Genetic Diversity within a Collection of Italian Maize Inbred Lines: A Resource for Maize Genomics and Breeding.

Genetic diversity is fundamental for studying the complex architecture of the traits of agronomic importance, controlled by major and minor loci. Moreover, well-characterized germplasm collections are essential tools for dissecting and analyzing genetic and phenotypic diversity in crops. A panel of 360 entries, a subset of a larger collection maintained within the GenBank at CREA Bergamo, which includes the inbreds derived from traditional Italian maize open-pollinated (OP) varieties and advanced breeding ones (Elite Inbreds), was analyzed to identify SNP markers using the tGBS® genotyping-by-sequencing technology. A total of 797,368 SNPs were found during the initial analysis. Imputation and filtering processes were carried out based on the percentage of missing data, redundant markers, and rarest allele frequencies, resulting in a final dataset of 15,872 SNP markers for which a physical map position was identified. Using this dataset, the inbred panel was characterized for linkage disequilibrium (LD), genetic diversity, population structure, and genetic relationships. LD decay at a genome-wide level indicates that the collection is a suitable resource for association mapping. Population structure analyses, which were carried out with different clustering methods, showed stable grouping statistics for four groups, broadly corresponding to 'Insubria', 'Microsperma', and 'Scagliolino' genotypes, with a fourth group composed prevalently of elite accessions derived from Italian and US breeding programs. Based on these results, the CREA Italian maize collection, genetically characterized in this study, can be considered an important tool for the mapping and characterization of useful traits and associated loci/alleles, to be used in maize breeding programs.

Predictors and prognosis of delirium among older subjects in cardiac intensive care unit: focus on potentially preventable forms.

BACKGROUND: Delirium is a common and potentially preventable condition in older individuals admitted to acute and intensive care wards, associated with negative prognostic effects. Its clinical relevance is being increasingly recognised also in cardiology settings. The aim of the present study was to assess the prevalence, incidence, predictors and prognostic role of delirium in older individuals admitted to two cardiology intensive care units. METHODS: All patients aged over 65 years consecutively admitted to the two participating cardiology intensive care units were enrolled. Assessment on admission included acute physiological derangement (modified rapid emergency medicine score, REMS), chronic comorbidity, premorbid disability and dementia. The Confusion Assessment Method-Intensive Care Unit was applied daily for delirium detection. RESULTS: Of 497 patients (40% women, mean age 79 years), 18% had delirium over the entire cardiology intensive care unit course, half of whom more than 24 hours after admission (incident delirium). Advanced age, a main diagnosis of ST-segment elevation myocardial infarction or acute respiratory failure, modified REMS, comorbidity and dementia were independent predictors of delirium. Adjusting for patient's features on admission, incident delirium was predicted by invasive procedures (insertion of peripheral arterial catheter, urinary catheter, central venous catheter, naso-gastric tube and intra-aortic balloon pump). In a logistic regression model, delirium was an independent predictor of inhospital mortality (odds ratio 3.18, 95% confidence interval 1.02, 9.93). CONCLUSIONS: Eighteen per cent of older cardiology intensive care unit patients had delirium, with half of the cases being incident, thus potentially preventable. Invasive procedures were independently associated with incident delirium. Delirium was an independent predictor of inhospital mortality. Awareness of delirium should be increased in the cardiology intensive care unit setting and prevention studies are warranted.

Primary PCI in a patient with acute occlusion of native LAD beyond the LIMA graft anastomosis: first reported case, technical challenges and review of the literature.

We present a case of a man with an anterior STEMI due to acute occlusion of the LAD, distally to the anastomosis with LIMA graft. We describe our treatment strategy with primary PCI and the difficulties we encountered: insufficient length of balloon and stent shafts and need for deep intubation of the graft with the guiding catheter. The procedure was complicated by graft dissection that was successfully treated with a DES. Afterwards we successfully stented the culprit lesion. We discuss technical possibilities for overcoming such difficulties and present brief review of literature on STEMI in patients with previous CABG.

Resistin level in coronary artery disease and heart failure: the central role of kidney function.

OBJECTIVES: The aim of this study was to evaluate resistin levels in patients with coronary artery disease (CAD) with or without chronic heart failure, in order to define its independent predictor. METHODS: One hundred and seven outpatients with CAD were enrolled in the study and divided into three groups: CAD without left-ventricular systolic dysfunction (group 1); CAD with left-ventricular dysfunction without heart failure symptoms (group 2); CAD with overt heart failure (group 3). Plasma resistin was determined by ELISA. RESULTS: Resistin progressively increased from group 1 (10.7±5.0 ng/ml) to groups 2 (11.8±5.8 ng/ml) and 3 (17.0±6.8 ng/ml), with the difference reaching statistical significance in group 3 versus groups 1 and 2 (P=0.001). A multivariable model of analysis demonstrated that the best predictor of plasma resistin level was the estimated glomerular filtration rate (P<0.001), indicating that reduction of kidney function was the main cause of the adipokine increase observed in patients with CAD and overt heart failure. CONCLUSIONS: Our data confirm the rise of resistin plasma levels previously described in patients affected by chronic heart failure; however, in our study, this relationship seemed to be mediated mainly by the level of kidney function, and only partially by the severity of ventricular dysfunction.

Atrial fibrillation is a possible marker of frailty in hospitalized patients: results of the GIFA Study.

BACKGROUND AND AIMS: Atrial fibrillation (AF) is the most common arrhythmia in elderly people, who are particularly exposed to its most severe complications, such as stroke, worsening heart failure and dementia. Some studies demonstrate that AF is associated with increased mortality in home-dwelling subjects, but little is known about the clinical impact of the arrhythmia in hospitalized patients. We studied the clinical associations and effects of AF on the 23,174 hospitalized patients enrolled in the GIFA (Gruppo Italiano di Farmacoepidemiologia nell'Anziano) Study. METHODS: Patients were divided into three groups according to the absence or presence of AF (sinus rhythm, non_AF; AF as main diagnosis, AF_main; AF as comorbid condition, AF_associated) and stratified into four age-groups (< or =60, 61-70, 71-80 and >80 yrs). RESULTS: AF_associated patients were older, more frequently disabled, and characterized by greater comorbidity and longer in-hospital length of stay. Urea nitrogen concentration was higher, and total cholesterol was lower in AF_associated patients, compared with the other two groups. Overall mortality was 6.0%. Mortality was higher in AF_associated patients (non_AF: 6.0% vs AF_associated: 7.1% vs AF_main: 0%, p<0.001). CONCLUSIONS: Our results suggest that, in hospitalized patients, AF as a comorbid condition is associated with worse metabolic profile and clinical outcomes, and thus, may represent a marker of frailty.

Multiple shocks affect thoracic electrical impedance during external cardioversion of atrial fibrillation.

BACKGROUND: Thoracic impedance (TI) influences the success of external cardioversion (ECV) or defibrillation because current intensity traversing the heart is inversely related to TI. Experimental data suggest that TI decreases after multiple shocks. We undertook a clinical study to determine changes of TI values in patients with atrial fibrillation or flutter requiring ECV. METHODS: We enrolled 222 consecutive patients (age 73 +/- 11 years; males 67%; body weight 75 +/- 13 kg) who underwent ECV between January 2004 and February 2007. Biphasic shocks were delivered through adhesive pads placed in the anteroposterior position. The initial energy was set at 1 J/kg, with progressive increases up to a maximum of 180 J in case of failure. In the last 39 elective patients, plasma concentration of interleukin-6 (IL-6) and tumor necrosis factor (TNF)-alpha were determined before and 6 hours after ECV. RESULTS: Sinus rhythm was restored in 202 patients (91.0%). Of these, 155 (69.8%) required more than one shock (on average, 2.5 +/- 1.5 shocks/patient). Final values of energy and peak current intensity were 136 +/- 47 J and 50 +/- 14 A, respectively. TI decreased significantly by 6.2% from baseline after > or =2 shocks (P < 0.001). The absolute reduction was correlated with baseline TI, number of delivered shocks, and hemoglobin oxygen saturation. IL-6 and TNF-alpha increased with ECV (P < 0.001 and P = 0.014, respectively). CONCLUSIONS: TI decreases significantly after multiple shocks, possibly by activation of acute inflammation.

Characterization of maize germplasm for the chemical composition of the grain.

The aim of this research was the evaluation of food grain quality-related traits in a collection of maize populations of different origins, currently used in the framework of breeding and genetic programs. A total of 1245 maize samples were scanned by near-infrared (NIR) spectroscopy to develop calibration equations to evaluate the content of crude protein, crude lipid, starch, and floatation area. The performances of the NIR equations developed in our study were assessed using the determination coefficient of cross-validation r(2) (ranging from 0.66 to 0.91) and the ratio of performance deviation (1.71-3.31) in flour starch and grain crude protein, respectively. Among the genotypes considered, 93 landraces belonging to the European Union Maize Landraces Core Collection (EUMLCC) were also analyzed for their content of lutein, zeaxanthin, and total carotenoids. Among the populations of the collection, several accessions, interesting from a nutritional point of view, were identified: VA25, VA158, VA282, VA284, VA285, VA567, VA572, VA814, VA950, VA1057, and VA1179. They showed protein and lipid contents ranging between 12.52 and 15.16% and 5.26 and 7.17%. The range of variation observed for antioxidants in the EUMLCC was quite large. Lutein varied between 1.03 and 21.00 mg kg(-1) dm, zeaxanthin varied between 0.01 and 35.00 mg kg(-1) dm, and total carotenoids ranged from 1.09 to 61.10 mg kg(-1) dm. Recently, a single cross-hybrid was developed from the ITA0370005 population; this hybrid had a high carotenoids content and is currently being used by the Italian food industry.

Determinants of thoracic electrical impedance in external electrical cardioversion of atrial fibrillation.

The success of external cardioversion (ECV) of atrial fibrillation depends on generating sufficient transmyocardial current for defibrillation with minimal myocardial injury. Thoracic electrical impedance plays an important role in the relation between the delivered energy and transmyocardial current. This study assessed the determinants of thoracic electrical impedance in ECV of atrial fibrillation. ECV of atrial fibrillation was performed in 80 consecutive patients (mean age 73 +/- 9 years; men 69%; body mass index 26.0 +/- 3.6 kg/m(2)) within 12 months, using biphasic shocks (Multipulse Biowave) delivered through adhesive pads in an anteroposterior position. Thoracic electrical impedance was measured using the first shock. The mean thoracic electrical impedance was 57.7 +/- 12.3 Omega (energy 71 +/- 43 J, current intensity 33 +/- 12 A). Sinus rhythm was immediately restored in 75 patients (94%). Thoracic electrical impedance was greater (60.9 +/- 11.8 vs 51.7 +/- 11.0 Omega, p = 0.001) in patients requiring >1 shock (65%). At multivariate linear regression analysis (R = 0.761, p <0.001), female gender (+9.7 +/- 2.0 Omega, p <0.001), body mass index (+1.5 +/- 0.3 for a 1 kg/m(2) increase, p <0.001), hemoglobin concentration (+1.9 +/- 0.6 for a 1 g/dl increase, p = 0.004), and the presence of chronic heart failure (-5.3 +/- 2.0 Omega, p = 0.009) were independent predictors of thoracic electrical impedance. In conclusion, to increase ECV efficacy and minimize complications, the delivered energy should be adjusted in accordance with the clinical variables that independently affect thoracic electrical impedance and, hence, transmyocardial current.

Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial.

BACKGROUND: Observational studies suggest that open visiting policies are preferred by most patients and visitors in intensive care units (ICUs), but no randomized trial has compared the safety and health outcomes of unrestrictive (UVP) and restrictive (RVP) visiting policies. The aim of this pilot, randomized trial was to compare the complications associated with UVP (single visitor with frequency and duration chosen by patient) and RVP (single visitor for 30 minutes twice a day). METHODS AND RESULTS: Two-month sequences of the 2 visiting policies were randomly alternated for 2 years in a 6-bed ICU, with 226 patients enrolled (RVP/UVP, n=115/111). Environmental microbial contamination, septic and cardiovascular complications, emotional profile, and stress hormones response were systematically assessed. Patients admitted during the randomly scheduled periods of UVP received more frequent (3.2+/-0.2 versus 2.0+/-0.0 visits per day, mean+/-SEM) and longer (2.6+/-0.2 versus 1.0+/-0.0 h/d) visits (P<0.001 for both comparisons). Despite significantly higher environmental microbial contamination during the UVP periods, septic complications were similar in the 2 periods. The risk of cardiocirculatory complications was 2-fold (odds ratio 2.0; 95% CI, 1.1 to 3.5; P=0.03) in the RVP periods, which were also associated with a nonsignificantly higher mortality rate (5.2% versus 1.8%; P=0.28). The UVP was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge. CONCLUSIONS: Despite greater environmental microbial contamination, liberalizing visiting hours in ICUs does not increase septic complications, whereas it might reduce cardiovascular complications, possibly through reduced anxiety and more favorable hormonal profile.

Renal, but not systemic, hemodynamic effects of dopamine are influenced by the severity of congestive heart failure.

OBJECTIVE: To determine whether the short-term systemic and renal hemodynamic response to dopamine is influenced by clinical severity of congestive heart failure. DESIGN: Effects of increasing doses of dopamine were assessed in patients consecutively admitted for acutely decompensated congestive heart failure. SETTING: Intensive care unit. PATIENTS: We enrolled 16 congestive heart failure patients stratified by clinical severity (New York Heart Association [NYHA] class III, n = 8; NYHA class IV, n = 8) and two additional NYHA class III patients as controls. INTERVENTIONS: Measurements were carried out throughout five 20-min experimental periods: baseline, dopamine infusion at 2, 4, and 6 microg x kg(-1) x min(-1), and recovery. Controls received a similar amount of saline. MEASUREMENTS AND MAIN RESULTS: Systemic and renal hemodynamics were determined respectively by right cardiac catheterization and radioisotopes (iodine 131-labeled hippuran and iodine 125-labeled iothalamate clearance). The peak increase in heart rate and cardiac index occurred at a dopamine dose of 4-6 microg x kg(-1) x min(-1). The dose-response relation was similar in NYHA classes III and IV. Improvement in effective renal plasma flow and glomerular filtration rate, peaking at 4 microg x kg(-1) x min(-1), was more rapid and marked in NYHA class III than class IV patients, in whom the renal fraction of cardiac output failed to increase. The systemic and renal effects of dopamine were independent of age. No change occurred in controls. CONCLUSIONS: The dose of dopamine producing an optimal improvement of systemic and renal hemodynamics in congestive heart failure is higher than usually reported. A greater clinical severity of congestive heart failure impairs the renal effects of dopamine, probably through a selective loss in renal vasodilating capacity.

Does advanced age affect the immediate and long-term results of direct-current external cardioversion of atrial fibrillation?

OBJECTIVES: To determine whether advanced age affects the immediate and long-term results of direct-current external cardioversion (ECV) of atrial fibrillation (AF), the sustained arrhythmia most commonly encountered in older patients. DESIGN: Retrospective analysis of medical records. SETTING: Intensive care unit. PARTICIPANTS: Two hundred fifty consecutive patients(age 34-100) with AF who underwent ECV following a standardized protocol in an intensive care unit. MEASUREMENTS: Immediate efficacy of ECV, defined as recovery of sinus rhythm, and maintenance of sinus rhythm over the follow-up were study outcomes. The univariate and multivariate associations of immediate efficacy of ECV and long-term results with clinical variables were analyzed. RESULTS: At univariate analysis, immediate efficacy of ECV (overall, 91.2%) was lower in older patients and in those with chronic obstructive pulmonary disease, higher for a 3- to 90-day pre-ECV duration of AF than for a duration of 2 days or less or more than 90 days, and independent of underlying cardiac disease, hypertension, diabetes mellitus, previous AF, and left atrial dimension. However, pre-ECV duration of AF was the only multivariate predictor of ECV immediate success. Major complications occurred in only three patients. Of 220 patients discharged in sinus rhythm, 211 were followed up for a mean period +/- standard deviation of 34 +/- 25 months. AF relapsed in 45.5% of them. At multivariate analysis, underlying cardiac disease was the only predictor of the relapse rate, and relapse rate was lower in coronary heart disease than in valvular heart disease, congestive heart failure, or lone AF. CONCLUSION: Immediate and long-term results of ECV of AF, an effective and safe procedure, are unaffected by age,at least after adjusting for several covariates.