Future perspective in diabetic patients with pre- and post-capillary pulmonary hypertension.

Pulmonary hypertension is a clinical syndrome that may include multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Pulmonary hypertension secondary to left heart disease is the prevalent clinical condition and accounts for two-thirds of all cases. Type 2 diabetes mellitus, which affects about 422 million adults worldwide, has emerged as an independent risk factor for the development of pulmonary hypertension in patients with left heart failure. While a correct diagnosis of pulmonary hypertension secondary to left heart disease requires invasive hemodynamic evaluation through right heart catheterization, several scores integrating clinical and echocardiographic parameters have been proposed to discriminate pre- and post-capillary types of pulmonary hypertension. Despite new emerging evidence on the pathophysiological mechanisms behind the effects of diabetes in patients with pre- and/or post-capillary pulmonary hypertension, no specific drug has been yet approved for this group of patients. In the last few years, the attention has been focused on the role of antidiabetic drugs in patients with pulmonary hypertension secondary to left heart failure, both in animal models and in clinical trials. The aim of the present review is to highlight the links emerged in the recent years between diabetes and pre- and/or post-capillary pulmonary hypertension and new perspectives for antidiabetic drugs in this setting.

Titania as Buffer Layer for Cd-Free Kesterite Solar Cells.

Pure sulfide kesterite (Cu2ZnSnS4) is one of the most promising emerging photovoltaic technologies thanks to its excellent absorption coefficient, cost-effectiveness, and environmental sustainability. However, record efficiencies are not exceeding 11% due to several issues, such as absorber defects or a nonoptimal band alignment with the toxic but conventionally used CdS buffer layer. To get rid of it, several efforts have been made in the past few years. Among recent theoretical works, TiO2 has been suggested as a suitable buffer layer due to its optical and electrical properties, giving extremely promising results in device simulation. However, there are few experimental examples combining TiO2 with kesterite, and they generally show very modest performances. In this Letter, we report on the preliminary and promising results of our experimental procedure for the production of Cd-free kesterite photovoltaic devices featuring ALD-TiO2 as a buffer layer, leading to efficiencies comparable with our CZTS/CdS reference devices.

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension.

BACKGROUND: COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH). MAIN BODY: The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities. CONCLUSION: Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.

KSEMAW: an open source software for the analysis of spectrophotometric, ellipsometric and photothermal deflection spectroscopy measurements.

The optical behavior of devices based on thin films is determined by complex refractive index and thickness of each slab composing the stack; these important parameters are usually evaluated from photometric and/or ellipsometric spectral measurements, given a model of the stack, by means of dedicated software. In the case of complex multilayer devices, generally a number of simpler specimens (like single-film on substrate) must be preliminarily characterized. This paper introduces the reader to a new open source software for thin film characterization finally released after about 30 years of development. The software has already been used in various fields of physics, such as thin film optical filters, architectural glazing, detectors for high energy physics, solar energy, and, last but not least, photovoltaic devices. Code source files, MS Windows executable, user manual as well as a sample of working directories populated with assorted files can be freely downloaded from the kSEMAW GitHub repository.

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece.

Pulmonary arterial hypertension (PAH) is a rare, progressive disease with a poor prognosis. The pathophysiologic model is mainly characterized by an afterload mismatch in which an increased right ventricle afterload, driven by increased pulmonary vascular resistance (PVR), leads to right heart failure. International guidelines recommend optimization of treatment based on regular risk assessments to achieve or maintain a low-risk status. Current risk scores are based on a multi-modality approach, including demographic, clinical, functional, exercise, laboratory, and hemodynamic parameters, which lack significant echocardiographic parameters. The originality of echocardiography relies on the opportunity to assess in a non-invasive way a physiologically meaningful combination of easy to measure variables tightly related to right ventricle adaptation/maladaptation to increased afterload, the main determinant of a patient's prognosis. Echo-derived morphological and functional parameters have been investigated in PAH, proving to have prognostic relevance. Different therapeutic strategies proved to have different effects in reducing PVR. An upfront combination of drugs, including a parenteral prostacyclin, has shown to be associated with right heart reverse remodeling in a greater proportion of patients than other treatment strategies as a function of PVR reduction. Adding echocardiographic data to current risk scores would allow better identification of right ventricle (RV) adaptation in PAH patients' follow-up. This additional information would allow better stratification of the patient, leading to optimized and personalized therapeutic management.

Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and under-recognized complication of acute pulmonary embolism (PE). Forty consecutive patients with acute PE (Group 1), predominantly female (22, 55%) with a mean age of 69 ± 15 years, were matched for demographic data with 40 healthy subjects (Group 2), 40 systemic hypertension patients (Group 3) and 45 prevalent idiopathic pulmonary arterial hypertension (IPAH) patients (Group 4). The baseline evaluation included physical examination, NYHA/WHO functional class, right heart catheterization (RHC) limited to IPAH patients, echocardiographic assessment and systemic arterial stiffness measurement by cardio-ankle vascular index (CAVI). Patients with PE underwent an echocardiographic evaluation within 1 month from hospital discharge (median 27 days; IQR 21-30) to assess the echo-derived probability of PH. The CAVI values were significantly higher in the PE and IPAH groups compared with the others (Group 1 vs. Group 2, p < 0.001; Group 1 vs. Group 3, p < 0.001; Group 1 vs. Group 4, p = ns; Group 4 vs. Group 2, p < 0.001; Group 4 vs. Group 3, p < 0.001; Group 2 vs. Group 3, p = ns). The predicted probability of echocardiography-derived high-risk criteria of PH increases for any unit increase of CAVI (OR 9.0; C.I.3.9-20.5; p = 0.0001). The PE patients with CAVI ≥ 9.0 at the time of hospital discharge presented an increased probability of PH. This study highlights a possible positive predictive role of CAVI as an early marker for the development of CTEPH.

Synthesis and Post-Annealing of Cu2ZnSnS4 Absorber Layers Based on Oleylamine/1-dodecanethiol.

Cu2ZnSnS4 (CZTS) nanocrystals in oleylamine (OLA) and 1-dodecanethiol (1-DDT) solvents were successfully prepared via hot-injection method, to produce inks for the deposition of absorber layers in photovoltaic cells. In this process, 1-DDT acts as a coordinating ligand to control the nucleation and growth of CZTS nanocrystals, whereas lower amounts of OLA promote a homogeneous growth of the grains in the absorber layer. X-Ray Diffraction (XRD) revealed both tetragonal and hexagonal phases of CTZS in films obtained after soft thermal treatments (labeled TT0). In particular, 1-DDT is responsible for the formation of a greater percentage of the hexagonal phase (ZnS-wurtzite type) than that formed when only OLA is used. The thermal treatments have been varied from 500 °C to 600 °C for improving crystallization and eliminating secondary phases. Both features are known to promote CZTS thin films with band gap values typical of CZTS (1.5-1.6 eV) and suitable resistivity. This study let to compare also the CZTS post-annealing without (TT1) and with sulfur vapor (TT2) in a tubular furnace. Only tetragonal CZTS phase is observed in the XRD pattern of CZTS thin films after TT2. A small presence of localized residues of secondary phases on the same samples was revealed by µRaman measurements. The best values of band gap (1.50 eV) and resistivity (1.05 ohm.cm) were obtained after thermal treatment at 500 °C, which is suitable for absorber layer in photovoltaic application.