Exploring the Prognostic Performance of MECKI Score in Heart Failure Patients with Non-Valvular Atrial Fibrillation Treated with Edoxaban

Introduction: Risk stratification in heart failure (HF) is essential for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model for assessing cardiovascular risk in HF patients with reduced ejection fraction (HFrEF). From the validation of the score, the prevalence of HF patients treated with direct oral anticoagulants (DOACs), such as edoxaban, for non-valvular atrial fibrillation (NVAF) has been increasing in recent years. This study aims to evaluate the reliability of the MECKI score in HFrEF patients treated with edoxaban for NVAF. Materials and Methods: This study included consecutive outpatients with HF and NVAF treated with edoxaban (n = 83) who underwent a cardiopulmonary exercise test (CPET). They were matched by propensity score with a retrospective group of HFrEF patients with NVAF treated with vitamin K antagonists (VKAs) from the MECKI score registry (n = 844). The study endpoint was the risk of cardiovascular mortality, urgent heart transplantation, or Left Ventricle Assist Device (LVAD) implantation. Results: Edoxaban patients were treated with a more optimized HF therapy and had different clinical characteristics, with a similar MECKI score. After propensity score, 77 patients treated with edoxaban were successfully matched with the MECKI-VKA control cohort. In both groups, MECKI accurately predicted the composite endpoint with similar area under the curves (AUC = 0.757 vs. 0.829 in the MECKI-VKA vs. edoxaban-treated group, respectively, p = 0.452). The two populations’ survival appeared non-significantly different at the 2-year follow-up. Conclusions: this study confirms the prognostic accuracy of the MECKI score in HFrEF patients with NVAF treated with edoxaban, showing improved predictive power compared to VKA-treated patients

Regional and sectoral varieties of capitalism

This study seeks to go beneath the generalizations that constitute characterizations of national economies in order to examine local and sectoral diversity - in particular, forms of capitalist organization at the level of localized sectors. It reports on the findings of research based on detailed case histories of local economies in four different types of production: modernized craft manufacturing (furniture), mass production (motor vehicles), high-technology production (biopharmaceuticals) and high-tech services (television film-making). In each case a local economy in Germany (usually seen counter-factually as an example of a particularly national system) was compared with one elsewhere in Europe: respectively, southern Sweden, Hungary (compared with eastern Germany) and the UK (for two studies). In the analysis, companies act rationally in response to sector-specific challenges, being partly bound by the existing institutional framework that they encounter, but partly acting to alter it. Two possibilities are distinguished and found in the cases. In the first (structurally conservative) case, arrangements of governance in the national innovation and production system prove to be beneficial for the companies and their aim to stand up to international competition. Insofar as national institutions help companies to deal with competition on their markets, they will probably try to preserve these arrangements. In the second (innovative) case, companies turn away from the national context and develop their own local governance structure. If the national institutional structure is seen as not adequate or 'non-fitting' to deal with sectorally specific terms of competition, then the internal and external coordination of companies - in reaction to challenges posed by the market - is likely to deviate from the national structure. In some instances evidence of 'creative incoherence', where local deviation from the national model provides a creative impulse, is found

A Novel Simplified Protocol for Pre-Processing Whole Wood Samples for Stable Isotope Analysis in Tree Rings

In the context of climate change, the stable isotope analysis of tree rings may play a crucial role in deciphering the eco-physiological mechanisms underlying forest decline and dieback phenomena. However, this technique is often considered expensive, time-consuming, and with several methodological constraints. Specifically, milling and transferring the material from jars to vials during the different steps of sample preparation involve risk of contamination among samples and loss of sample material. When dealing with declining trees (i.e., trees affected by loss of vitality with strong percentage of defoliation and reduction in growth) and trees subjected to extreme events or negative pointer years (characterized by extremely narrow ring) the sample preparation is particularly difficult because of scarce amount of wood material. In such a case, pooling rings from several years to achieve the minimum weight of wood is often necessary, thus losing information at the annual resolution. In order to overcome such limitations, we developed a novel protocol for quick and accurate whole-wood pre-processing, testing it on oak tree rings of different widths taken from living trees. The main novelty introduced by our protocol was freezing tree-ring samples at −80 °C and milling multiple samples at a time by using a 24-tube plate. The results showed that our novel simplified protocol significantly reduced the pre-processing time with respect to the standard protocol (12 vs. 284 sec/sample), while achieving the same wood particle size, limiting the loss of wood material and reducing the risk of contamination among samples

Genetic variability and divergence in Scots pine (Pinus sylvestris L.) within its natural range in Italy

Twenty-one populations of Scots pine sampled over the entire Italian range of the species were analysed for genetic variation scored at nine nuclear SSR markers. The main aim of the work was to find genetic features seful for conservation management, namely allelic composition, gene diversity and differentiation. High levels of intra-population variability were scored. The only population sampled in the Apennines gave the lowest values, confirming the genetic erosion undergone in the Scots pine remnants in this area. A low level of genetic variability was also scored for populations from the Po valley and hills of Piedmont. Most genetic diversity was found within populations, while only a small amount occurred among them (FST = 0.058). Both Bayesian clustering and sPCA analysis showed a East–West subdivision, notwithstanding the unclear position of populations from the Po valley. The population from the Apennines was always clearly separated from the others. The results are discussed in terms of post-glacial recolonisation, as well as for defining genetically homogeneous regions for Scots pine in Italy. The management of genetic resources could benefit from the identification of such ‘gene zones’, thereby avoiding the use of non-local reproductive material for plantations, which can represent one of the most important reasons for failure of reforestation. In addition, the assessment of the biogeographic genetic structure by neutral markers is a prerequisite for disentangling the influence of selectively neutral and non-neutral processes on the distribution of adaptive genetic variability