Seascape Genetics of a Globally Distributed, Highly Mobile Marine Mammal: The Short-Beaked Common Dolphin (Genus Delphinus)

Identifying which factors shape the distribution of intraspecific genetic diversity is central in evolutionary and conservation biology. In the marine realm, the absence of obvious barriers to dispersal can make this task more difficult. Nevertheless, recent studies have provided valuable insights into which factors may be shaping genetic structure in the world's oceans. These studies were, however, generally conducted on marine organisms with larval dispersal. Here, using a seascape genetics approach, we show that marine productivity and sea surface temperature are correlated with genetic structure in a highly mobile, widely distributed marine mammal species, the short-beaked common dolphin. Isolation by distance also appears to influence population divergence over larger geographical scales (i.e. across different ocean basins). We suggest that the relationship between environmental variables and population structure may be caused by prey behaviour, which is believed to determine common dolphins' movement patterns and preferred associations with certain oceanographic conditions. Our study highlights the role of oceanography in shaping genetic structure of a highly mobile and widely distributed top marine predator. Thus, seascape genetic studies can potentially track the biological effects of ongoing climate-change at oceanographic interfaces and also inform marine reserve design in relation to the distribution and genetic connectivity of charismatic and ecologically important megafauna

Anticoagulation in "real world" patients with atrial fibrillation in Italy: Results from the ISPAF (Indagine Sicoa Paziente Con Fibrillazione Atriale) survey study

Background Atrial fibrillation (AF) is associated with a high risk of stroke and other thrombo-embolic events and their prevention relies on antithrombotic therapy, at present mainly with vitamin K antagonists (VKA). The aim of this study was to provide an overall picture on the extent to which current recommendations on oral anticoagulation (OAC) therapy with VKA in AF correspond to actually prescribed OAC in an unselected, real world, population of consecutive patients with AF in Italy. Secondary objective was to assess the rate of "optimal" anticoagulation. Methods Sixty-three cardiology units located in different geographic areas of Italy enrolled a total of 2046 outpatients with nonvalvular AF (54% males and 46% females, age 73.3 ± 10.2 years). Results OAC with VKAs was prescribed in 1394 (68%) of patients and was progressively more frequent on going from paroxysmal (46%) to persistent (71%) and permanent AF (78%)(P < 0.001). A high prescription rate (88%) occurred in patients with CHA2DS2-VASc > 2. In patients with CHA2DS2-VASc = 0 and HAS-BLED < 3, still 59% were on OAC, whereas in 33% of patients with CHA2DS2-VASc ≥ 2 and HAS-BLED < 3, OAC therapy was not prescribed. In patients with CHA2DS2-VASc ≥ 2 and HAS-BLED > 3, the preference was towards OAC prescription. 66% of patients were at target for INR. Conclusions The ISPAF study shows that in an Italian population of real world patients with AF adherence to current guidelines on OAC therapy based on stroke-risk scoring system is rather high, although rate of prescription should be increased. However, contrary to recommendations, in a high proportion of low-risk patients OAC therapy is still prescribed, and this might expose patients to unjustified risks. © 2013 Elsevier Ireland Ltd

Incidence and clinical presentation of myocardial ischemia in patients with chronic CAD in Italy: The ISPICA survey study

Aim: This survey study was performed to provide an overall picture on the incidence of symptoms, with or without typical angina, in the real-life clinical practice and to identify clinical factors associated with atypical presentations in an unselected population of consecutive outpatients with chronic coronary artery disease (CAD). Methods: Thirty-six cardiology units located in different geographic areas of Italy enrolled a total of 1475 outpatients (73.6% men and 26.3% women; mean age 71±10 and 67±9 years in men and women, respectively) with a documented diagnosis of chronic CAD. Each patient underwent a medical history, with a detailed investigation as to the presence of typical angina or ischemic equivalents defined as sensation of chest pressure, or arm, neck, or jaw pain. Results: At admission, symptoms suggesting ischemic episodes were reported by 24.4% of patients. After an in-depth medical history collection by the specialist, the prevalence of combined typical or atypical myocardial ischemic episodes was ascertained in 39.3% of the overall population. Typical angina was reported by 13.6% of men and 22.7% of women (P<0.0001), whereas ischemic equivalents were present in 7.3 and 12.9% of male and female patients, respectively (P<0.001). Previous coronary artery bypass grafting (CABG; P<0.001) and fewer medical visits by cardiologists (P=0.02) were independent predictors of atypical presentations. Conclusion: The ISPICA study shows that in an Italian population of real-world patients with chronic CAD, ischemic episodes, with both typical and atypical presentation, are still present in nearly 50% of patients, despite optimal medical therapy, and that atypical presentations of angina are linked to fewer visits by specialists and previous CABG. These findings would suggest to encourage patients with chronic CAD and general practitioners to consider more frequent cardiology specialist visits and to take into account the possibility of atypical presentations, particularly in patients with previous CABG

A prospective comparison of alginate-hydrogel with standard medical therapy to determine impact on functional capacity and clinical outcomes in patients with advanced heart failure (AUGMENT-HF trial)

© 2015 The Author 2015.Aims AUGMENT-HF was an international, multi-centre, prospective, randomized, controlled trial to evaluate the benefits and safety of a novel method of left ventricular (LV) modification with alginate-hydrogel. Methods Alginate-hydro

La lenta accettazione dei nuovi anticoagulanti orali in Italia : analisi critica di un problema [The slow acceptance of new oral anticoagulants in Italy : a critical analysis of a problem]

L\u2019introduzione degli anticoagulanti orali non antagonisti della vitamina K (NAO) nella pratica clinica ha rivoluzionato la terapia di prevenzione degli eventi tromboembolici nei pazienti affetti da fibrillazione atriale non valvolare e rappresenta indubbiamente uno dei pi\uf9 importanti progressi in medicina cardiovascolare negli ultimi decenni. I NAO, a fronte di una comparabile efficacia rispetto agli antagonisti della vitamina K, permettono di superare molte limitazioni di questi ultimi, in quanto presentano un minor numero di interazioni farmacologiche e un effetto anticoagulante prevedibile che permette una somministrazione a dose fissa senza necessit\ue0 di monitoraggio. Tuttavia, la penetrazione dei NAO nel mercato italiano appare pi\uf9 lenta di quanto sarebbe stato previsto sulla base del loro utilizzo in altri paesi europei. Obiettivo di questa rassegna \ue8 quello di analizzare criticamente le ragioni di tale limitazione, mediante l\u2019utilizzo della \u201cnominal group technique\u201d, metodologia che permette il raggiungimento formale del consenso.The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has revolutionized the prevention and the therapeutic approaches to thromboembolic events in patients with nonvalvular atrial fibrillation and represents with no doubts one of the most remarkable advances in the history of cardiovascular medicine over the last years. NOACs beyond a comparable efficacy with vitamin K antagonists allow to overcome the limitations of this last category of drugs owing to their less drug to drug interactions and a predictable anticoagulant effect that allows a fixed dose administration without the need for continuous monitoring. However, the penetration of NOACs into the Italian market is still lower than predicted with respect to their use in other European countries. The aim of this review is to critically analyze the reasons behind this attitude through the adoption of the nominal group technique, a methodology that permits to reach an official consensus

High-sensitive cardiac troponin T (hs-cTnT) assay as serum biomarker to predict cardiac risk in myotonic dystrophy : A case-control study

Background Myotonic dystrophy (DM) is a genetic disorder caused by nucleotide repeats expansion. Sudden death represents the main cause of mortality in DM patients. Here, we investigated the relationship between serum cardiac biomarkers with clinical parameters in DM patients. Methods Case-control study included 59 DM patients and 22 healthy controls. An additional group of 62 controls with similar cardiac defects to DM were enrolled. Results NT-proBNP, hs-cTnT and CK levels were significantly increased in DM patients compared to healthy subjects (p\ua0=\ua00.0008, p\ua0<\ua00.0001, p\ua0<\ua00.0001). Also, hs-cTnT levels were significantly higher in DM compared to control group with cardiac defects (p\ua0=\ua00.0003). Positive correlation was found between hs-cTnT and hs-cTnI in both DM patients and controls (p\ua0=\ua00.019, p\ua0=\ua00.002). Independently from the age, the risk of DM disease was positively related to an increase in hs-cTnT (p\ua0=\ua00.03). On the contrary, the risk of DM was not related to hs-cTnI, but was evidenced a role of PR interval (p\ua0=\ua00.03) and CK (p\ua0=\ua00.08). Conclusions The levels of hs-cTnT were significantly higher in DM patients. Analysis, with anti-cTnT, shows that this increase might be linked to heart problems. This last finding suggests that hs-cTnT might represent a helpful serum biomarker to \u201cpredict\u201d cardiac risk in DM disease