Commento al caso clinico: <em>Com’è profondo il male. Complessità e opportunità nella clinica con MSNA: un caso clinico</em>

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Displacements approach with external variables only for multi-domain analysis via symmetric BEM

In the present paper a new displacement method, defined as external variables one, is proposed inside the multidomain symmetric Boundary Element formulation. This method is a natural evolution of the displacement approach with interface variables in the multidomain symmetric BEM analysis. Indeed, the strategy employed has the advantage of considering only the kinematical quantities of the free boundary nodes and the algebraic operators involved show symmetry and very small dimensions. The proposed approach is characterized by strong condensation of the mechanical and kinematical boundary nodes variables of the macro-elements. All the domain quantities, such as tractions and stresses, displacements and strains, are computed through the Somigliana Identities in a subsequent phase. Some examples are shown using the calculus code Karnak.sGbem, by which it was possible to make some comparisons with analytical solutions andothe rapproaches to show the effectiveness of the method propose

Multidomain SBEM analysis for two dimensionalelastoplastic-contact problems

The Symmetric Boundary Element Method based on the Galerkin hypotheses has found application in the nonlinear analysis of plasticity and contact-detachment problems, but dealt with separately. In this paper we wants to treat these complex phenomena together. This method works in structures by introducing a subdivision into sub-structures, distinguished into macroelements, where elastic behaviour is assumed, and bem-elements, where it is possible for plastic strains to occur. In all the sub-structures, elasticity equations are written and regularity conditions in weighted (weak) form and/or in nodal (strong) form between boundaries have to be introduced, to attain the solving equation system

Congenital musculoskeletal abnormalities associated with aortic, pulmonary and iliac aneurysms

We present the case of a young patient with severe congenital musculoskeletal abnormalities. associated with different pathologies, with involvement of the arterial tree on both the systemic and pulmonary circulation, and involvement of the lungs due to thoracic hypoplasia. The presence of such extensive pathology raises the question of the suitability of such patients to undergo major corrective cardiac surgery procedures. (Cardiol J 2010; 17, 4: 412-414

Active macro-zones algorithm via multidomain SBEM for strain-hardening elastoplastic analysis

In this paper a strategy to perform strain-hardening elastoplastic analysis by using the Symmetric Boundary Element Method (SBEM) for multi-domain type problems is shown. The procedure has been developed inside Karnak.sGbem code by introducing an additional module

In search of a new attractant for monitoring Stegobium paniceum L. (Coleoptera: Anobiidae): Poster

Stegobium paniceum (L.) is a major pest for several stored products worldwide. Monitoring methods for this species, based on pheromone traps, are affected by the complexity and expensiveness of the chemical synthesis of the pheromone isomer [(2S,3R,1’R)-Stegobinone] and/or by its lost of efficacy after two weeks at room temperature. So other semiochemicals that can be exploited for monitoring this species are highly desirable. In this study was tested the behavioral response in two-choice olfactometer of S. paniceum adults to Volatile Organic Compounds (VOCs) collected from colonized substrate. The elution of the headspace collection from S. paniceum colony elicited attraction of both sexes. The GC-MS chemical analysis of the extract indicated the presence of several alkanes, alcohols, aldehydes and fatty acids, some of them already reported to attract other stored product coleopteran pests and promising candidates for further studies to test their attractiveness on S. paniceum.Stegobium paniceum (L.) is a major pest for several stored products worldwide. Monitoring methods for this species, based on pheromone traps, are affected by the complexity and expensiveness of the chemical synthesis of the pheromone isomer [(2S,3R,1’R)-Stegobinone] and/or by its lost of efficacy after two weeks at room temperature. So other semiochemicals that can be exploited for monitoring this species are highly desirable. In this study was tested the behavioral response in two-choice olfactometer of S. paniceum adults to Volatile Organic Compounds (VOCs) collected from colonized substrate. The elution of the headspace collection from S. paniceum colony elicited attraction of both sexes. The GC-MS chemical analysis of the extract indicated the presence of several alkanes, alcohols, aldehydes and fatty acids, some of them already reported to attract other stored product coleopteran pests and promising candidates for further studies to test their attractiveness on S. paniceum

Immunity, Inflammation and Heart Failure. Their Role on Cardiac Function and Iron Status

Aims: Heart failure is a clinical syndrome characterized by subclinical systemic inflammation and immune system activation associated with iron deficiency. No data exist on the various activations of immune-mediated mechanisms of inflammation in heart failure patients with reduced/preserved ejection fraction. We aimed to (1) investigate possible differences in inflammatory parameters and oxidative stress, and (2) detect a different iron status between groups. Materials and Methods: We enrolled 50 consecutive Caucasian outpatients with heart failure. All patients underwent echocardiographic measurements, laboratory determinations, evaluation of iron status and Toll-like receptors, and NF-κB expression in peripheral blood mononuclear cells, as well as pro-inflammatory cytokines. All statistical calculations were made using SPSS for Mac version 21.0. Results: Patients with reduced ejection fraction showed significantly lower hemoglobin levels (12.3 ± 1.4 vs. 13.6 ± 1.4 g/dl), serum iron (61.4 ± 18.3 vs. 93.7 ± 33.7 mcg/dl), transferrin iron binding capacity (20.7 ± 8.4 vs. 31.1 ± 15.6 %), and e-GFR values (78.1 ± 36.1 vs. 118.1 ± 33.9 ml/min/1.73 m2) in comparison to patients with preserved ejection fraction, while unsaturated iron binding capacity (272.6 ± 74.9 vs. 221.7 ± 61.4 mcg/dl), hepcidin (4.61 ± 0.89 vs. 3.28 ± 0.69 ng/ml), and creatinine (1.34 ± 0.55 vs. 1.03 ± 0.25 mg/dl) were significantly higher in the same group. When considering inflammatory parameters, patients with reduced ejection fraction showed significantly higher expression of both Toll-like receptors-2 (1.90 ± 0.97 vs. 1.25 ± 0.76 MFI) and Toll-like receptors-4 (4.54 ± 1.32 vs. 3.38 ± 1.62 MFI), respectively, as well as a significantly higher activity of NF-κB (2.67 ± 0.60 vs. 1.07 ± 0.30). Furthermore, pro-inflammatory cytokines, interleukin-1, and interleukin-6, was significantly higher in patients with reduced ejection fraction, while the protective cytokine interleukin-10 was significantly lower in the same group. Correlational analyses demonstrated a significant and inverse relationship between left ventricular function and inflammatory parameters in patients with reduced ejection fraction, as well as a direct correlation between ferritin and inflammatory parameters. Conclusions: Our data demonstrate a different immune-mediated inflammatory burden in heart failure patients with reduced or preserved ejection fraction, as well as significant differences in iron status. These data contribute to further elucidate pathophysiologic mechanisms leading to cardiac dysfunction

A Genetic and Metabolic Staging System for Predicting the Outcome of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of liver-related events (LREs). Here, we have assessed the ability of a composite score based on clinical features, metabolic comorbidities, and genetic variants to predict LREs. A total of 546 consecutive patients with NAFLD were recruited and stratified according to the fibrosis-4 (FIB-4) index. LREs were defined as occurrence of hepatocellular carcinoma or hepatic decompensation. Cox regression multivariate analysis was used to identify baseline variables associated with LREs. The UK Biobank was used as the validation cohort, and severe liver disease (incidence of cirrhosis, decompensated liver disease, hepatocellular carcinoma, and/or liver transplantation) was used as the outcome. LREs were experienced by 58 patients, only one of whom was in the cohort of patients with a FIB-4 score &lt; 1.3. Multivariate Cox regression analysis of 229 patients with a FIB-4 score ≥ 1.3 highlighted clinical variables independently associated with the development of LREs, including older age, low platelet count, low albumin, low high-density lipoprotein cholesterol, certain genetic factors, and interactions between genetic factors and sex or diabetes. The area under the curve (AUC) for the model was 0.87 at 1, 3, and 5 years. Our novel Genetic and Metabolic Staging (GEMS) scoring system was derived from the Cox model linear predictor, ranked from 0 to 10, and categorized into five classes (0-5, 5-6, 6-7, 7-8, and 8-10). The risk of LREs increased from 4% in patients in the best class (GEMS score 0-5) to 91% in the worst (GEMS score 8-10). GEMS score was associated with incident severe liver disease in the study population (hazard ratio, 1.56; 95% confidence interval, 1.48-1.65; P &lt; 0.001) as well as in the UK Biobank cohort where AUCs for prediction of severe liver disease at 1, 3, and 5 years were 0.70, 0.69, and 0.67, respectively. Conclusion: The novel GEMS scoring system has an adequate ability to predict the outcome of patients with NAFLD

Donor Simvastatin Treatment Is Safe and Might Improve Outcomes After Liver Transplantation: A Randomized Clinical Trial.

BACKGROUND The current curative approaches for ischemia/reperfusion injury on liver transplantation are still under debate for their safety and efficacy in patients with end-stage liver disease. We present the SIMVA statin donor treatment before Liver Transplants study. METHODS SIMVA statin donor treatment before Liver Transplants is a monocentric, double-blind, randomized, prospective tial aiming to compare the safety and efficacy of preoperative brain-dead donors' treatment with the intragastric administration of 80 mg of simvastatin on liver transplant recipient outcomes in a real-life setting. Primary aim was incidence of patient and graft survival at 90 and 180 d post-transplant; secondary end-points were severe complications. RESULTS The trial enrolled 58 adult patients (18-65 y old). The minimum follow-up was 6 mo. No patient or graft was lost at 90 or 180 d in the experimental group (n = 28), whereas patient/graft survival were 93.1% (P = 0.016) and 89.66% (P = 0.080) at 90 d and 86.21% (P = 0.041) and 86.2% (P = 0.041) at 180 d in the control group (n = 29). The percentage of patients with severe complications (Clavien-Dindo ≥IIIb) was higher in the control group, 55.2% versus 25.0% in the experimental group (P = 0.0307). The only significant difference in liver tests was a significantly higher gamma-glutamyl transferase and alkaline phosphatase at 15 d (P = 0.017), (P = 0.015) in the simvastatin group. CONCLUSIONS Donor simvastatin treatment is safe, and may significantly improve early graft and patient survival after liver transplantation, although further research is mandatory

Effect of uric acid serum levels on carotid arterial stiffness and intima-media thickness: A high resolution Echo-Tracking Study

Serum uric acid (UA) has been shown to be a predictor of cardiovascular (CV) morbidity and mortality, and it may play a role in the pathogenesis of CV disease affecting vascular structure and function. However, there is limited evidence of its specific association with carotid artery stiffness and structure. The aim of our study was to evaluate whether UA is associated with early signs of atherosclerosis, namely local carotid arterial stiffness and intima-media thickening. We evaluated 698 consecutive asymptomatic patients, referred to the Cardiovascular Department for risk factors evaluation and treatment. All patients underwent carotid artery ultrasonography with measurement of common carotid intima-media thickness (IMT) and echo-tracking carotid artery stiffness index Beta. Patients with hyperuricemia (defined as serum uric acid ≥7 mg/dL in men and ≥6 mg/dL in women) had higher IMT (0.97±0.22 vs 0.91±0.18, p<0.001) and stiffness index Beta (8.3±3.2 vs 7.5±2.7, p=0.005). UA levels correlated with both IMT (r=0.225; p<0.001) and stiffness index Beta (r=0.154; p<0.001); the correlations were statistically significant in males and females. In a multivariate model which included age, arterial pressure, serum glucose and LDL-cholesterol, serum UA emerged as an independent explanatory variable of IMT and stiffness index Beta. Carotid IMT and local arterial stiffness are related to UA independently of established CV risk factors; UA may play a role in the early development of atherosclerosis