PROGETTO LIFE11 ENV IT 215 RESILFORMED - RESILIENZA AL CAMBIAMENTO CLIMATICO NELLE FORESTE MEDITERRANEE

Le condizioni climatiche delle regioni mediterranee, caratterizzate da frequenti annate siccitose, contribuiscono all’indebolimento degli ecosistemi forestali. Come risultato le foreste riducono le loro capacità produttive e sono più soggette a fenomeni di degrado secondario. Inoltre i contesti economico-sociali possono acuire il degrado con la diffusione di uno scorretto uso della risorsa (tagli boschivi, pascolamento) e con la diffusione degli incendi boschivi. L’obiettivo generale del progetto è preservare i sistemi forestali in ambiente mediterraneo dai rischi derivanti dai cambiamenti climatici, tramite processi di naturalizzazione, aumento di biodiversità e migliorata reattività, nei processi di recupero, in seguito ad eventi destabilizzanti. Obiettivo specifico è implementare una politica forestale regionale in grado di aumentare la capacità di resilienza delle foreste siciliane, migliorandone l’efficienza ecosistemica e favorendo la salvaguardia della biodiversità. Tra le azioni principali previste dal progetto, che si concluderà alla fine del 2015, si possono citare la classificazione delle categorie forestali siciliane in funzione della sensibilità alla desertificazione, l’indagine diacronica sull’uso e copertura del suolo dei principali paesaggi forestali siciliani, la definizione di prassi selvicolturali specifiche; la realizzazione di 120 ettari di interventi dimostrativi in 6 aree della Sicilia; la realizzazione di 6 piani di indirizzo forestali attraverso processi partecipativi con le popolazioni locali. Nella fase finale del progetto è prevista l’implementazione delle linee strategiche sperimentate con ResilForMed nel Piano Forestale Regionale della Sicilia

Typhoid fever as a cause of opportunistic infection: case report

BACKGROUND: Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, which is acquired by ingestion of contaminated food and water. Each year the disease affects at least 16 million persons world-wide, most of whom reside in the developing countries of Southeast Asia and Africa. In Italy the disease is uncommon with a greater number of cases in Southern regions than in Northern ones. CASE PRESENTATION: We report on a 57-year-old Sri-Lankan male affected by typhoid fever, the onset of which was accompanied by oropharyngeal candidiasis. This clinical sign was due to a transient cell-mediated immunity depression (CD4+ cell count was 130 cells/mm(3)) probably caused by Salmonella typhi infection. Human immunodeficiency virus infection was ruled out. Diagnosis of typhoid fever was made by the isolation of Salmonella typhi from two consecutive blood cultures. The patient recovered after a ten days therapy with ciprofloxacin and his CD4+ cell count improved gradually until normalization within 3 weeks. CONCLUSION: Our patient is the first reported case of typhoid fever associated with oropharyngeal candidiasis. This finding suggests a close correlation between Salmonella typhi infection and transitory immunodepression

Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

In vitro pharmacokinetic phantom for two-compartment modeling in DCE-MRI

\u3cp\u3eDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is an established minimally-invasive method for assessment of extravascular leakage, hemodynamics, and tissue viability. However, differences in acquisition protocols, variety of pharmacokinetic models, and uncertainty on physical sources of MR signal hamper the reliability and widespread use of DCE-MRI in clinical practice. Measurements performed in a controlled in vitro setup could be used as a basis for standardization of the acquisition procedure, as well as objective evaluation and comparison of pharmacokinetic models. In this paper, we present a novel flow phantom that mimics a two-compartmental (blood plasma and extravascular extracellular space/EES) vascular bed, enabling systemic validation of acquisition protocols. The phantom consisted of a hemodialysis filter with two compartments, separated by hollow fiber membranes. The aim of this phantom was to vary the extravasation rate by adjusting the flow in the two compartments. Contrast agent transport kinetics within the phantom was interpreted using two-compartmental pharmacokinetic models. Boluses of gadolinium-based contrast-agent were injected in a tube network connected to the hollow fiber phantom; time-intensity curves (TICs) were obtained from image series, acquired using a T1-weighted DCE-MRI sequence. Under the assumption of a linear dilution system, the TICs obtained from the input and output of the system were then analyzed by a system identification approach to estimate the trans-membrane extravasation rates in different flow conditions. To this end, model-based deconvolution was employed to determine (identify) the impulse response of the investigated dilution system. The flow rates in the EES compartment significantly and consistently influenced the estimated extravasation rates, in line with the expected trends based on simulation results. The proposed phantom can therefore be used to model a two-compartmental vascular bed and can be employed to test and optimize DCE-MRI acquisition sequences in order to determine a standardized acquisition procedure leading to consistent quantification results.\u3c/p\u3

Monitoring thoracic fluid content using bioelectrical impedance spectroscopy and Cole modeling

Heart failure is a chronic disease marked by frequenthospitalizations due to pulmonary fluid congestion. Monitoringthe thoracic fluid status may favor the detection of fluidcongestion in an early stage and enable targeted preventivemeasures. Bioelectrical impedance spectroscopy (BIS) has beenused in combination with the Cole model for monitoring bodycomposition including fluid status. The model parameters reflectintracellular and extracellular fluid volume as well as cell sizes,types and interactions. Transthoracic BIS may be a suitableapproach to monitoring variations in thoracic fluid content.The aim of this study was to identify BIS measures, which canbe derived based on the Cole model, that are sensitive to earlystages of thoracic fluid accumulation. We simulated this medicalcondition in healthy subjects by shifting a part of the whole bloodfrom the periphery towards the thorax. The redistribution ofblood was achieved non-invasively through leg compression usinginflatable leg sleeves. We acquired BIS data before, during andafter compression of the legs and examined the effect of thoracicfluid variations on parameters derived based on the Cole modeland on geometrical properties of the impedance arc. Indicatordilution measurements obtained through cardiac magneticresonance imaging were used as a reference for the changes inpulmonary fluid volume.Eight healthy subjects were included in the study. The Colemodel parameters of the study group at baseline were: R0 = 51.4 ±6.7 Ω, R∞ = 25.0 ± 7.0 Ω, fc = 49.0 ± 10.5 kHz, α = 0.687 ± 0.027, theresistances of individual fluid compartments were RE = 51.4 ± 6.7Ω, RI = 50.5 ± 22.9 Ω, the fluid distribution ratio was K = 1.1 ± 0.3,and the radius, area and depression of the arc’s center were: R =15.7 ± 1.3 Ω, XC = −8.5 ± 1.5 Ω, A = 134.0 ± 15.6 Ω2. The effect ofleg compression was a relatively small, reversible increase inpulmonary blood volume of 90 ± 57 mL. We observed significantchanges in parameters associated with intracellular, extracellularand total fluid volume (R0: -1.5 ± 0.9 %, p < 0.01; R∞: −2.1 ± 1.1, p <0.01; RI: −2.6 ± 1.6 %, p < 0.01), and in the arc’s geometricalproperties (R: -1.6 ± 1.3 %, p < 0.05; XC: −1.7 ± 1.5 %, p < 0.05, A:−2.9 ± 1.2 %, p < 0.01). K and the parameters associated withtissue structure fc and α remained stable.Transthoracic BIS is sensitive to small variations in intrathoracicblood volume, in particular the resistances of fluidcompartments and the geometric properties of the impedancearc. Taken together with previous studies, our findings suggestthat R0 may be a suitable parameter to monitor congestion. Use ofadditional parameters such as RI, K, XC, fc and α may enable thediscrimination between different types and stages of thoracic fluidaccumulation and should be the focus of future research

Noninvasive pulmonary transit time:a new parameter for general cardiac performance

\u3cp\u3eIntroduction: Pulmonary transit time (PTT) assessed with contrast-enhanced ultrasound (CEUS) is a novel tool to evaluate cardiac function. PTT represents the time for a bolus of contrast to pass from the right to the left ventricle, measured according to the indicator dilution principles using CEUS. We investigated the hypothesis that PTT is a measure of general cardiac performance in patient populations eligible for cardiac resynchronization therapy (CRT). Methods: The study population consisted of heart failure patients referred for CRT with NYHA class II–IV, left ventricular ejection fraction (LVEF)≤35% and QRS≥120 ms. CEUS, ECG, and blood were analyzed, and participants completed a quality of life questionnaire at baseline and 3 months after CRT implantation. Normalized PTT (nPTT) was calculated to compensate for the heart rate. Correlations were assessed with Pearson's or Spearman's coefficients and stratified for rhythm and NYHA class. Results: The study population consisted of 94 patients (67 men) with a mean age of 70±8.9 years. (n)PTT was significantly correlated with left ventricular parameters (r\u3csub\u3es\u3c/sub\u3e=−.487, P<.001), right ventricular parameters (r=−.282, P=.004), N-terminal pro-B-type natriuretic peptide (NT-proBNP) (r\u3csub\u3es\u3c/sub\u3e=.475, P<.001), and quality of life (r\u3csub\u3es\u3c/sub\u3e=.364, P<.001). Stronger significant correlations were found in patients in sinus rhythm. Conclusion: CEUS-derived PTT and nPTT correlate to a fair degree with measures of systolic and diastolic function, NT-pro-BNP, and quality of life. As CEUS-derived PTT can be obtained easily, noninvasively and at the bedside, it is a promising future measure of general cardiac performance.\u3c/p\u3