[Persistent ST-elevation with elevated myocardial necrosis markers: a case of myocardial contusion]. / Sopraslivellamento persistente del tratto ST con marcatori di miocardiocitonecrosi elevati: un caso di contusione cardiaca.

Myocardial contusion is a rare and potentially fatal complication of chest trauma. There is no unique definition for this entity: some authors define myocardial contusion as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence of pathologic findings at cardiac imaging. Consequently, the real incidence of myocardial contusion remains unknown, varying in reports between 8% and 71%. We describe a case of cardiac contusion secondary to a low-energy blunt chest trauma, manifesting as persistent ST-elevation associated with elevation of myocardial necrosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the diagnostic pathway, it is essential to integrate first-level exams (ECG and laboratory findings) with cardiac magnetic resonance imaging, to define the presence of cardiac contusion and its extent, particularly if the echocardiographic data are unconclusive.

Plastic and Placenta: Identification of Polyethylene Glycol (PEG) Compounds in the Human Placenta by HPLC-MS/MS System.

The placenta is a crucial interface between the fetus and the maternal environment. It allows for nutrient absorption, thermal regulation, waste elimination, and gas exchange through the mother's blood supply. Furthermore, the placenta determines important adjustments and epigenetic modifications that can change the phenotypic expression of the individual even long after birth. Polyethylene glycol (PEG) is a polyether compound derived from petroleum with many applications, from medicine to industrial manufacturing. In this study, for the first time, an integration of ultra-high-performance liquid chromatography (UHPLC) coupled with mass spectrometry (MS) was used to detect suites of PEG compounds in human placenta samples, collected from 12 placentas, originating from physiological pregnancy. In 10 placentas, we identified fragments of PEG in both chorioamniotic membranes and placental cotyledons, for a total of 36 samples.

Deeply in Plasticenta: Presence of Microplastics in the Intracellular Compartment of Human Placentas.

Microplastics (MPs) are defined as plastic particles smaller than 5 mm. They have been found almost everywhere they have been searched for and recent discoveries have also demonstrated their presence in human placenta, blood, meconium, and breastmilk, but their location and toxicity to humans have not been reported to date. The aim of this study was twofold: 1. To locate MPs within the intra/extracellular compartment in human placenta. 2. To understand whether their presence and location are associated with possible structural changes of cell organelles. Using variable pressure scanning electron microscopy and transmission electron microscopy, MPs have been localized in ten human placentas. In this study, we demonstrated for the first time the presence and localization in the cellular compartment of fragments compatible with MPs in the human placenta and we hypothesized a possible correlation between their presence and important ultrastructural alterations of some intracytoplasmic organelles (mitochondria and endoplasmic reticulum). These alterations have never been reported in normal healthy term pregnancies until today. They could be the result of a prolonged attempt to remove and destroy the plastic particles inside the placental tissue. The presence of virtually indestructible particles in term human placenta could contribute to the activation of pathological traits, such as oxidative stress, apoptosis, and inflammation, characteristic of metabolic disorders underlying obesity, diabetes, and metabolic syndrome and partially accounting for the recent epidemic of non-communicable diseases.

Cardiac magnetic resonance imaging of myocarditis and pericarditis following COVID-19 vaccination: a multicenter collection of 27 cases.

OBJECTIVES: To assess clinical and cardiac magnetic resonance (CMR) imaging features of patients with peri-myocarditis following Coronavirus Disease 2019 (COVID-19) vaccination. METHODS: We retrospectively collected a case series of 27 patients who underwent CMR in the clinical suspect of heart inflammation following COVID-19 vaccination, from 16 large tertiary centers. Our patient's cohort was relatively young (36.6 ± 16.8 years), predominately included males (n = 25/27) with few comorbidities and covered a catchment area of approximately 8 million vaccinated patients. RESULTS: CMR revealed typical mid-subepicardial non-ischemic late gadolinium enhancement (LGE) in 23 cases and matched positively with CMR T2 criteria of myocarditis. In 7 cases, typical hallmarks of acute pericarditis were present. Short-term follow-up (median = 20 days) from presentation was uneventful for 25/27 patients and unavailable in two cases. CONCLUSIONS: While establishing a causal relationship between peri-myocardial inflammation and vaccine administration can be challenging, our clinical experience suggests that CMR should be performed for diagnosis confirmation and to drive clinical decision-making and follow-up. KEY POINTS: • Acute onset of dyspnea, palpitations, or acute and persisting chest pain after COVID-19 vaccination should raise the suspicion of possible myocarditis or pericarditis, and patients should seek immediate medical attention and treatment to help recovery and avoid complications. • In case of elevated troponin levels and/or relevant ECG changes, cardiac magnetic resonance should be considered as the best non-invasive diagnostic option to confirm the diagnosis of myocarditis or pericarditis and to drive clinical decision-making and follow-up.

Maize-Brachiaria intercropping: A strategy to supply recycled N to maize and reduce soil N2O emissions?

Nitrogen use in agriculture directly impacts food security, global warming, and environmental degradation. Forage grasses intercropped with maize produce feed for animals and or mulch for no-till systems. Forage grasses may exude nitrification inhibitors. It was hypothesized that brachiaria intercropping increases N recycling and maize grain yield and reduces nitrous oxide (N2O) emissions from soil under maize cropping. A field experiment was set up in December 2016 to test three cropping system (maize monocropped, maize intercropped with Brachiaria brizantha or with B. humidicola) and two N rates (0 or 150 kg ha-1). The grasses were sown with maize, but B. humidicola did not germinate well in the first year. B. brizantha developed slowly during the maize cycle because of shading but expanded after maize was harvested. The experiment was repeated in 2017/2018 when B. humidicola was replanted. N2O and carbon dioxide (CO2) emissions, maize grain yield and N content were measured during the two seasons. After the first maize harvest, the above- and below-ground biomass, C and N content of B. brizantha grown during fall-winter, and the biological nitrification inhibition potential of B. brizantha were evaluated. Maize yield responded to N fertilization (5.1 vs. 9.8 t ha-1) but not to brachiaria intercropping. B. brizantha recycled approximately 140 kg N ha-1 and left 12 t dry matter ha-1 for the second maize crop. However, the 2017/18 maize yields were not affected by the N recycled by B. brizantha, whereas N2O emissions were higher in the plots with brachiaria, suggesting that part of the recycled N was released too early after desiccation. Brachiarias showed no evidence of causing nitrification inhibition. The strategy of intercropping brachiarias did not increase maize yield, although it added C and recycled N in the system.

Plasticenta: First evidence of microplastics in human placenta.

Microplastics are particles smaller than five millimeters deriving from the degradation of plastic objects present in the environment. Microplastics can move from the environment to living organisms, including mammals. In this study, six human placentas, collected from consenting women with physiological pregnancies, were analyzed by Raman Microspectroscopy to evaluate the presence of microplastics. In total, 12 microplastic fragments (ranging from 5 to 10 µm in size), with spheric or irregular shape were found in 4 placentas (5 in the fetal side, 4 in the maternal side and 3 in the chorioamniotic membranes); all microplastics particles were characterized in terms of morphology and chemical composition. All of them were pigmented; three were identified as stained polypropylene a thermoplastic polymer, while for the other nine it was possible to identify only the pigments, which were all used for man-made coatings, paints, adhesives, plasters, finger paints, polymers and cosmetics and personal care products.

Potassium application to the cover crop prior to cotton planting as a fertilization strategy in sandy soils.

Urochloa grasses are used as cover crops in tropical cropping systems under no-till to improve nutrient cycling. We hypothesized that potassium (K) applied to ruzigrass (Urochloa ruziziensis) grown before cotton in a sandy soil could be timely cycled and ensure nutrition, yield and quality of cotton cultivars with no need to split K application. Field experiments were performed with different K managements, applied to ruzigrass, to cotton grown after grass and without grass, or split as it is done conventionally. No yield differences were observed on K fertilized treatments. At 0 K, cotton yields were low, but they increased by 16% when ruzigrass was grown before, and short fiber content was lower when there was more K available. Ruzigrass grown before cotton increased micronaire as much as the application of 116 kg ha-1 of K without the grass. Fiber maturity was higher when K was applied to the grass or split in the grass and sidedressed in cotton. Growing ruzigrass before cotton allows for early K fertilization, i.e., application of all the fertilizer to de grass, since the nutrient is recycled, and cotton K nutrition is not harmed. Eventually K rates could be reduced as a result of higher efficiency of the systems.

Exudation of organic acid anions by tropical grasses in response to low phosphorus availability.

It has been suggested that some tropical grasses can acquire phosphorus (P) from hematite and gypsite by exuding organic acid anions (OAs). However, it remains to be determined exactly which OAs could be involved in each case. The objective of this study was to verify the exudation OAs by ruzigrass (Urochloa ruziziensis), palisade grass (U. brizantha), and Guinea grass (Megathyrsus maximus) as a response to P deficiency. The grasses were grown in leachate columns with adequate and deficient P nutrient solutions. The concentration of OAs in the leacheate and root surface, as well as shoot and root dry matter, and P uptake were determined. Citrate, isocitrate, and malate concentration in leachates and root surfaces increased with P starvation, mainly for the Urochloa grasses. Oxalate exudation was similar for the grasses under adequate P supply, but was lower in Guinea grass under P starvation. Palisade grass showed a higher concentration of total OAs in the root surface than the other species due to a great production of oxalate and isocitrate. Palisade grass showed greater dry matter yields regardless of P deficiency, and Guinea grass always had the higher shoot:root ratio. Urochloa grasses have a higher capacity to cope with low P availability by exuding OAs along with a lower shoot:root ratio than Guinea grass.

Microbial N-cycling gene abundance is affected by cover crop specie and development stage in an integrated cropping system.

Grasses of the Urochloa genus have been widely used in crop-livestock integration systems or as cover crops in no-till systems such as in rotation with maize. Some species of Urochloa have mechanisms to reduce nitrification. However, the responses of microbial functions in crop-rotation systems with grasses and its consequence on soil N dynamics are not well-understood. In this study, the soil nitrification potential and the abundance of ammonifying microorganisms, total bacteria and total archaea (16S rRNA gene), nitrogen-fixing bacteria (NFB, nifH), ammonia-oxidizing bacteria (AOB, amoA) and archaea (AOA, amoA) were assessed in soil cultivated with ruzigrass (Urochloa ruziziensis), palisade grass (Urochloa brizantha) and Guinea grass (Panicum maximum). The abundance of ammonifying microorganisms was not affected by ruzigrass. Ruzigrass increased the soil nitrification potential compared with palisade and Guinea grass. Ruzigrass increased the abundance of N-fixing microorganisms at the middle and late growth stages. The abundances of nitrifying microorganisms and N-fixers in soil were positively correlated with the soil N-NH4+ content. Thus, biological nitrogen fixation might be an important input of N in systems of rotational production of maize with forage grasses. The abundance of microorganisms related to ammonification, nitrification and nitrogen fixing and ammonia-oxidizing archea was related to the development stage of the forage grass.

Serum copper profile in patients with type 1 diabetes in comparison to other metals.

BACKGROUND: Type 1 diabetes (T1D) is a chronic condition in which the pancreas loses the ability to produce insulin due to an autoimmune destruction of the insulin producing beta cells in the pancreatic islets of Langerhans. Pathophysiological complications related to diabetes include micro and macrovascular disease, nephropathy, and neuropathy that can also be affected by environmental factors such as lifestyle and diet. OBJECTIVES: The current study aimed to evaluate the serum levels of total copper, the copper-carrying protein, ceruloplasmin and nonceruloplasmin bound copper (nonceruloplasmin-Cu) and other essential and environmental metals and metalloids in subjects with T1D compared with healthy controls. METHODS: A cohort of 63 subjects with T1D attending Diabetes Clinics at the University of Miami and 65 healthy control subjects was studied. Metals and metalloids were measured by inductively coupled plasma mass spectrometry. RESULTS: A main finding of this study was that total copper and ceruloplasmin levels were higher in persons with T1D compared to healthy controls. In comparison to other metals and clinical variables, elevated copper was the strongest factor associated with T1D resulting in a15-fold increased odds of having the disease per standard deviation increase. CONCLUSION: Our results suggest a metal and metalloid perturbation in T1D with a significant involvement of Copper dysfunction in the disease pathology, possibly linked to inflammatory processes.

Oxidative Stress Related to Iron Metabolism in Relapsing Remitting Multiple Sclerosis Patients With Low Disability.

Oxidative status may play a role in chronic inflammation and neurodegeneration which are considered critical etiopathogenetic factors in Multiple Sclerosis (MS), both in the early phase of the disease and in the progressive one. The aim of this study is to explore oxidative status related to iron metabolism in peripheral blood of stable Relapsing-Remitting MS with low disability. We studied 60 Relapsing-Remitting MS patients (age 37.2 ± 9.06, EDSS median 1.0), and 40 healthy controls (age 40.3 ± 10.86). We measured total hydroperoxides (dROMs test) and Total Antioxidant Status (TAS), along with the iron metabolism biomarkers: Iron (Fe), ferritin (Ferr), transferrin (Tf), transferrin saturation (Tfsat), and ceruloplasmin (Cp) panel biomarkers [concentration (iCp) and enzymatic activity (eCp), copper (Cu), ceruloplasmin specific activity (eCp:iCp), copper to ceruloplasmin ratio (Cu:Cp), non-ceruloplasmin copper (nCp-Cu)]. We computed also the Cp:Tf ratio as an index of oxidative stress related to iron metabolism. We found lower TAS levels in MS patients than in healthy controls (CTRL) and normal reference level and higher dROMs and Cp:Tf ratio in MS than in healthy controls. Cp and Cu were higher in MS while biomarkers of iron metabolism were not different between patients and controls. Both in controls and MS, dROMs correlated with iCp (CTRL r = 0.821, p < 0.001; MS r = 0.775 p < 0.001) and eCp (CTRL r = 0.734, p < 0.001; MS r = 0.820 p < 0.001). Moreover, only in MS group iCp correlated negatively with Tfsat (r = -0.257, p = 0.047). Dividing MS patients in "untreated" group and "treated" group, we found a significant difference in Fe values [F(2, 97) = 10.136, p < 0.001]; in particular "MS untreated" showed higher mean values (mean = 114.5, SD = 39.37 µg/dL) than CTRL (mean 78.6, SD = 27.55 µg/dL p = 0.001) and "MS treated" (mean = 72.4, SD = 38.08 µg/dL; p < 0.001). Moreover, "MS untreated" showed significantly higher values of Cp:Tf (mean = 10.19, SD = 1.77∗10-2; p = 0.015), than CTRL (mean = 9.03, SD = 1.46 ∗10-2). These results suggest that chronic oxidative stress is relevant also in the remitting phase of the disease in patients with low disability and short disease duration. Therefore, treatment with antioxidants may be beneficial also in the early stage of the disease to preserve neuronal reserve.

Removal of Capybara (Hydrochoerus hydrochaeris) population as measure to control Amblyomma tick population and reduce Brazilian Spotted Fever transmission risk in a Gated Community in Bragança Paulista (SP, Brazil) ­ Case Study / Remoção de capivaras (Hydrochoerus hydrochaeris) como ação para controle da população de carrapatos Amblyomma e redução do risco de transmissão da Febre Maculosa Brasileira em um Condomínio Residencial em Bragança Paulista (SP, Brasil) ­ Estudo de Caso

This study reports the factors which led a gated community located in Bragança Paulista (SP, Brazil), a non-endemic area for Brazilian Spotted Fever (BSF), to be classified as a Risk Area for transmission of this disease, showing that an increasing resident population of capybaras (Hydrochoerus hydrochaeris) in the area was likely responsible for a proliferation of Amblyomma sculptum ticks and acted as an amplifying host for Rickettsia rickettsii, the main etiologic agent of BSF. We report management actions proposed to control the local tick burden and reduce BSF risk, including measures to control parasitic and free-living tick populations and exclusion of the resident capybara population. Analyses of tick population data and R. rickettsii serology tests indicate that these measures were effective, greatly reducing the environmental burden of Amblyomma sculptum ticks and reducing the BSF transmission risk at the area.(AU)

Este estudo relata os fatores que levaram um Residencial localizado em Bragança Paulista (SP, Brasil), área não-endêmica para Febre Maculosa Brasileira (FMB), a ser classificado como Área de Risco para a doença, mostrando que uma crescente população residente de capivaras (Hydrochoerus hydrochaeris) na área era a provável responsável por uma proliferação de carrapatos Amblyomma sculptum e estava atuando como hospedeiro amplificador da bactéria Rickettsia rickettsii, principal agente etiológico da FMB. Relatamos as ações de manejo ambiental propostas para controlar a quantidade de carrapatos no local e reduzir o risco de transmissão da doença, incluindo medidas para o controle de populações de carrapatos parasíticas e no ambiente e a eliminação da população residente de capivaras. Análises de dados populacionais de carrapatos e testes serológicos para R. rickettsii indicaram que as medidas tomadas foram efetivas, causando grande redução da população de carrapatos no ambiente e reduzindo o risco de transmissão de FMB na área.(AU)

Scheduled intermittent inotropes for Ambulatory Advanced Heart Failure. The RELEVANT-HF multicentre collaboration.

BACKGROUND: Ambulatory Advanced Heart Failure (AAHF) is characterized by recurrent HF hospitalizations, escalating diuretic requirements, intolerance to neurohormonal antagonists, end-organ dysfunction, short-term reduced life expectancy despite optimal medical management (OMM). The role of intermittent inotropes in AAHF is unclear. The RELEVANT-HF registry was designed to obtain insight on the effectiveness and safety of compassionate scheduled repetitive 24-hour levosimendan infusions (LEVO) in AAHF patients. METHODS: 185 AAHF NYHA class III-IV patients, with ≥2 HF hospitalizations/emergency visits in the previous 6 months and systolic dysfunction, were treated with LEVO at tailored doses (0.05-0.2 µg/kg/min) without prior bolus every 3-4 weeks. We compared data on HF hospitalizations (percent days spent in hospital, DIH) in the 6 months before and after treatment start. RESULTS: Infusion-related adverse events occurred in 23 (12.4%) patients the commonest being ventricular arrhythmias (16, 8.6%). During follow-up, 37 patients (20%) required for clinical instability treatment adjustments (decreases in infusion dose, rate of infusion or interval). From the 6 months before to the 6 months after treatment start we found lower DIH (9.4 (8.2) % vs 2.8 (6.6) %, p < 0.0001), cumulative number (1.3 (0.6) vs 1.8 (0.8), p = 0.0001) and length of HF admissions (17.4 (15.6) vs 21.6 (13.4) days, p = 0.0001). One-year survival was 86% overall and 78% free from death/LVAD/urgent transplant. CONCLUSIONS: In AAHF patients, who remain symptomatic despite OMM, LEVO is well tolerated and associated with lower overall length of hospital stay during six months. This multicentre clinical experience underscores the need for a randomized controlled trial of LEVO impact on outcomes in AAHF patients.

Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry.

BACKGROUND: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals. METHODS: A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance. RESULTS: At presentation, 118 patients (26.6%) had left ventricular ejection fraction <50%, sustained ventricular arrhythmias, or a low cardiac output syndrome, whereas 325 (73.4%) had no such complications. Endomyocardial biopsy was performed in 56 of 443 (12.6%), and a baseline cardiac magnetic resonance was performed in 415 of 443 (93.7%). Cardiac mortality plus heart transplantation rates at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus heart transplantation rates were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (log-rank P<0.0001). Major AM-related cardiac events after the acute phase (postdischarge death and heart transplantation, sustained ventricular arrhythmias treated with electric shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at the 5-year follow-up, with a higher incidence in patients with complicated forms (10.8% versus 0% in uncomplicated AM; log-rank P<0.0001). ß-Adrenoceptor blockers were the most frequently used medications both in complicated (61.9%) and in uncomplicated forms (53.8%; P=0.18). After a median time of 196 days, 200 patients had follow-up cardiac magnetic resonance, and 8 of 55 (14.5%) with complications at presentation had left ventricular ejection fraction <50% compared with 1 of 145 (0.7%) of those with uncomplicated presentation. CONCLUSIONS: In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction <50%, ventricular arrhythmias, or low cardiac output syndrome at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent left ventricular systolic dysfunction.

Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure.

Since increased heart rate (HR) is associated with higher mortality in several cardiac disorders, HR is considered not only a physiological indicator but also a prognostic and biological marker. In heart failure (HF), it represents a therapeutic target in chronic phase. The use or up-titration of beta-blockers, a milestone in HF with reduced left ventricular ejection fraction (LVEF) treatment, is at times limited by patients' hemodynamic profile or intolerance. Ivabradine, a HR-lowering drug inhibiting the f-current in pacemaker cells, has been shown to improve outcome in patients with chronic HF, in sinus rhythm with increased HR beyond beta-blocker therapy. The rationale for this review is to update the role of HR as a prognostic biomarker and a potential therapeutic target in other scenarios than chronic HF; namely, in patients with coexisting atrial fibrillation (AF), in HF with preserved LVEF (HFpEF), in acute HF, and in patients discharged after an episode of acute HF. Preliminary studies and case reports that evaluated the use of ivabradine in the setting of acute HF will be summarized. Recent results of HR reduction in the setting of HFpEF with ivabradine will be presented. Finally, data from large registries and trials that evaluated the prognostic impact of HR in patients with acute HF and sinus rhythm or AF will be reviewed, showing that only patients in sinus rhythm may benefit from HR reduction.

Sacubitril/Valsartan in "Field Practice" Patients with Advanced Heart Failure: A Monocentric Italian Experience.

Patients with advanced heart failure (HF) experience a continuous decline in quality of life and have a very poor prognosis. Moreover, due to numerous comorbidities present in these patients, transplantation and left ventricular assist devices are usually impracticable in clinical practice. In this challenging setting, administration of inotropic agents may be the only possible therapy; however, this treatment requires frequent hospitalizations. Our hypothesis is that sacubitril/valsartan, given its marked efficacy and manageability, can be safely used in clinical practice in this setting, potentially reducing hospitalizations and the need for inotropic support. We report here our experience in a small series of patients with advanced HF treated with sacubitril/valsartan.

[Heart rate and outcome in patients with acute and chronic heart failure]. / La frequenza cardiaca e la prognosi nello scompenso cardiaco acuto e cronico.

Heart rate (HR) is not only a physical sign but also a biomarker. High HR in several cardiac disorders is associated with increased mortality. In heart failure (HF), HR represents an important therapeutic target, both in the acute and chronic phase. Beta-blockers are a milestone of recommended treatments in HF patients with reduced ejection fraction. However, hemodynamic profile or intolerance may limit the use or the optimization of beta-blocker treatment, both during hospitalization and outpatient follow-up. More recently, ivabradine has become available, a drug that lowers HR by blocking the I(f) current in the pacemaker cells at the sinoatrial node level. In the SHIFT trial, ivabradine was shown to improve the outcome of patients with chronic HF, in sinus rhythm, with HR >70 b/min while on beta-blockers. Preliminary data have shown that this drug has a good safety profile and lowers effectively HR even during hospitalization due to worsening HF. However, further studies are warranted to understand if an earlier administration of ivabradine can lead to a better prognosis beyond symptom control and improved hemodynamics. In patients with atrial fibrillation and HF, the target is the restoration of sinus rhythm, alternatively rate control should be pursued with beta-blockers, amiodarone or digitalis, even if there is no clear evidence of an association between ventricular rate response in patients with atrial fibrillation at discharge after an HF hospitalization and major cardiovascular events. In this review, the studies that point to a role of HR both as a biomarker and a therapeutic target in patients with acute and chronic HF are described. In addition, the proportions of patients who do not reach target HR values at discharge after an acute decompensated HF episode or in the chronic phase are evaluated based on the Italian registries.

Late driveline left ventricular assist device infection treated with frozen-and-thawed allogeneic platelet gel.

In this case report, we report the application of frozen-and-thawed allogeneic platelet gel (PLT-gel) to treat a late driveline exit site infection in a 56-year old patient supported by a Heartware-HVAD left ventricular assist device. The treatment duration was 4 weeks and at the follow-up the skin around the exit site was free from further infection. PLT-gel can be used to treat local infection of the driveline exit site and to prevent further high-risk infections.

Adubação potássica para o crambe / Potassic fertilization for crambe crop

São escassos os trabalhos para a cultura do crambe (Crambe abyssinica Hochst), sendo necessários estudos que caracterizem o nível de suficiência de potássio (K) no solo e nas folhas, visando subsidiar futuros programas de adubação potássica para essa cultura de outono/inverno. Foi realizado um experimento visando estudar a resposta do crambe ao K do solo. O experimento foi realizado em um Latossolo Vermelho argiloso sob o sistema de semeadura direta, em Botucatu - SP. Os tratamentos consistiram de sete níveis de K no solo, resultantes da aplicação anual de 2000 a 2010, na cultura de verão (soja), de 0, 30, 60, 90, 120, 150 e 180 kg ha-1 de K2O. Antes de iniciar o experimento, amostras de solo foram coletadas na camada de 0-20 cm e os teores de K no solo determinados pelos métodos da resina e Mehlich-1. Os níveis de suficiência de K no solo e nas folhas foram obtidos considerando-se a produtividade relativa de grãos de 90%. Quando os teores de K do solo, extraídos por resina e por Mehlich-1, são superiores a 88 e 94 mg dm-3, respectivamente, equivalente a 26 g kg-1 de K nas folhas, o aumento da produtividade de grãos da cultura do crambe é improvável. Estes valores devem corresponder ao nível de suficiência da cultura e são suficientes para atingir produtividade de grãos relativa de 90%.

There are few studies for the crambe crop (Crambe abyssinica Hochst), and studies that characterize the sufficiency level of K in the soil and leaves are indispensable to support future programs potassium fertilization for this crop of fall/winter. An experiment was carried out to investigate the response of crambe to K soil. The experiment was carried out on a clayey Red Latossol under no-till in Botucatu, São Paulo State, Brazil. Treatments consisted of seven K levels in the soil, resulting from the application year (2000 to 2010), the summer crop (soybean), 0, 30, 60, 90, 120, 150 and 180 kg ha-1 K2O. Before starting the experiment, soil samples were collected at depths of 0-20 cm and soil K contents determined by the resin and Mehlich-1 method. The sufficiency levels of K in soil and leaves were obtained considering the relative yield of 90%. When the levels of soil K extracted by resin and Mehlich-1, are above 88 and 94 mg dm-3, respectively, equivalent to 26 g kg-1 K in the leaves, the increase in crop yield of crambe is unlikely. These values should match the sufficiency level of crop and are sufficient to achieve relative grain yield of 90%.