Molecular Pathways of Vulnerable Carotid Plaques at Risk of Ischemic Stroke: A Narrative Review.

The concept of vulnerable carotid plaques is pivotal in understanding the pathophysiology of ischemic stroke secondary to large-artery atherosclerosis. In macroscopic evaluation, vulnerable plaques are characterized by one or more of the following features: microcalcification; neovascularization; lipid-rich necrotic cores (LRNCs); intraplaque hemorrhage (IPH); thin fibrous caps; plaque surface ulceration; huge dimensions, suggesting stenosis; and plaque rupture. Recognizing these macroscopic characteristics is crucial for estimating the risk of cerebrovascular events, also in the case of non-significant (less than 50%) stenosis. Inflammatory biomarkers, such as cytokines and adhesion molecules, lipid-related markers like oxidized low-density lipoprotein (LDL), and proteolytic enzymes capable of degrading extracellular matrix components are among the key molecules that are scrutinized for their associative roles in plaque instability. Through their quantification and evaluation, these biomarkers reveal intricate molecular cross-talk governing plaque inflammation, rupture potential, and thrombogenicity. The current evidence demonstrates that plaque vulnerability phenotypes are multiple and heterogeneous and are associated with many highly complex molecular pathways that determine the activation of an immune-mediated cascade that culminates in thromboinflammation. This narrative review provides a comprehensive analysis of the current knowledge on molecular biomarkers expressed by symptomatic carotid plaques. It explores the association of these biomarkers with the structural and compositional attributes that characterize vulnerable plaques.

The Role of the Coagulation System in Peripheral Arterial Disease: Interactions with the Arterial Wall and Its Vascular Microenvironment and Implications for Rational Therapies.

Peripheral artery disease (PAD) is a clinical manifestation of atherosclerotic disease with a large-scale impact on the economy and global health. Despite the role played by platelets in the process of atherogenesis being well recognized, evidence has been increasing on the contribution of the coagulation system to the atherosclerosis formation and PAD development, with important repercussions for the therapeutic approach. Histopathological analysis and some clinical studies conducted on atherosclerotic plaques testify to the existence of different types of plaques. Likely, the role of coagulation in each specific type of plaque can be an important determinant in the histopathological composition of atherosclerosis and in its future stability. In this review, we analyze the molecular contribution of inflammation and the coagulation system on PAD pathogenesis, focusing on molecular similarities and differences between atherogenesis in PAD and coronary artery disease (CAD) and discussing the possible implications for current therapeutic strategies and future perspectives accounting for molecular inflammatory and coagulation targets. Understanding the role of cross-talking between coagulation and inflammation in atherosclerosis genesis and progression could help in choosing the right patients for future dual pathway inhibition strategies, where an antiplatelet agent is combined with an anticoagulant, whose role, despite pathophysiological premises and trials' results, is still under debate.

Ecology of yeasts associated with kernels of several durum wheat genotypes and their role in co-culture with Saccharomyces cerevisiae during dough leavening.

This work was performed to investigate on the yeast ecology of durum wheat to evaluate the interaction between kernel yeasts and the commercial baker's yeast Saccharomyces cerevisiae during dough leavening. Yeast populations were studied in 39 genotypes of durum wheat cultivated in Sicily. The highest level of kernel yeasts was 2.9 Log CFU/g. A total of 413 isolates was collected and subjected to phenotypic and genotypic characterization. Twenty-three yeast species belonging to 11 genera have been identified. Filobasidium oeirense, Sporobolomyces roseus and Aureobasidium pullulans were the species most commonly found in durum wheat kernels. Doughs were co-inoculated with yeasts isolated from wheat kernels and commercial Saccharomyces cerevisiae, in order to evaluate the interactions between yeasts and the leavening performance. Yeast populations of all doughs have been monitored as well as dough volume increase and weight loss (as CO2) measured after 2 h of fermentation. The doughs whose final volume was higher than control dough (inoculated exclusively with S. cerevisiae) were those inoculated with Naganishia albida, Vishniacozyma dimennae (118 mL each), and Candida parapsilosis (102 mL). The weight losses were variable, depending on the co-culture used with S. cerevisiae and the values were in the range of 0.08-1.00 g CO2/100 g. The kernel yeasts species C. parapsilosis, N. albida, P. terrestris, R. mucilaginosa and V. dimennae deserves future attention to be co-inoculated with the commercial starter S. cerevisiae in order to improve the sensory characteristics of bread.

Relationship between HRV measurements and demographic and clinical variables in a population of patients with atrial fibrillation.

Little is known about the role of HRV in atrial fibrillation (AF) patients. Aim of our study was to assess the relationship between HRV measurements and demographic and clinical variables in a population of 274 AF patients. We selected all consecutive patients with persistent/permanent AF among whom had performed a Holter ECG in our Department from April 2010 to April 2015. Time-domain analysis of HRV was evaluated. Demographic and clinical variables were collected for each patient. At multivariable logistic regression, a higher pNN50 was associated with ACE inhibitors/ARBs (p = 0.016) and a lower pNN50 with obesity (p = 0.037) and higher heart rate (HR) (p < 0.0005). A higher RMSSD was associated with ACE inhibitors/ARBs (p = 0.001), digitalis (p < 0.0005) and beta-blockers (p = 0.002) and a lower RMSSD with a higher HR (p < 0.0005). A higher SDNNi was associated with ACE inhibitors/ARBs (p < 0.0005), digitalis (p < 0.0005) and beta-blockers (p = 0.002) and a lower SDNNi with dysthyroidism (p = 0.048) and higher HR (p < 0.0005). A higher SDANN was associated with non-dihydropyiridine calcium-channel-blockers (p = 0.002) and ACE inhibitors/ARBs (p = 0.002) and a lower SDANN with hypertension (p = 0.034), obesity (p = 0.011), stroke (p = 0.031), pneumonia (p = 0.005) and higher HR (p < 0.0005). A higher SDNN was associated with ACE inhibitors/ARBs (p < 0.0005), digitalis (p < 0.0005) and beta-blockers (p = 0.022) and a lower SDNN with obesity (p = 0.012), pneumonia (p = 0.049) and higher HR (p < 0.0005). Our study showed that, in AF patients, there is a direct relationship between some clinical variables and HRV measurements; as for patients with sinus rhythm, even in AF patients this relationship seemed to reflect the autonomic nervous system activity.

Codium fragile (Suringar) Hariot as Biostimulant Agent to Alleviate Salt Stress in Durum Wheat: Preliminary Results from Germination Trials.

Soil salinization is a critical environmental problem in arid and semiarid regions of the world. The aim of the present study was to evaluate the effect of an algae-based biostimulant on germination and seedling vigour of durum wheat (Triticum turgidum L. subsp. durum (Desf.) Husn.), under different saline conditions (0, 100, and 200 mM NaCl). The experiment was carried out under controlled-environment conditions. Seeds were sprayed with a solution containing a combination of fungicide and different concentrations of Codium fragile (Suringar) Hariot algae (0%w/v, 10%w/v, 20%w/v, and 30%w/v). All experimental units were placed in a germination cabinet. The effect of the seaweed extract (SWE) on seed germination and seedling performance under salinity stress was evaluated over a period of 8 days. Coleoptile length and biomass were found to be significantly and positively affected by the application of different SWE doses as compared to the control treatment (0% algae). As for germination traits, seeds treated with SWE showed a final germination (from 82% to 88%), under severe saline conditions, significantly higher than that observed in the control treatment (61%). Our findings indicate that the appropriate dose of biostimulant can markedly improve the germination and the seedlings vigour of durum wheat seeds under saline conditions. Additional studies will be needed to understand the mechanism of action of this biostimulant and its effectiveness in longer studies under field conditions.

The Contribution of Innate Immunity in Large-Vessel Vasculitis: Detangling New Pathomechanisms beyond the Onset of Vascular Inflammation.

Large-vessel vasculitis (LVV) are autoimmune and autoinflammatory diseases focused on vascular inflammation. The central core of the intricate immunological and molecular network resides in the disruption of the "privileged immune state" of the arterial wall. The outbreak, initially primed by dendritic cells (DC), is then continuously powered in a feed-forward loop by the intimate cooperation between innate and adaptive immunity. If the role of adaptive immunity has been largely elucidated, knowledge of the critical function of innate immunity in LVV is still fragile. A growing body of evidence has strengthened the active role of innate immunity players and their key signaling pathways in orchestrating the complex pathomechanisms underlying LVV. Besides DC, macrophages are crucial culprits in LVV development and participate across all phases of vascular inflammation, culminating in vessel wall remodeling. In recent years, the variety of potential pathogenic actors has expanded to include neutrophils, mast cells, and soluble mediators, including the complement system. Interestingly, new insights have recently linked the inflammasome to vascular inflammation, paving the way for its potential pathogenic role in LVV. Overall, these observations encourage a new conceptual approach that includes a more in-depth study of innate immunity pathways in LVV to guide future targeted therapies.

Productivity of two Brassica oilseed crops in a Mediterranean environment and assessment of the qualitative characteristics of raw materials for bioenergy purposes.

Rapeseed (Brassica napus var. oleifera D.C.) and Ethiopian mustard (Brassica carinata A. Braun) are promising industrial crops for cultivation in the Southern Mediterranean area due to profitable yields under semi-arid conditions. The exploitation of raw materials produced by these crops is very convenient for farmers to produce bioenergy directly on-farm and permits them to create a short agri-energy supply chain. The purpose of this study was to determine their yield performance under rainfed conditions and make an economic assessment of a combined heat and power plant (CHP) system operating on pure vegetable oil (PVO). Tests were conducted in Sicily (Italy) from 2012 to 2014. Seed and crop residue yields were detected. The analysis of seed, defatted seed meal and crop residue, and the chemical-physical aspects of PVO were carried out according to conventional protocols. A pilot CHP system was used for cogenerating electricity and heat. In general, rapeseed had the highest seed (2.27 t ha-1) and oil (1.11 t ha-1) yields. The average oil content ranged from 44.88 % (Ethiopian mustard) to 45.73 % dry matter (rapeseed). Ethiopian mustard performed better than rapeseed in terms of aboveground biomass yield (5.49 t ha-1), in both years. The two crops showed different fatty acid profiles of the oil mainly due to diverse content of erucic and oleic acids. The CHP system had an average consumption of 14.41 kg PVO h-1. These results confirm that the productivity of the species can be appreciable in the Southern Mediterranean area and indicate the use of raw materials of these crops as crucial to the development a sustainable short agri-energy supply chain.

Foliar application of various biostimulants produces contrasting response on yield, essential oil and chemical properties of organically grown sage (Salvia officinalis L.).

Sage (Salvia officinalis L.) is a medicinal and aromatic plant (MAP) belonging to the Lamiaceae family. Its morphological, productive and chemical characteristics are affected by abiotic and biotic factors. The use of biostimulants seems to be one of the most interesting innovative practices due to fact they can represent a promising approach for achieving sustainable and organic agriculture. Despite a large application in horticulture, the use of biostimulants on MAPs has been poorly investigated. On this basis, a field experiment in a 2-year study was done to assess the effect of foliar treatments with different types of biostimulants (containing seaweeds, fulvic acids and protein hydrolysates) and two frequencies of application on morphological, productive, and chemical characteristics of S. officinalis grown organically in Mediterranean environment. Morphological, productive, and chemical parameters were affected by the factors. The biostimulant application generated higher plant height, chlorophyll content, relative water content, biomass yield and essential oil yield compared to control plants. In addition, more frequent application of biostimulants produced higher biomass and essential oil yield. The application of fulvic acid and protein hydrolysates every week produced the highest total fresh yields (between 3.9 and 8.7 t ha-1) and total dry yields (between 1.3 and 2.5 t ha-1). The essential oil yield almost doubled (33.9 kg ha-1) with a higher frequency of protein hydrolysates application. In this study, 44 essential oil compounds were identified, and the frequency factor significantly influenced the percentage of 38 compounds. The highest percentage of some of the most representative monoterpenes, such as 1,8-cineole, α-thujone and camphor, were observed in biostimulated plants, with average increases between 6% and 35% compared to control plants. The highest values for total phenolics, rosmarinic acid, antioxidant activity were obtained in control plants and with a lower frequency of biostimulant applications. This study emphasizes how biostimulant applications may be used to improve sage production performance and essential oil parameters when produced in agricultural organic system. At the same time, biostimulants application caused a decrease in total phenolic, antioxidant activity and rosmarinic acid values.

[Health care in agricultural work in the Sicilian Services of Prevention and Healthcare]. / La tutela della salute nel lavoro agricolo nei Servizi di Prevenzione delle AA.SS.PP. Siciliane.

Agriculture is a work sector at high risk for the health of those who work there. The services of prevention and safety in the work area of the AA.SS.PP. (Provincial Health Agencies) of the Sicilian Region began a program of prevention, in the three year term 2010/2013, in this sector. A plan that has been laid out in the "Regional Plan for Prevention and Safety in Agriculture and Fowl Farming" outlined in DA (Administrative Decree number 1174/10. To be able to activate such a plan, the SPreSAL (Prevention and Health Service for the Work Area), have received extra resources that have permitted us to reach pre-planned objectives. The activity carried out brought to light serious defects, in respect to the maintenance of health and safety at work. These tend to derive mainly from the individual and family typologies of companies in the sector. For a more efficient activity of prevention we have shown the opportunity to underline and empower the preventative activity of a support type, rather than surveillance, and to reinforce the Services in such a way that, with their multi-disciplinary competences, they will be able to recover their capacity to carry out a direct control over the risk factors present in the work area.

Artificial Intelligence in Acute Ischemic Stroke Subtypes According to Toast Classification: A Comprehensive Narrative Review.

The correct recognition of the etiology of ischemic stroke (IS) allows tempestive interventions in therapy with the aim of treating the cause and preventing a new cerebral ischemic event. Nevertheless, the identification of the cause is often challenging and is based on clinical features and data obtained by imaging techniques and other diagnostic exams. TOAST classification system describes the different etiologies of ischemic stroke and includes five subtypes: LAAS (large-artery atherosclerosis), CEI (cardio embolism), SVD (small vessel disease), ODE (stroke of other determined etiology), and UDE (stroke of undetermined etiology). AI models, providing computational methodologies for quantitative and objective evaluations, seem to increase the sensitivity of main IS causes, such as tomographic diagnosis of carotid stenosis, electrocardiographic recognition of atrial fibrillation, and identification of small vessel disease in magnetic resonance images. The aim of this review is to provide overall knowledge about the most effective AI models used in the differential diagnosis of ischemic stroke etiology according to the TOAST classification. According to our results, AI has proven to be a useful tool for identifying predictive factors capable of subtyping acute stroke patients in large heterogeneous populations and, in particular, clarifying the etiology of UDE IS especially detecting cardioembolic sources.

Effects of Genotype and Climate on Productive Performance of High Oleic Carthamus tinctorius L. under Rainfed Conditions in a Semi-Arid Environment of Sicily (Italy).

Safflower (Carthamus tinctorius L.) is a promising oilseed crop for cultivation in central Southern Italy due to its high tolerance to drought and salinity stress and appreciable seed and oil yields. The genetic diversity of cultivars and climate factors can affect fatty acid composition and yield traits. This study aimed to assess the effects of genotype and climate conditions on the productive performance of eight high oleic safflower genotypes under rainfed conditions in Sicily (Italy). These genotypes were compared to the Montola 2000 cultivar, which was used as a reference. Tests were carried out during the growing seasons of 2014-2015 and 2015-2016. The experimental design was a randomized complete block design with three replications. Morphological and yield components were significantly affected by genotype while the year had a significant effect on plant height only. In general, CTI 17 produced the highest seed yield (1.40 t ha-1) and oil yield (0.58 t ha-1). The seed oil content was found on 40.2% of dry matter, on average. The "genotype" factor significantly affected oil content and fatty acid composition. Oleic acid content was on average 66.1% and did not vary greatly over the two growing seasons. The above- and belowground plant parts showed the highest carbon content and the lowest nitrogen content as a percentage of dry matter. The results indicate that, under rainfed conditions, yield parameters of high oleic safflower genotypes can be profitable in southern Italy though significantly dependent upon genotype.

Postprandial hypotension as a predictor of respiratory failure in patients with foodborne botulinum intoxication - a case-control study in outbreak investigation.

OBJECTIVES: Botulism is a rare syndrome characterized by acute, flaccid paralysis with possible involvement of respiratory muscle-producing pump failure requiring mechanical ventilation. A predominance of autonomic involvement can occur. METHODS: We enrolled patients affected by foodborne botulism during an outbreak. All patients underwent the detection of the toxin in stool specimens, and 24-hour ambulatory blood pressure monitoring (ABPM). A blinded expert operator analyzed ABPM data for the diagnosis of hypertension and postprandial hypotension (PPH). RESULTS: Twenty male patients met the inclusion and exclusion criteria. Thirty-four healthy subjects matched for sex and age were enrolled as a control group. PPH was significantly more frequent in the botulin group than in healthy subjects (40% vs 2.9%, P <0.0001). At the logistic regression, the probability that patients affected by botulinum could require ventilation was increased by 733% (adjusted odds ratio: 8.33) when PPH is encountered. CONCLUSIONS: The likelihood of resorting to ventilation in subjects with botulinum intoxication was seven times greater in patients presenting PPH. These results could allow the prompt identification of patients at high risk for requiring ventilation.

Heart rate variability is associated with disease severity and portal hypertension in cirrhosis.

INTRODUCTION: Autonomic nervous system activity in cirrhotic portal hypertension is linked to hyperdynamic circulation. Heart rate variability (HRV) is a validated noninvasive method to assess the sympathovagal balance. To investigate the correlation between HRV parameters and degree of portal hypertension, we studied a cohort of patients with cirrhosis accounting for etiology and treatments. PATIENTS AND METHODS: In this cross-sectional, observational cohort study, 157 outpatients of both sex with nonalcoholic cirrhosis were assessed by upper gastrointestinal endoscopy to search for esophagogastric varices. Twenty-four-hour electrocardiogram Holter monitoring with 3 HRV parameters measurement [SD of the NN intervals, root mean square successive difference of NN intervals, and SD of the averages of NN intervals (SDANN)] according to time-domain analysis were performed in all patients. Sixteen patients with large esophagogastric varices underwent measurements of the HVPG and assessment of HRV parameters at baseline and after 45 days on carvedilol. RESULTS: The liver dysfunction, expressed by Child-Pugh class or MELD score, was directly related to root mean square successive difference of NN intervals and inversely related to SDANN. Presence of ascites was inversely related to SDANN and to SD of the NN intervals. Treatment with carvedilol had an inverse relation with SDANN. Presence and size of esophagogastric varices had an inverse relation to SDANN and SD of the NN intervals. Upon multivariate analysis the associations between SDANN and Child-Pugh class, size of varices and ascites were confirmed. In the subgroup of 16 patients undergoing HVPG measurement, pressure gradient was unrelated to heart rate and HRV parameters. CONCLUSIONS: Time-domain HRV parameters in patients with cirrhosis, confirm the autonomic nervous system alteration, and their correlation to the degree of portal hypertension suggesting a role of the ANS in hepatic decompensation.

Effect of legume grains as a source of dietary protein on the quality of organic lamb meat.

BACKGROUND: This study evaluated the effects on lamb growth, carcass traits and meat quality of replacing conventional soybean meal in the diet with alternative legume grains. RESULTS: Twenty-eight male lambs of Comisana breed weighing 16.9 ± 2.7 kg at weaning (66 ± 6 days old) were assigned to one of four diets. Until slaughter at 129 ± 6 days of age, each group received ad libitum pelleted alfalfa hay and concentrates differing in the source of protein: chickpea, faba bean, pea or soybean meal. Lambs fed chickpea showed higher dry matter and protein intakes from concentrate than those fed soybean. Lambs' growth, carcass weight and net dressing percentage did not vary by protein source, although chickpea lambs had more perirenal and pelvic fat than those in the soybean group. Diet did not affect chemical composition, colour, thawing and cooking losses, tenderness, and sensory properties of meat. Chickpea increased trans-vaccenic and linoleic acid, and chickpea and faba bean increased the isomers of conjugated linoleic acid. CONCLUSIONS: Legume grains can completely replace soybean meal in concentrate, resulting in lamb carcasses and meat of comparable quality. Chickpea leads to an increase in feed intake of lambs and in fat depots in the carcass, and a more beneficial fatty acid profile.

The innate face of Giant Cell Arteritis: Insight into cellular and molecular innate immunity pathways to unravel new possible biomarkers of disease.

Giant cell arteritis (GCA) is an inflammatory chronic disease mainly occurring in elderly individuals. The pathogenesis of GCA is still far from being completely elucidated. However, in susceptible arteries, an aberrant immune system activation drives the occurrence of vascular remodeling which is mainly characterized by intimal hyperplasia and luminal obstruction. Vascular damage leads to ischemic manifestations involving extra-cranial branches of carotid arteries, mostly temporal arteries, and aorta. Classically, GCA was considered a pathological process resulting from the interaction between an unknown environmental trigger, such as an infectious agent, with local dendritic cells (DCs), activated CD4 T cells and effector macrophages. In the last years, the complexity of GCA has been underlined by robust evidence suggesting that several cell subsets belonging to the innate immunity can contribute to disease development and progression. Specifically, a role in driving tissue damage and adaptive immunity activation was described for dendritic cells (DCs), monocytes and macrophages, mast cells, neutrophils and wall components, such as endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). In this regard, molecular pathways related to cytokines, chemokines, growth factors, vasoactive molecules and reactive oxygen species may contribute to the inflammatory process underlying GCA. Altogether, innate cellular and molecular pathways may clarify many pathogenetic aspects of the disease, paving the way for the identification of new biomarkers and for the development of new treatment targets for GCA. This review aims to deeply dissect past and new evidence on the innate immunological disruption behind GCA providing a comprehensive description of disease development from the innate perspective.

"The importance of being external": review of the literature of the rare phenomenon of common carotid occlusion with bulb reverse-crossed stenosis and external collaterals activation. Is still correct speaking about carotid steal?

Common carotid artery occlusion (CCAO) is a rare phenomenon associated with the development of neurological symptoms. In CCAO, diversion of blood flow from the external carotid artery (ECA) to the internal carotid artery (ICA) via the carotid bulb (CB) may occur. This pathway activation has been called "carotid steal". Starting from a particular case we describe the ECD finding of a complete occlusion of CCA with patency of ICA and ECA. In case of occlusion of CCA, inversion of the ECA flow may occur, towards the ICA, and it can be damped by a significant stenosis crossed in retrograde direction that may concur to maintain the pressure balance between the two circulations. Usually, this particular compensation can guarantee normal flow velocities in middle cerebral arteries without signs of activation of anterior collateral pathways. In this review we underline the protective role of ECA and we propose a new definition for this phenomenon. The ECA may provide blood to the cerebral circulation through several anastomotic secondary channels. Finally, only with an extensive knowledge of hemodynamic information of all intracranial and extracranial arteries, including ECA, we can estimate cerebral ischemic risk of the patient and choose the correct management of this occlusion.

Effect of irrigation with treated wastewater on bermudagrass (Cynodon dactylon (L.) Pers.) production and soil characteristics and estimation of plant nutritional input.

In recent years, climate change has greatly affected rainfall and air temperature levels leading to a reduction in water resources in Southern Europe. This fact has emphasized the need to focus on the use of non-conventional water resources for agricultural irrigation. The reuse of treated wastewater (TWW) can represent a sustainable solution, reducing the consumption of freshwater (FW) and the need for mineral fertilisers. The main aim of this study was to assess, in a three-year period, the effects of TWW irrigation compared to FW on the biomass production of bermudagrass [Cynodon dactylon (L.) Pers.] plants and soil characteristics and to estimate the nutritional input provided by TWW irrigation. TWW was obtained by a constructed wetland system (CWs) which was used to treat urban wastewater. The system had a total surface area of 100 m2. An experimental field of bermudagrass was set up close to the system in a Sicilian location (Italy), using a split-plot design for a two-factor experiment with three replications. Results highlighted a high organic pollutant removal [five days biochemical oxygen demand (BOD5): 61%, chemical oxygen demand (COD): 65%] and a good efficiency in nutrients [total nitrogen (TN): 50%, total phosphorus (TP): 42%] of the CWs. Plants irrigated with TWW showed higher dry aboveground dry-weight (1259.3 kg ha-1) than those irrigated with FW (942.2 kg ha-1), on average. TWW irrigation approximately allowed a saving of 50.0 kg TN ha-1 year-1, 24.0 kg TP ha-1 year-1 and 29.0 kg K ha-1 year-1 on average with respect to commonly used N-P-K fertilisation programme for bermudagrass in the Mediterranean region. Soil salinity increased significantly (p ≤ 0.01) over the years and was detected to be higher in TWW-irrigated plots (+6.34%) in comparison with FW-irrigated plots. Our findings demonstrate that medium-term TWW irrigation increases the biomass production of bermudagrass turf and contributes to save significant amounts of nutrients, providing a series of agronomic and environmental benefits.

Growth and development of succulent mixtures for extensive green roofs in a Mediterranean climate.

Green roof systems, aimed at reducing anthropic impact on the environment, are considered environmental mitigation technologies and adopted by many countries across the world to strengthen urban ecosystem services. This study evaluates two mixtures of succulent: one of Crassulaceae and the other of Aizoaceae, used in the creation of a continuous and homogenous plant groundcover in Mediterranean environments. To assess the species mixtures, the parameters plant height, growth index, cover percentage and flowering were observed. Hydrological observations were also carried out to evaluate the rainfall retained by the test system in any given month. All data were subjected to analysis of variance. Growth indicators in the study showed trends characteristic of xeric plants, which tend to slow down in dry, summer climate conditions to the point of halting plant vertical growth and ground cover development completely. The Aizocaeae mix, during the initial stage, showed prevalent horizontal growth, confirmed by greater a greater growth index (13,21) and cover percentage (45%) compared to Sedum (Growth index: 3,61; Cover: 36%). In contrast, the Sedum mix recorded greater vertical growth at the beginning (Sedum mixture: 7.53 cm; Aizoaceae mixture: 6,11 cm). During the final stages of observations, however, greater vertical growth in the Aizoaceae (7,88 cm) became apparent together with a recovery in horizontal growth in the Sedum (79%), albeit not sufficient to outperform the Aizoaceae mixture (87%). Flowering in the two mixtures occurred between late spring and late summer. The Sedum mixture guaranteed a longer flowering period (130 days) compared to the Aizoaceae (93 days), with a gradual start followed by steady flower emission. Regarding rainfall water retention, a comparison of the mixtures in late winter/early spring revealed that the Sedum performed best (44.9 L m2 vs 37.4 L m2), whilst the Aizoaceae outperformed the Sedum in Autumn (63 L m2 vs 55 L m2), in conjunction with favorable growth rates in both species mixtures. Both mixtures demonstrated satisfying results and are considered suited to a Mediterranean environment. Furthermore, based on the different growth rates of the species in the two test mixtures, this study suggests that new combinations of Sedum and Aizoaceae together might prove more resilient in Mediterranean environments.

Autonomic dysfunction in a group of lower extremities arterial disease outpatients.

BACKGROUND: The understanding of the specific role of sympathetic neural control and dysregulation in lower extremities arterial disease (LEAD) is still very limited. Aim of our study was to investigate the autonomic profile in LEAD patients and to evaluate if the eventual autonomic alterations were more severe in patients with advanced disease. METHODS: We enrolled all consecutive outpatients with LEAD referred to our Departments between July 2012 and September 2014. They were compared to a group of matched outpatients without LEAD. All patients underwent Holter ECG monitoring. Time-domain analysis of heart rate variability (HRV) was evaluated. RESULTS: Compared to controls, patients with LEAD had a lower SDNN (P=0.007) and SDANN (P=0.003). Patients with clinically advanced LEAD had a lower SDNN (P=0.006) and SDANN (P=0.004) compared to LEAD patients with less severe disease and to those without disease. CONCLUSIONS: LEAD patients had a reduced SDNN and SDANN than patients without LEAD. Autonomic dysfunction was more significant in clinically advanced stages of disease. This association did not relate to ABI value but to clinical stage of disease.

Old and New Drugs for Treatment of Advanced Heart Failure.

BACKGROUND: Advanced heart failure (HF) is a progressive disease with high mortality and limited medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard treatments for these patients; however, access to these therapies is limited by the advanced age and multiple comorbidities of affected patients, as well as by the limited number of organs available. METHODS: Traditional and new drugs available for the treatment of advanced HF have been researched. RESULTS: To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous loop diuretic therapy and inotropic support. However, many patients with advanced HF experience loop diuretics resistance and alternative therapeutic strategies to overcome this problem have been developed, including sequential nephron blockade or use of the hypertonic saline solution in combination with high-doses of furosemide. As classic inotropes augment myocardial oxygen consumption, new promising drugs have been introduced, including levosimendan, istaroxime and omecamtiv mecarbil. However, pharmacological agents still remain mainly short-term or palliative options in patients with acute decompensation or excluded from mechanical therapy. CONCLUSION: Traditional drugs, especially when administered in combination, and new medicaments represent important therapeutic options in advanced HF. However, their impact on prognosis remains unclear. Large trials are necessary to clarify their therapeutic potential and prognostic role in these fragile patients.