Shipwrecked on the Rock, or Not Quite: Gypsophytes and Edaphic Islands.

Species-area relationships (SAR) constitute a key aspect of ecological theory and are integral to other scientific disciplines, such as biogeography, which have played a crucial role in advancing biology. The theory of insular biogeography provides a clear example. This theory initially expanded from true islands to other types of systems characterized by their insularity. One such approach was linked to geoedaphic islands, as seen in gypsum outcrops. While these continental areas have been considered insular systems, only limited and mostly indirect evidence thereof has been provided. This study utilized SAR to advance the understanding of gypsum outcrops as insular continental territories. It is hereby hypothesized that gypsum outcrops are edaphic islands, although their insular nature depends on the different functional or ecological plant types, and this nature will be reflected in the potential Arrhenius model z values. The results obtained support both hypotheses and provide insight into the ecological factors that help interpret the insularity of these areas. This interpretation goes beyond their mere extent and the distance among outcrops, emphasizing the importance of environmental filters. Said filters vary in permeability depending on the degree of gypsophily, or preference for gypsum, exhibited by different species.

Applicability and performance of heart failure prognostic scores in dilated cardiomyopathy: the real-world experience of an Italian referral center for cardiomyopathies.

BACKGROUND: The performance of heart failure (HF) risk models is validated in the general population with HF but in specific aetiological settings, and specifically in dilated cardiomyopathy (DCM), has scarcely been explored. We tested eight of the main prognostic scores used in HF in a large real-world population of patients with DCM. METHODS: We included 784 consecutive DCM patients enrolled, both inpatients and outpatients, enrolled between January 2000 and December 2017. The risk of 1 and/or 3-year all-cause mortality/heart transplantation/durable left ventricular assist device (LVAD) implantation (D/HTx/LVAD) was estimated in our cohort according to the following risk scores SHFM, 3-CHF, CHARM, MAGGIC, GISSI-HF, MECKI, Barcelona Bio-HF, Krakow score and their accuracy calculated through the receiver operator characteristic (ROC) curve analysis. RESULTS: During a median follow-up of 5.8 years (Interquartile Range 3.2-7.6 years), 191 patients (20%) died or underwent HTx/LVAD (158 deaths, 30 heart transplantations, and 3 LVAD implantations). The high missing rate allowed to calculated only four prognostic models (MAGGIC, CHARM, 3-CHF and SHFM). All the scores overestimated the rate of D/HTx/LVAD. The prognostic accuracy was suboptimal for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores and only modest for 3-CHF (AUC 0.677) and SHFM (AUC 0.667). CONCLUSIONS: Main prognostic scores for the risk stratification of HF are only partially applicable to real-world patients with DCM. MAGGIC and CHARM scores showed the best accuracy, despite the overestimation of risk. Our findings corroborate the need of specific risk scores for the prognostic stratification of DCM. CLINICAL PERSPECTIVE: What is new? The present study is the largest analysis in literature which investigate how the main existing heart failure prognostic risk scores performed in a real-world of dilated cardiomyopathy population, both in- and outpatients. What are the clinical implications? DCM is a stand-alone model of heart failure, where the performance of multiple heart failure prognostic scores for the risk stratification is quite limited. The need for contemporary, dedicated prognostic scores in this disease is increasingly evident.

[Degree of implementation in Spain of the therapeutic recommendations for hypotonia of central origin according to the consensus of experts of the American Academy for Cerebral Palsy and Developmental Medicine]. / Grado de implementación en España de las recomendaciones terapéuticas para la hipotonía de origen central según el consenso de expertos de la AACPDM.

INTRODUCTION: In early childhood, there are a number of different neurological conditions and syndromes that present with hypotonia of central origin. In 2019, the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) drew up a set of guidelines on therapeutic recommendations for the population aged from 0 to 6 years, based on the consensus of experts and on scientific evidence. The aim of this study is to determine how those therapeutic recommendations are being implemented in Spain. SUBJECTS AND METHODS: A survey of paediatric physiotherapists treating 0-6-year-old children with central hypotonia was carried out by means of a questionnaire consisting of 31 questions: 10 questions on sociodemographic and practice-related data, and the remaining 21 related to the use of the therapeutic recommendations based on the AACPDM guidelines for children with hypotonia of central origin. RESULTS: From a sample of 199 physiotherapists, it was found that familiarity with the AACPDM guidelines was significantly associated with the number of years of clinical experience, level of qualification and the community in which the professionals practise. CONCLUSION: These guidelines can serve to raise awareness and unify criteria regarding the therapeutic approach to children with central hypotonia. The results indicate that, with the exception of a few techniques, in our country most of the therapeutic strategies are being implemented within the framework of early care.

TITLE: Grado de implementación en España de las recomendaciones terapéuticas para la hipotonía de origen central según el consenso de expertos de la AACPDM.Introducción. En la primera infancia existen diferentes condiciones y síndromes neurológicos que presentan hipotonía de origen central. La American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) elaboró una guía en 2019 sobre recomendaciones terapéuticas para esta población de 0 a 6 años, basadas en un consenso de expertos y en la evidencia científica. El objetivo de este estudio fue ver cómo esas recomendaciones terapéuticas se están implementando en España. Sujetos y métodos. Se realizó una encuesta a fisioterapeutas pediátricos que tratan niños con hipotonía central de 0 a 6 años a través de un cuestionario que constaba de 31 preguntas: 10 preguntas sobre datos sociodemográficos y relativos al ejercicio de la profesión, y las 21 restantes relacionadas con el uso de las recomendaciones terapéuticas basadas en la guía de la AACPDM dirigidas a niños con hipotonía de origen central. Resultados. A partir de una muestra de 199 fisioterapeutas, se pudo objetivar que el conocimiento de la guía de la AACPDM se asociaba de forma significativa con los años de experiencia clínica, el nivel de titulación y la comunidad donde ejercen. Conclusión. Esta guía puede servir para concienciar y unificar los criterios en cuanto al abordaje terapéutico de los niños con hipotonía central. Los resultados indican que, excepto algunas técnicas, la mayoría de las estrategias terapéuticas se está implementado en nuestro país en el marco de la atención temprana.

Spontaneous Primary Succession and Vascular Plant Recovery in the Iberian Gypsum Quarries: Insights for Ecological Restoration in an EU Priority Habitat.

Gypsum covers a vast area of the Iberian Peninsula, making Spain a leader in its production. Gypsum is a fundamental raw material for modern societies. However, gypsum quarries have an obvious impact on the landscape and biodiversity. Gypsum outcrops host a high percentage of endemic plants and unique vegetation, considered a priority by the EU. Restoring gypsum areas after mining is a key strategy to prevent biodiversity loss. For the implementation of restoration approaches, understanding vegetation's successional processes can be of invaluable help. To fully document the spontaneous succession in gypsum quarries and to evaluate its interest for restoration, 10 permanent plots of 20 × 50 m were proposed, with nested subplots, in which vegetation change was recorded for 13 years in Almeria (Spain). Through Species-Area Relationships (SARs), these plots' floristic changes were monitored and compared to others in which an active restoration was carried out, as well as others with natural vegetation. Furthermore, the successional pattern found was compared to those recorded in 28 quarries distributed throughout the Spanish territory. The results show that an ecological pattern of spontaneous primary auto-succession is widely recurring in Iberian gypsum quarries, which is capable of regenerating the pre-existing natural vegetation.

Recent and ancient evolutionary events shaped plant elemental composition of edaphic endemics: a phylogeny-wide analysis of Iberian gypsum plants.

The analysis of plant elemental composition and the underlying factors affecting its variation are a current hot topic in ecology. Ecological adaptation to atypical soils may shift plant elemental composition. However, no previous studies have evaluated its relevance against other factors such as phylogeny, climate or individual soil conditions. We evaluated the effect of the phylogeny, environment (climate, soil), and affinity to gypsum soils on the elemental composition of 83 taxa typical of Iberian gypsum ecosystems. We used a new statistical procedure (multiple phylogenetic variance decomposition, MPVD) to decompose total explained variance by different factors across all nodes in the phylogenetic tree of target species (covering 120 million years of Angiosperm evolution). Our results highlight the relevance of phylogeny on the elemental composition of plants both at early (with the development of key preadaptive traits) and recent divergence times (diversification of the Iberian gypsum flora concurrent with Iberian gypsum deposit accumulation). Despite the predominant phylogenetic effect, plant adaptation to gypsum soils had a strong impact on the elemental composition of plants, particularly on sulphur concentrations, while climate and soil effects were smaller. Accordingly, we detected a convergent evolution of gypsum specialists from different lineages on increased sulphur and magnesium foliar concentrations.

A checklist of larval Digenea (Platyhelminthes: Trematoda) in molluscs from inland waters of Argentina: one hundred years of research.

A checklist of larval digeneans parasitising molluscs from inland waters of Argentina is presented here. Based on the bibliographical survey of 113 scientific articles and nine theses published between 1930 and 2021, 213 digeneans were found, which were distributed within 13 superfamilies and 35 families. The parasites were identified in 102 locations, encompassing eight of the sixteen biogeographical provinces in Argentina. Digeneans were found in 34 mollusc species (31 gastropods and three bivalves) belonging to 17 genera. The available data are presented for each digenean species, and included host information, localities, prevalence values, type of habitat, life cycle information (natural or experimental host), and information on material and genetic sequences deposited in repositories. Only 21.1% of individuals were identified to species level, and 8.5% to genus level. In addition, the genetic sequences of only 10 species (4.7%) were available at GenBank. This survey constitutes the first checklist of parasitic helminths in molluscs from inland waters of Argentina.

["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]. / « Troubles à symptomatologie somatique ¼ chez les adolescents. Une revue systématique.

OBJECTIVES: Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern "Somatic Symptom and Related Disorders" according to the DSM-5 (Diagnostic and Statistical Manual - 5th Edition) among adolescents. METHODS: The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items "somatoform disorders" or "somatic symptom disorders". An age filter was applied for "adolescents", and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis. RESULTS: A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these "somatic symptom disorders" were varied, such as "somatization", "somatic complaints/symptoms", "functional disorder", "unexplained symptoms" and "somatoform disorders". Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about "functional neurological symptom disorder", "factitious disorder" and "somatic symptom disorder" with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented. CONCLUSIONS: Only nine articles included "somatic symptom disorder" in their titles, despite a terminology valued by many authors (compared to "somatoform disorders" from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.

Reproductive compensation in female Palaemonetes argentinus (Decapoda: Natantia) due to Microphallus szidati (Trematoda) infection.

Parasites may affect host demographic characteristics because they can directly or indirectly cause the death of their hosts and/or influence their reproduction. Parasitism is therefore recognized as a factor that influences the composition and structure of populations and communities. One of these behaviours is the compensatory response: the host can compensate for the parasite losses effect, modifying the reproductive effort to enhance fitness. Ovigerus female Palaemonetes argentinus was collected and sorted into two groups according to the degree of development of their embryos: newly spawned embryos and embryos ready to hatch. The number of embryos and their dry weight for each female were determined. All parts of the female body were checked for parasites. The females of P. argentinus were parasitized by Microphalus szidati. We found that parasitized females produce more embryos but had more egg loss during development and the percentage of embryonic loss was higher in the parasitized females than in non-parasitized. Parasitized females produced lighter eggs than those from uninfected females. This supports the compensatory reproduction hypothesis suggested for this species. Parasitism can change life history traits in a way that fecundity can be compensated; this co-evolution between host and parasites will be population or context dependent. Parasites are a functional part of any ecosystem and as our results show, deleting parasites in life history traits and reproduction studies in free living organisms could lead to an incomplete picture of the true processes that happen in nature.

Feline testicular ultrasonogram differentiates pre vs. postpubertal and normal vs. disrupted spermatogenesis.

The aims of this study were: to ultrasonograhically describe and compare testicular parenchyma echogenicity and heterogeneity using digital image analysis in: I) prepubertal (PREP), peripubertal (PERI) and mature (MAT) cats; II) Normal and abnormal mature felids. Secondary, the relationships between histomorphological and ultrasonographic attributes of the testes were also determined. I) Fourteen, PREP, PERI and MAT male cats were ultrasonographically examined and then castrated. II) Seven adult cats were ultrasonographically examined before and after a GnRH antagonist administration and then castrated. All the testes were grossly and histomorphometrically assessed. In the frozen digital images of the longitudinal ultrasound sections, 3 regions of interest (ROI, 1 mm2) were selected. Within each ROI the echogenicity and the heterogeneity of the testicular parenchyma were digitally analyzed. In experiment I, testicular volume (0.15 ± 0.0 vs. 0.49 ± 0.1 vs. 1.65 ± 0.1; P < 0.01) and gonadosomatic index (0.04 ± 0.0 vs. 0.05 ± 0.0 vs. 0.08 ± 0.0; P < 0.01), echogenicity (56.54 ± 0.75 vs. 81.87 ± 5.88 vs.94.67 ± 3.62; P < 0.01) and heterogeneity (10.2420 ± 1.3740 vs.13.65 ± 0.65 vs. 14.67 ± 1.49; P < 0.01) augmented throughout PRE, PERI, and MAT. In experiment II, testicular volume (1.00 ± 0.09 vs. 0.85 ± 0.09; P < 0.05), echogenicity (87.74 ± 1.53 vs. 83.32 ± 1.54; P 0.01) but not heterogeneity (14.09 ± 0.26 vs. 14.19 ± 0.29; P > 0.05) decreased in the post GnRH antagonist abnormal testes. For both experiments, testicular volume, seminiferous tubular diameter, percentage of spermatids as the most mature cell type, and luminal/intertubular ratio were highly correlated (P < 0.01) with their echotextural attributes. Computer-assisted image analysis of B mode ultrasonogram appears as a good indicator of pubertal development and mild alterations of spermatogenesis in felids.

Spatio-temporal variations in larval digenean assemblages of Heleobia parchappii (Mollusca: Cochliopidae) inhabiting four human-impacted streams.

In the last years, a growing number of studies have focused on the search for biological indicators of human impact in freshwater environments. Given their susceptibility to different types of impact, larval digeneans have been considered as useful tools for the study of temporal variations in parasite communities. However, few studies have been carried out in lotic environments. For that reason, the spatio-temporal variations of the larval digenean assemblages parasitizing the gastropod Heleobia parchappii were analysed in four human-impacted streams, located on the coast of Argentina. In total, 4800 specimens of H. parchappii were collected seasonally, and 12 digenean species belonging to eight families were registered. Three of the streams showed similar species presence but, during spring and summer, the streams located within the city presented lower species presence than the streams located in the urban periphery. By contrast, the spatial prevalence values evidenced a higher variation between the environments. Streams located in the urban periphery showed higher prevalence values throughout the year, compared to those calculated for streams located within the city. The spatio-temporal variations of larval digenean assemblages parasitizing H. parchappii seem to be mainly influenced by the diversity and vagility of definitive hosts, the types of digenean life cycles and habitat characteristics. However, environmental disturbances derived from anthropogenic activities are highlighted as the probable main factors that may affect the composition and dynamic of these parasite assemblages.

Quantitative bidimentional and Doppler ultrasound assessment of the effect of a GnRH antagonist on canine prostatic hyperplasia.

The objectives of this article were: a) To describe the effect of a single administration of the third generation GnRH antagonist, acyline, on canine benign prostatic hyperplasia (BPH) b)To quantitatively compare parenchyma echogenicity, heterogeneity (SD echogenicity) and blood flow in hyperplastic and treated prostate glands. Seven mixed bred dogs, 11.14 ± 0.8 years of age, weighing 8.5 ± 1.4 (3.8-15.6) kg, with BPH were included in this study and administered acyline 330 mg/kg sc (day 0). Then the dogs were examined by B Mode and Doppler ultrasound on days 15, 30 and 60 after treatment. Parenchymal frozen images were digitally analyzed. On day -7, prostatic volume was 1.60-5.36 fold (volume ratio) enlarged in relation to the expected volume. Prostatic volume decreased up to a mean of -38.44% (P < 0.01; range -32.2 to -70.9%) on day 30 to gradually increase towards pretreatment values. A correlation between volume ratio and nadir treatment volume was also found (r = - 0.87; P < 0.05). Mean parenchyma echogenicity (P < 0.01) and heterogeneity (P < 0.01) diminished in all the post treatment evaluations. Pretreatment intraprostatic cysts disappeared at the time point of peak treatment effect. Prostatic arteries RI increased on day 30, being different from day -7 and also from day 60 values (P < 0.05). It was concluded that a single administration of a third generation GnRH antagonist safely decreased prostatic volume and parenchyma and blood flow abnormities associated with canine BPH during 30 days. Monthly administrations of this treatment could represent a rapid, efficient and safe therapeutic option for BPH.

Strain analysis reveals subtle systolic dysfunction in confirmed and suspected myocarditis with normal LVEF. A cardiac magnetic resonance study.

AIMS: Lake Louise Criteria (LLC) are time-dependent and some acute myocarditis (AM) with preserved left ventricular ejection fraction (LVEF) could be missed, due to the limited accessibility of Cardiac Magnetic Resonance (CMR). We aimed to assess the potential value of cardiac strain measured by feature tracking (FT) imaging in this population. METHODS AND RESULTS: Eighty-three patients with clinically suspected AM and normal LVEF were divided into 39 "confirmed AM" (positive LLC) and 44 "suspected AM" (negative LLC). An age and gender-matched sample of 42 normal subjects underwent CMR. In all groups, FT-derived biventricular strains and STE- global longitudinal strain (GLS) were assessed, being regularly measurable. Strain values < 5th percentile of the control group were considered abnormal. "Suspected" and "confirmed" AM were similar, except for medium time of CMR evaluation (5.2 vs 1 months from presentation, respectively; p = 0.004). Compared to healthy controls, both "suspected" and "confirmed" AM showed significantly impaired strain values. LV-global circumferential strain (GCS), right ventricular GCS and LV-GLS were abnormal in 15.4% and 15.9%, 20.5% and 15.9%, 7.7% and 9.1% in "confirmed" and "suspected" AM, respectively. STE analysis confirmed the results on LV-GLS, however a weak correlation emerged between STE and CMR-FT LV-GLS (p = 0.08). CONCLUSIONS: Compared to STE, CMR-FT analysis provided a more comprehensive and complementary biventricular strain evaluation that resulted similar in "confirmed" and "suspected" AM with normal LVEF. Conversely, mostly biventricular GCS was significantly reduced in up to 20% of patients, compared to healthy controls.

Dioctophyme renale in a domestic cat (Felis catus): Renal location and nephrectomy.

Dioctophymosis is caused by Dioctophyme renale, nematode with indirect life cycle. Its intermediate host is a freshwater oligochaete and its definitive host is a wild or household carnivore. The adult nematode develops in the definite host, generally locating itself in the kidney. This article was meant to describe the first nephrectomy performed in a domestic cat due to renal dioctophymosis in Argentina. The subject showed a non-specific appearance of generally feeling ill, hematuria and mild diarrhea. It was diagnosed through abdominal ultrasound, followed by exploratory celiotomy and nephrectomy. After verifying absence of free specimens, the right kidney was removed. This organ was found to be enlarged in a spheroidal manner in contrast to the left kidney, with significant thickening of the renal capsule, excessive congestion of vessels and adhesions involving the caudal vena cava. An adult nematode was removed from the right kidney and identified as Dioctophyme renale. Reports of feline dioctophymosis are scarce being most of them necropsy findings. In this we are presenting a confirmed case of D. renale removed by surgery from a live cat. The results presented here reinforces the fact that cats are also appropriate definitive hosts for this parasite.

Physical, histological, endocrinological and steroidogenical evaluation of male cats postnatally exposed to sexual steroids.

To test the hypothesis that postnatal sexual steroids induce an impairment of domestic male cat reproductive function, this study describes the physical, endocrine, steroidogenical and histological effects of a single, high dose of a postnatal sexual steroid in this species. Twenty male kittens were randomly assigned within the first 24 h of birth to: Testosterone enanthate 12.5 mg sc (TE; n = 8), medroxyprogesterone acetate 10 mg sc (MA; n = 6), or Placebo sc (PL; n = 6). The cats were followed until puberty when they were castrated. Kittens achieved puberty without age differences among groups (P > 0.05). Two MA cats presented abnormal testicular descent. Histological evaluation of the MA (P < 0.01), but not of TE testes revealed decreased diameter (P < 0.01) and epithelial height (P < 0.01) of the seminiferous tubules. Leydig cell nuclear area was also reduced in this group. Conversely, tubular/intertubular ratio was increased in TE animals (P < 0.01). Quantitative real-time PCR analysis of mRNA expression of testicular tissue revealed no significant differences among groups for StAR, CYP17A1 and androgen receptors. TE animals showed decreased CYP19A1 mRNA expression (P < 0.05). In the first 4 postnatal weeks, fecal testosterone (T) values were high, basal and intermediate in TE, MA and PL (P < 0.05), respectively. These differences progressively diminished and the three groups presented basal T concentrations from the 7th week on (P > 0.05). It was concluded that the postnatal progestagen initially suppressed the gonadal axis and caused an impairment of spermatogenesis and testicular descent at puberty. Androgen treatment caused downregulation of the final steroidogenic cascade.

Effect of the indenopyridine RTI-4587-073 (l) on feline testicle.

The aim of this study was to describe the seminal, histomorphological and hormonal effects of the oral indenopyridine RTI-4587-073(l) on feline testicle. Clinical side effects were also recorded. Sixty testicles of 30 adult cats that had been treated (d 0) with RTI-4587-073(l) 12.5 mg/kg PO and randomly hemiorchiectomized twice on: day -14 (n = 8), 6 h (n = 6), 12 h (n = 8), 24 h (n = 6), day 7 (n = 8), day 14 (n = 6), day 21 (n = 6), day 35 (n = 6) or day 42 (n = 6) were studied. Before each hemiorchiectomy, fecal samples for testosterone (T) measurement were collected and the testes were grossly and ultrasound examined. This indenopyridine did not cause changes in testicular weight (P > 0.1), volume (P > 0.1), echostructure, gonadosomatic index (P > 0.1), fecal T concentrations (P > 0.1), nor clinical side effects. A severe disorganization of the cytoarchitecture of the seminiferous epithelium, sloughed cells and fluid, were observed in the 6 h samples up to a maximum at 24 h. Tubular diameter (P < 0.01) increased twice, during the first 24 h and on d 35. Germinal epithelium achieved its minimum height on d 14 to rapidly recover thereafter. This treatment caused a significant decrease in the volume of all the seminiferous cell components, except spermatogonias. All histotological parameters normalized by the end of the study. It was concluded that RTI-4587-073(l) severely disrupted spermatogenesis during the first 24 h after treatment returning to normality in approximately one spermatic cycle without clinical side effects.

Genetics of Dilated Cardiomyopathy: Clinical Implications.

PURPOSE OF REVIEW: This review aims to summarize the current knowledge on the genetic background of dilated cardiomyopathy (DCM), with particular attention to the genotype-phenotype correlations and the possible implications for clinical management. RECENT FINDINGS: Next generation sequencing (NGS) has led to the identification of an increasing number of genes and mutations responsible for DCM. This genetic variability is probably related to the extreme heterogeneity of disease manifestation. Important findings have associated mutations of Lamin A/C (LMNA) and Filamin C (FLNC) to poor prognosis and the propensity to cause an arrhythmic phenotype, respectively. However, a deeper understanding of the genotype-phenotype correlation is necessary, because it could have several implications for the clinical management of the patients. Furthermore, the correct interpretation of pathogenicity of mutations and the clinical impact of genetic testing in DCM patients still represent important fields to be implemented. A pathogenic gene mutation can be identified in almost 40% of DCM patients. The recent discoveries and future research in the field of genotype-phenotype correlation may lead to a more personalized management of the mutation carriers towards the application of precision medicine in DCM.

Reverse remodeling in Dilated Cardiomyopathy: Insights and future perspectives.

Dilated Cardiomyopathy (DCM) has been classically considered a progressive disease of the heart muscle that inexorably progresses towards refractory heart failure, ventricular arrhythmias and heart transplant. However, the prognosis of DCM has significantly improved in the past few years, mostly as the result of successful therapy-induced reverse remodeling. Reverse remodeling is a complex process that involves not only the left ventricle, but also many other cardiac structures and it is now recognized both as a measure of therapeutic effectiveness and as an important prognostic tool. Nevertheless, several aspects of reverse remodeling remain unclear, including the best timing for its quantification, its predictors and its interaction with individual genetic backgrounds. In this review, we summarize our current understanding of reverse remodeling in patients with DCM and provide practical recommendations for the clinical management of this challenging patient population.

Prognostic Impact of BNP Variations in Patients Admitted for Acute Decompensated Heart Failure with In-Hospital Worsening Renal Function.

BACKGROUND: The significance of worsening renal function (WRF) in patients admitted for acute decompensated heart failure (ADHF) is still controversial. We hypothesised that changes in brain natriuretic peptide (BNP) might identify patients with optimal diuretic responsiveness resulting in transient WRF, not negatively affecting the prognosis. Our aim was to verify if in-hospital trends of BNP might be helpful in the stratification of patients with WRF after treatment for ADHF. METHODS: 122 consecutive patients admitted for ADHF were enrolled. Brain natriuretic peptide and eGFR were evaluated at admission and discharge. A 20% relative decrease in eGFR defined WRF, whereas a BNP reduction ≥40% was considered significant. The primary combined endpoint was death/urgent heart transplantation and re-hospitalisation for ADHF. RESULTS: Worsening renal function occurred in 23% of patients without differences in outcome between patients with and without WRF (43% vs. 45%, p=0.597). A significant reduction in BNP levels over the hospitalisation occurred in 59% of the overall population and in 71% of patients with WRF. At a median follow-up of 13.0 (IQR 6-36) months, WRF patients with ≥40% BNP reduction had a lower rate of death/urgent heart transplantation/re-hospitalisation compared to WRF patients without BNP reduction (30% and 75%, respectively; p=0.007). Favourable BNP trend was the strongest variable in predicting the outcome in WRF patients (HR 0.222, 95% CI 0.066-0.753, p=0.016). CONCLUSIONS: Worsening renal function does not affect the prognosis of ADHF and, when associated with a significant BNP reduction, identifies patients with adequate decongestion at discharge and favourable outcome.