Thermal Care of Functional Dyspepsia Based on Bicarbonate-Sulphate-Calcium Water: A Sequential Clinical Trial

Drug treatment of functional dyspepsia is often unsatisfactory. We assessed the efficacy of a bicarbonate-sulphate-calcium thermal water cycle of 12 days, in patients with functional dyspepsia. Patients with functional dyspepsia were sent by their general practitioners to 12 days of treatment with thermal water, 200–400 ml in the morning, at temperature of 33°C (91.4 F) and were evaluated on a strict intention to treat basis. Four efficacy endpoints were analyzed as follows: (i) reduction of the global symptoms score, (ii) reduction of intensity to a level not interfering with everyday activities, (iii) specific efficacy on ulcer-like or dysmotility-like dyspepsia and (iv) esophageal or abdominal-associated symptoms. Statistical significance was reached for all three primary outcomes after the first 29 consecutive patients. Thermal water reduced the global symptom score, reduced intensity of symptoms to a level not interfering with everyday activity, but was unable to completely suppress all symptoms. A parallel effect emerged for ulcer-like and dyspepsia-like subgroups. The effect on heartburn and abdominal symptoms was not significant, suggesting a specific effect of the water on the gastric and duodenal wall. The Roma II criteria identify a natural kind of dyspepsia that improves with thermal water. Ulcer-like and dysmotility-like are not therapeutically distinguishable subgroups. Patients with dominant esophageal or abdominal symptoms should receive a different therapy. Sequential methods are very effective for the evaluation of traditional care practices and should be considered preliminary and integrative to randomized controlled trials in this context

Tele-echocardiography between Italy and Balkan area

A project (PIS-SRCE) has been started for promoting international medical cooperation in the Balkan area according to the Stabilization and Association Process, the European Union\u27s policy framework for the Western Balkan countries. Information and communication technology is presently mature to set up a telemedicine network breaking down geographical barriers and providing specialized medical care virtually anywhere in the world. Videoconferencing equipment is commercially available to transmit securely over Internet echocardiography or other modality images in addition to standard audio/video signals. Real-time transmission capability is crucial for allowing specialists to drive remotely proper echo scanning of cardiac structures in patient or foetus with suspected congenital heart disease

The Small GTPase Arf1 Modulates Arp2/3-Mediated Actin Polymerization via PICK1 to Regulate Synaptic Plasticity

SummaryInhibition of Arp2/3-mediated actin polymerization by PICK1 is a central mechanism to AMPA receptor (AMPAR) internalization and long-term depression (LTD), although the signaling pathways that modulate this process in response to NMDA receptor (NMDAR) activation are unknown. Here, we define a function for the GTPase Arf1 in this process. We show that Arf1-GTP binds PICK1 to limit PICK1-mediated inhibition of Arp2/3 activity. Expression of mutant Arf1 that does not bind PICK1 leads to reduced surface levels of GluA2-containing AMPARs and smaller spines in hippocampal neurons, which occludes subsequent NMDA-induced AMPAR internalization and spine shrinkage. In organotypic slices, NMDAR-dependent LTD of AMPAR excitatory postsynaptic currents is abolished in neurons expressing mutant Arf1. Furthermore, NMDAR stimulation downregulates Arf1 activation and binding to PICK1 via the Arf-GAP GIT1. This study defines Arf1 as a critical regulator of actin dynamics and synaptic function via modulation of PICK1

Water retention efficiency of green roof systems in "extensive" and "intensive" type covers

La inundación en áreas urbanas por sobrecarga de las redes de drenaje es un problema recurrente de importancia creciente. Las cubiertas vegetadas (naturadas) retienen parte de la lámina de agua precipitada, reduciendo el escurrimiento superficial y generando hidrogramas de escorrentía directa con caudales pico menores y más retardados. Estas propiedades hacen que esta tecnología pueda contribuir a reducir la sobrecarga de cauces urbanos. Los resultados obtenidos a lo largo de casi dos años de estudio permitieron estimar una capacidad de retención de las cubiertas ensayadas (en la Ciudad de Buenos Aires), que ha sido variable en función de la precipitación, del grado de cobertura y profundidad del sustrato. Es así que el porcentaje retenido ha sido alto (73% a 100%) con precipitaciones menores o iguales a los 20 mm, alrededor del 60% con lluvias de 35 a 40 mm, y con precipitaciones cercanas a 100 mm los porcentajes de retención se redujeron notablemente, alcanzando valores cercanos al 30%. Estos resultados posicionan las cubiertas vegetadas, para las condiciones y sitio del ensayo, como una alternativa dentro del manejo hídrico integrado en cuencas urbanas.Flash floods in urban areas caused by overload of drainage networks are a recurrent problem of raising importance. Greenroofs retain part of the stormwater, lowering surface flow and generating runoff hydrographs with lower and delayed peak flows. Therefore, this technology can contribute to mitigate the overload of drainage networks. The results of the study that was carried out in City of Buenos Aires along almost two years, showed that the retention capacity of the tested lots tasted varied, depending upon precipitation, coverage and depth of the substrate. With precipitation less than or equal to 20 mm, the retention fraction was high (73% to 100%), and when precipitation reached 35 to 40 mm, the maximum percentage of retention was around 60%. However, when the rainfall was approximately 100 mm, the retention fraction was reduced substantially, reaching values nearing 30%. The results of the test showed that green roofs system represent a good alternative in the integrated management of water runoff in urban watersheds.Fil: Rosatto, Héctor. Universidad de Buenos Aires. Facultad de AgronomíaFil: Meyer, Maia. Universidad de Buenos Aires. Facultad de AgronomíaFil: Laureda, Daniel. Universidad de Buenos Aires. Facultad de AgronomíaFil: Cazorla, Laura. Universidad de Buenos Aires. Facultad de AgronomíaFil: Barrera, Daniel. Universidad de Buenos Aires. Facultad de AgronomíaFil: Gamboa, Paula. Universidad de Buenos Aires. Facultad de AgronomíaFil: Villalba, Gustavo Ariel. Universidad de Buenos Aires. Facultad de AgronomíaFil: Bargiela, Martha. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Recursos Naturales y AmbienteFil: Pruzzo, Laura. Universidad de Buenos Aires. Facultad de AgronomíaFil: Rodríguez Plaza, Luis. Universidad Nacional de Cuyo. Facultad de Ciencias Agrarias. Departamento de Ingeniería AgrícolaFil: Mazzeo, Nadia. Universidad de Buenos Aires. Facultad de AgronomíaFil: Caso, César Eduardo. Universidad de Buenos Aires. Facultad de AgronomíaFil: Rocca, Carlos. Universidad de Buenos Aires. Facultad de AgronomíaFil: Hashimoto, Patricia. Universidad Nacional de Lomas de Zamora. Facultad de Ciencias AgrariasFil: Kohan, Diana. Universidad Nacional de Entre Ríos. Facultad de IngenieríaFil: Quaintenne, Elina. Universidad de Buenos Aires. Facultad de Agronomí

PICK1 inhibition of the Arp2/3 complex controls dendritic spine size and synaptic plasticity

Dendritic spine remodelling involves regulated actin dynamics and is essential for synaptic plasticity. The Arp2/3 inhibitor PICK1 is here shown to regulate spine size: inducing shrinkage during long-term depression

Eficiencia en la retención del agua de lluvia de cubiertas vegetadas de tipo "extensivo" e "intensivo" *

Flash floods in urban areas caused by overload of drainage networks are a recurrent problem of raising importance. Greenroofs retain part of the stormwater, lowering surface flow and generating runoff hydrographs with lower and delayed peak flows. Therefore, this technology can contribute to mitigate the overload of drainage networks. The results of the study that was carried out in City of Buenos Aires along almost two years, showed that the retention capacity of the tested lots tasted varied, depending upon precipitation, coverage and depth of the substrate. With precipitation less than or equal to 20 mm, the retention fraction was high (73% to 100%), and when precipitation reached 35 to 40 mm, the maximum percentage of retention was around 60%. However, when the rainfall was approximately 100 mm, the retention fraction was reduced substantially, reaching values nearing 30%. The results of the test showed that green roofs system represent a good alternative in the integrated management of water runoff in urban watersheds.La inundación en áreas urbanas por sobrecarga de las redes de drenaje es un problema recurrente de importancia creciente. Las cubiertas vegetadas (naturadas) retienen parte de la lámina de agua precipitada, reduciendo el escurrimiento superficial y generando hidrogramas de escorrentía directa con caudales pico menores y más retardados. Estas propiedades hacen que esta tecnología pueda contribuir a reducir la sobrecarga de cauces urbanos. Los resultados obtenidos a lo largo de casi dos años de estudio permitieron estimar una capacidad de retención de las cubiertas ensayadas (en la Ciudad de Buenos Aires), que ha sido variable en función de la precipitación, del grado de cobertura y profundidad del sustrato. Es así que el porcentaje retenido ha sido alto (73% a 100%) con precipitaciones menores o iguales a los 20 mm, alrededor del 60% con lluvias de 35 a 40 mm, y con precipitaciones cercanas a 100 mm los porcentajes de retención se redujeron notablemente, alcanzando valores cercanos al 30%. Estos resultados posicionan las cubiertas vegetadas, para las condiciones y sitio del ensayo, como una alternativa dentro del manejo hídrico integrado en cuencas urbanas

The Italian National Project of Astrobiology-Life in Space-Origin, Presence, Persistence of Life in Space, from Molecules to Extremophiles

The \u2018\u2018Life in Space\u2019\u2019 project was funded in the wake of the Italian Space Agency\u2019s proposal for the development of a network of institutions and laboratories conceived to implement Italian participation in space astrobiology experiments

Evaluation of the effect of sodium–glucose co‐transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR‐Reduced trial

Drugs that inhibit the sodium–glucose co‐transporter 2 (SGLT2) have been shown to reduce the risk of hospitalizations for heart failure in patients with type 2 diabetes. In populations that largely did not have heart failure at the time of enrolment, empagliflozin, canagliflozin and dapagliflozin decreased the risk of serious new‐onset heart failure events by ≈30%. In addition, in the EMPA‐REG OUTCOME trial, empagliflozin reduced the risk of both pump failure and sudden deaths, the two most common modes of death among patients with heart failure. In none of the three trials could the benefits of SGLT2 inhibitors on heart failure be explained by the actions of these drugs as diuretics or anti‐hyperglycaemic agents. These observations raise the possibility that SGLT2 inhibitors could reduce morbidity and mortality in patients with established heart failure, including those without diabetes. The EMPEROR‐Reduced trial is enrolling ≈3600 patients with heart failure and a reduced left ventricular ejection fraction (≤ 40%), half of whom are expected not to have diabetes. Patients are being randomized to placebo or empagliflozin 10 mg daily, which is added to all appropriate treatment with inhibitors of the renin–angiotensin system and neprilysin, beta‐blockers and mineralocorticoid receptor antagonists. The primary endpoint is the time‐to‐first event analysis of the combined risk of cardiovascular death and hospitalization for heart failure, but the trial will also evaluate the effects of empagliflozin on renal function, cardiovascular death, all‐cause mortality, and recurrent hospitalization events. By adjusting eligibility based on natriuretic peptide levels to the baseline ejection fraction, the trial will preferentially enrol high‐risk patients. A large proportion of the participants is expected to have an ejection fraction < 30%, and the estimated annual event rate is expected to be at least 15%. The EMPEROR‐Reduced trial is well‐positioned to determine if the addition of empagliflozin can add meaningfully to current approaches that have established benefits in the treatment of chronic heart failure with left ventricular systolic dysfunction

Evaluation of the effects of sodium–glucose co‐transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction: rationale for and design of the EMPEROR‐Preserved Trial

Background: The principal biological processes that characterize heart failure with a preserved ejection fraction (HFpEF) are systemic inflammation, epicardial adipose tissue accumulation, coronary microcirculatory rarefaction, myocardial fibrosis and vascular stiffness; the resulting impairment of left ventricular and aortic distensibility (especially when accompanied by impaired glomerular function and sodium retention) causes increases in cardiac filling pressures and exertional dyspnoea despite the relative preservation of left ventricular ejection fraction. Independently of their actions on blood glucose, sodium–glucose co‐transporter 2 (SGLT2) inhibitors exert a broad range of biological effects (including actions to inhibit cardiac inflammation and fibrosis, antagonize sodium retention and improve glomerular function) that can ameliorate the pathophysiological derangements in HFpEF. Such SGLT2 inhibitors exert favourable effects in experimental models of HFpEF and have been found in large‐scale trials to reduce the risk for serious heart failure events in patients with type 2 diabetes, many of whom were retrospectively identified as having HFpEF. Study design: The EMPEROR‐Preserved Trial is enrolling ≈5750 patients with HFpEF (ejection fraction >40%), with and without type 2 diabetes, who are randomized to receive placebo or empagliflozin 10 mg/day, which is added to all appropriate treatments for HFpEF and co‐morbidities. Study aims: The primary endpoint is the time‐to‐first‐event analysis of the combined risk for cardiovascular death or hospitalization for heart failure. The trial will also evaluate the effects of empagliflozin on renal function, cardiovascular death, all‐cause mortality and recurrent hospitalization events, and will assess a wide range of biomarkers that reflect important pathophysiological mechanisms that may drive the evolution of HFpEF. The EMPEROR‐Preserved Trial is well positioned to determine if empagliflozin can have a meaningful impact on the course of HFpEF, a disorder for which there are currently few therapeutic options

Baseline characteristics of patients with heart failure with preserved ejection fraction in the EMPEROR-Preserved trial.

AIMS: EMPEROR-Preserved is an ongoing trial evaluating the effect of empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). This report describes the baseline characteristics of the EMPEROR-Preserved cohort and compares them with patients enrolled in prior HFpEF trials. METHODS AND RESULTS: EMPEROR-Preserved is a phase III randomized, international, double-blind, parallel-group, placebo-controlled trial in which 5988 symptomatic HFpEF patients [left ventricular ejection fraction (LVEF) >40%] with and without type 2 diabetes mellitus (T2DM) have been enrolled. Patients were required to have elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations (i.e. >300?pg/mL in patients without and >900?pg/mL in patients with atrial fibrillation) along with evidence of structural changes in the heart or documented history of heart failure hospitalization. Among patients enrolled from various regions (45% Europe, 11% Asia, 25% Latin America, 12% North America), the mean age was 72?±?9?years, 45% were women. Almost all patients had New York Heart Association class II or III symptoms (99.6%), and 23% had prior heart failure hospitalization within 12?months. Thirty-three percent of the patients had baseline LVEF of 41-50%. The mean LVEF (54?±?9%) was slightly lower while the median NT-proBNP [974 (499-1731) pg/mL] was higher compared with previous HFpEF trials. Presence of comorbidities such as diabetes (49%) and chronic kidney disease (50%) were common. The majority of the patients were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (80%) and beta-blockers (86%), and 37% of patients were on mineralocorticoid receptor antagonists. CONCLUSION: When compared with prior trials in HFpEF, the EMPEROR-Preserved cohort has a somewhat higher burden of comorbidities, lower LVEF, higher median NT-proBNP and greater use of mineralocorticoid receptor antagonists at baseline. Results of the EMPEROR-Preserved trial will be available in 2021