; Finco, G.; Landoni, G.; Zangrillo, A.; Ajello, S.; Cappelletti, A. M.; Fominskiy, E.; Nisi, F. G.; Pazzanese, V.; Pieri, M.; Canavosio, F.; Palmesino, F.; Bernasconi, M.; Gallioli, G.; Marino, G.; Vetrugno, L.; Millin, C.; Missio, D.; Gallicchio, F.; Azzali, B.; Bozzetti, M.; Cristadoro, D.; Perone, R.; Cantatore, L. P.; Curci, G.; Pabon, I. M.; Garofalo, E.; Mainetti, M.; Calamai, I.; Maraggia, D.; Mattei, A.; Yavorovskiy, A

Perfil de ácidos graxos do leite de vacas alimentadas com óleo de soja e monensina no início da lactação Milk fatty acid profile of cows fed monensin and soybean oil in early lactation

Avaliaram-se os efeitos da adição de monensina sódica combinada com óleo de soja na dieta de vacas lactantes sobre o perfil de ácidos graxos (AG) do leite na 5ª e 15ª semanas da lactação. Foram utilizadas 16 vacas multíparas cruzadas, dispostas em delineamento em blocos casualizados, em um arranjo fatorial 2 x 2 (presença ou não de monensina e presença ou não de óleo de soja). Os tratamentos consistiram das dietas: CT (controle) = sem monensina ou óleo; MN = 33 ppm de monensina; OL = 3,9% de óleo de soja; e OM = óleo e monensina. Os animais foram confinados e alimentados com 52% de silagem de milho e 48% de concentrado. Não foi verificada interação entre óleo de soja e monensina para os ácidos graxos avaliados. A monensina aumentou os AG insaturados, monoinsaturados e poliinsaturados em 9,0; 8,8; e 10,7%, respectivamente. O óleo apresentou maior impacto sobre os AG poliinsaturados, aumentando-os em 39,2; 39,3; e 24,2%, respectivamente. Também reduziu os AG de cadeias curta (43,7%) e média (49,1%) e aumentou os AG de cadeia longa (55,3%). Os isômeros trans-C18:1 foram aumentados tanto pelo óleo como pela monensina, indicando efeito aditivo para trans-10 C18:1, que foi negativamente correlacionado ao teor de gordura do leite. O isômero cis-9 trans-11 do ácido linoléico conjugado (CLA) não foi influenciado pelos tratamentos, observando-se que o óleo reduziu a atividade da delta9-desaturase. Houve interação entre tratamentos e semana da lactação sobre os AG de cadeias curta e média, C14:0, C16:0, cis-9 C18:1 e trans-10 C18:1. Os maiores efeitos sobre o perfil de AG do leite foram registrados quando monensina e óleo foram fornecidos em conjunto na dieta de vacas lactantes.<br>The objective of this trial was to evaluate the effects of dietary monensin and soybean oil on milk fatty acid (FA) profile in the 5th and 15th week of lactation of dairy cows. Sixteen multiparous crossbred dairy cows averaging 30 days in milk were assigned to a completely randomized block design in a 2 x 2 factorial arrangement (presence or absence of monensin and soybean oil). The following diets were used: control not supplemented with monensin or soybean oil (CT), 33 ppm of monensin (MN), 3.9% of soybean oil (OL) or a combination of soybean oil plus monensin (OM). Cows were confined and fed diets with 52% of corn silage and 48% of concentrate. No significant interaction between soybean oil and monensin was observed for any measured FA. Monensin increased unsaturated, monounsaturated, and polyunsaturated FA by 9.0, 8.8 and 10.7%, respectively, while supplementation with soybean oil resulted in greater responses: 39.2, 39.3, and 24.2% for the same FA. Soybean oil also reduced short chain FA (43.7%) and medium chain FA (49.1%) and increased long chain FA (55.3%) in this study. The isomers trans-C18:1 were increased by inclusion of oil and monensin in the diet indicating an additive effect for trans-10 C18:1 that was negatively correlated with milk fat content. The CLA isomer cis-9 trans-11 C18:2 was not affected by treatments but soybean oil reduced delta9-desaturase activity. There were interactions between treatment and week of lactation for short and medium chain FA, C14:0, C16:0, cis-9 C18:1 and trans-10. The combination of monensin and soybean oil in diet of lactating dairy cows was responsible for the most significant changes observed in the profile of milk FA