Unexpected increase of myocardial extracellular volume fraction in low cardiovascular risk HIV patients

Background People living with HIV (PLWH) are prone to develop sub-clinical Cardiovascular (CV) disease, despite the effectiveness of combined Antiretroviral Therapy (cART). Algorithms developed to predict CV risk in the general population could be inaccurate when applied to PLWH. Myocardial Extra-Cellular Matrix (ECM) expansion, measured by computed tomography, has been associated with an increased CV vulnerability in HIV-negative population. Measurement of Myocardial Extra-Cellular Volume (ECV) by computed tomography or magnetic resonance, is considered a useful surrogate for clinical evaluation of ECM expansion. In the present study, we aimed to determine the extent of cardiovascular involvement in asymptomatic HIV-infected patients with the use of a comprehensive cardiac computed tomography (CCT) approach. Materials and methods In the present study, ECV in low atherosclerotic CV risk PLWH was compared with ECV of age and gender matched HIV- individuals. 53 asymptomatic HIV + individuals (45 males, age 48 (42.5–48) years) on effective cART (CD4 + cell count: 450 cells/µL (IQR: 328–750); plasma HIV RNA: <37 copies/ml in all subjects) and 18 age and gender matched controls (14 males, age 55 (44.5–56) years) were retrospectively enrolled. All participants underwent CCT protocol to obtain native and postcontrast Hounsfield unit values of blood and myocardium, ECM was calculated accordingly. Results The ECV was significantly higher in HIV + patients than in the control group (ECV: 31% (IQR: 28%-31%) vs. 27.4% (IQR: 25%-28%), p < 0.001). The duration of cART (standardized β = 0.56 (0.33–0.95), p = 0.014) and the years of exposure to HIV infection (standardized β = 0.53 (0.4–0.92), p < 0.001), were positively and strongly associated with ECV values. Differences in ECV (p < 0.001) were also observed regarding the duration of cART exposure (< 5 years, 5–10 years and > 10 years). Moreover, ECV was independently associated with age of participants (standardized β = 0.42 (0.33–0.89), p = 0.084). Conclusions HIV infection and exposure to antiretrovirals play a detrimental role on ECV expansion. An increase in ECV indicates ECM expansion, which has been associated to a higher CV risk in the general population. The non-invasive evaluation of ECM trough ECV could represent an important tool to further understand the relationship between HIV infection, cardiac pathophysiology and the increased CV risk observed in PLWH

Dropstones in the Mar del Plata Canyon Area (SW Atlantic): Evidence for Provenance, Transport, Distribution, and Oceanographic Implications

A variety of gravel- to cobble-sized rocks, recovered from the Mar del Plata (MdP) Canyon area (Western South Atlantic at 38°S) and interpreted as ice-rafted debris, represent the first evidence that large icebergs have floated in the Falkland (Malvinas) Current from the southern polar high latitudes far northward. Detailed petrographic analyses identified the Antarctic Peninsula, sub-Antarctic islands in the Scotia Sea, and Tierra del Fuego as plausible source areas. The drift process could have started as early as at the beginning of the last deglaciation, according to an age obtained from a cold-water coral fragment associated with one of the dropstones. At the end of the Last Glacial Maximum, large icebergs have been supplied to the Antarctic Circumpolar Current, captured by those ocean current branches that circumvent the Falkland (Malvinas) Islands and entered the Argentine Margin. When the iceberg fleets approached the Brazil-Falkland (Malvinas) Confluence Zone with its steep latitudinal temperature gradient, the icebergs got oceanographically trapped and melted off rapidly. The sediment load sinking down to the seafloor formed a dropstone blanket particularly where the MdP Canyon had incised into the continental slope. Here, mass-flow processes, induced by local slope instability, and along-slope sediment resorting, due to the erosional effects of strong and persistent contouritic bottom currents, favored local enrichment in dropstones in the form of a loose, coarse sediment drape inside morphological depressions. The bottom current velocity would be locally strong enough to rework this sediment, leaving coarse rafted debris as a lag deposit.Fil: Bozzano, Graziella. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cerredo, Maria Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Remesal, Marcela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Steinmann, L.. Universitat Bremen; AlemaniaFil: Hanebuth, Till J.J.. Coastal Carolina University; Estados UnidosFil: Schwenk, T.. Universitat Bremen; AlemaniaFil: Baqués, Michele. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval; Argentina. Ministerio de Defensa. Armada Argentina. Dirección Gral. de Investigación y Desarrollo de la Ara. Dirección de Investigación de la Armada; ArgentinaFil: Hebbeln, Dierk. Universitat Bremen; AlemaniaFil: Spoltore, Daniela Veronica. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Silvestri, Ornella. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval; Argentina. Universidad de Buenos Aires; ArgentinaFil: Acevedo, Rogelio Daniel. Universidad Nacional de Tierra del Fuego, Antártida e Islas del Atlántico Sur. Instituto de Ciencias Polares, Ambientales y Recursos Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: Spiess, V.. Universitat Bremen; AlemaniaFil: Violante, Roberto Antonio. Ministerio de Defensa. Armada Argentina. Servicio de Hidrografía Naval; ArgentinaFil: Kasten, Sabine. Universitat Bremen; Alemania. Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research; Alemani

Costruire le università: aspetti architettonici e urbanistici, tra ragioni economiche e scelte politiche

No abstract availabl

Proposal of a new methodology for the improvement of risk analysis based on Analityc Network Process

The identification and choice of a suitable risk assessment model has been considered as a crucial issue for decades. In fact, the concern for safety in industrial activities, both inside the establishments and in the surroundings, has a long history. As a result, many laws and regulations apply. The use of risk assessment techniques is fairly widespread in policy and regulations. Current available risk analysis techniques are well adapted to industry needs since they were developed for its purpose. Risk assessment is a necessary step in the management of risk. Increasing safety is often difficult, especially when you have already obtained good of results, so the aim of our paper is the proposal of a new methodological approach called SIRA - Safety Improve Risk Assessment to assess the risk by defining an index called Total Risk Priority Number Index – TRPN. The index proposed is based on the Improved Risk Priority Number – IRPN and the Analytic Network Process – ANP, a Multi Criteria Decision Making – MCDM analysis tool

Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia: the MAREA study

Abstract Background Children are the most vulnerable population exposed to the use of antibiotics often incorrectly prescribed for the treatment of infections really due to viruses rather than to bacteria. We designed the MAREA study which consisted of two different studies: i) a surveillance study to monitor the safety/efficacy of the antibiotics for the treatment of pneumonia (CAP), pharyngotonsillitis and acute otitis media in children younger than 14 yrs old, living in Liguria, North-West Italy and ii) a pre−/post-interventional study to evaluate the appropriateness of antibiotic prescription for the treatment these infections. In this paper, we show only results of the appropriateness study about the antibiotic prescription for the treatment of pneumonia. Methods Patients included in this study met the following inclusion criteria: i) admission to the Emergency/Inpatient Dpt/outpatient clinic of primary care pediatricians for pneumonia requiring antibiotics, ii) informed written consent. The practice of prescribing antibiotics was evaluated before-and-after a 1 day-educational intervention on International/National recommendations. Results Global adherence to guidelines was fulfilled in 45%: main reason for discordance was duration (shorter than recommended). Macrolide monotherapy and cephalosporins were highly prescribed; ampicillin/amoxicillin use was limited. 61% of patients received >1 antibiotic; parenteral route was used in 33%. After intervention, i) in all CAP, cephalosporin prescription decreased (−23%) and the inappropriate macrolide prescriptions was halved and, ii) in not hospitalized CAP (notH-CAP), macrolides were prescribed less frequently (−25%) and global adherence to guidelines improved (+39%); and iii) in H-CAP antibiotic choice appropriateness increase. Conclusion Prescribing practices were sufficiently appropriate but widespread preference for multidrug empirical regimens or macrolide in monotherapy deserve closer investigation

[Consensus document on endomyocardial biopsy of theAssociazione per la Patologia Cardiovascolare Italiana].

The Italian Scientific Associations of Cardiologists and Cardiovascular Pathologists have produced this consensus document on the diagnostic role of endomyocardial biopsy (EMB) in terms of techniques, analysis and reporting. The document is intended for clinical cardiologists, hemodynamic experts, electrophysiologists, surgical pathologists, and cardiac surgeons. It has three main aims: a) to collocate EMB in the context of currently available tools for diagnosis of heart diseases; b) to provide recommendations for rational implementation; c) to outline key characteristics (standards) for Italian cardiology and surgical pathology centers that perform and analyze EMB. A general lack of prospective, controlled studies addressing EMB prohibited the use of traditional evidence-based recommendations that rely on classes of available evidence. Thus, it was agreed that three key points should be taken into account: a) the specific pathology to be diagnosed (or excluded); b) the existence of any alternative, non-invasive diagnostic techniques; c) the overall consequences of reaching a definite diagnosis on patients' clinical management. Accordingly, we propose recommendations for EMB based on the following levels of diagnostic value: level 1: no alternative method exists to reach a definite diagnosis that can have obvious consequences for clinical management; level 2a: no alternative method exists to reach a definite diagnosis; however, the implications for clinical management are uncertain; level 2b: no alternative method exists to reach a definite diagnosis; however, the diagnosis would not influence clinical management; level 3: an alternative method exists to reach a definite diagnosis. The second part of the document proposes current protocols for the preparation, analysis and reporting of EMB in the context of each main pathologic entity. Particular attention is given to tissue characterization and implementation of molecular tests

Mitochondrial DNA Mutations and Mitochondrial Abnormalities in Dilated Cardiomyopathy

Mitochondrial (mt)DNA defects, both deletions and tRNA point mutations, have been associated with cardiomyopathies. The aim of the study was to determine the prevalence of pathological mtDNA mutations and to assess associated defects of mitochondrial enzyme activity in dilated cardiomyopathy (DCM) patients with ultrastructural abnormalities of cardiac mitochondria. In a large cohort of 601 DCM patients we performed conventional light and electron microscopy on endomyocardial biopsy samples. Cases with giant organelles, angulated, tubular, and concentric cristae, and crystalloid or osmiophilic inclusion bodies were selected for mtDNA analysis. Mutation screening techniques, automated DNA sequencing, restriction enzyme digestion, and densitometric assays were performed to identify mtDNA mutations, assess heteroplasmy, and quantify the amount of mutant in myocardial and blood DNA. Of 601 patients (16 to 63 years; mean, 43.5 ± 12.7 years), 85 had ultrastructural evidence of giant organelles, with abnormal cristae and inclusion bodies; 19 of 85 (22.35%) had heteroplasmic mtDNA mutations (9 tRNA, 5 rRNA, and 4 missense, one in two patients) that were not found in 111 normal controls and in 32 DCM patients without the above ultrastructural mitochondrial abnormalities. In all cases, the amount of mutant was higher in heart than in blood. In hearts of patients that later underwent transplantation, cytochrome c oxidase (Cox) activity was significantly lower in cases with mutations than in those without or controls (P = 0.0008). NADH dehydrogenase activity was only slightly reduced in cases with mutations (P = 0.0388), whereas succinic dehydrogenase activity did not significantly differ between DCM patients with mtDNA mutations and those without or controls. The present study represents the first attempt to detect a morphological, easily identifiable marker to guide mtDNA mutation screening. Pathological mtDNA mutations are associated with ultrastructurally abnormal mitochondria, and reduced Cox activity in a small subgroup of non-otherwise-defined, idiopathic DCMs, in which mtDNA defects may constitute the basis for, or contribute to, the development of congestive heart failure