Effect of beta-blockers and angiotensin receptor blockers in reducing the aortic growth rate in children with bicuspid aortic valve-related aortopathy.

AIMS: The aim of this study is to evaluate the effect of beta-blockers and angiotensin receptor blockers in reducing the aortic growth rate in children with bicuspid aortic valve (BAV)-related aortopathy and ascending phenotype. METHODS: Consecutive paediatric patients (≤16 years) with BAV and ascending aorta (AsAo) dilation (z-score > 3) were enrolled in this observational retrospective cohort study. Patients receiving prophylactic treatment with either atenolol (0.5 to 1.0 mg/kg/daily) or losartan (0.7 to 1.4 mg/kg/daily) were compared with those who did not receive medical prophylaxis (control group). The primary outcome of interest was the annual rate of change in maximal AsAo diameter z-score in the treatment and control groups. RESULTS: From a cohort of 1005 patients, 120 (mean age 11.3 ± 4.5 years, 82% males) fulfilled the inclusion criteria and were included in the study. Patients in the treatment and control group had similar age, sex, family history of BAV, BAV morphology, and baseline AsAo diameter. During a median follow-up of 7.1 years (interquartile range 3.8-10.2), no differences were observed in the annual growth rate of aortic diameter z-score between patients on treatment and controls. The prevalence of aortic diameter progression was similar in the treatment and control groups, and treatment with atenolol or losartan was not associated with a lower rate of aortic disease progression. CONCLUSIONS: The findings revealed no significant difference in the annual aortic growth rate between treated and untreated patients. Larger cohort studies or, ideally, randomized clinical controlled trials are needed to validate these findings.

Prevalence and Clinical Significance of Intraventricular Conduction Disturbances in Hospitalized Children.

Introduction: Data on the prevalence and clinical significance of interventricular conduction disturbances (IVCDs) in children are scarce. While incomplete right bundle branch blocks (IRBBBs) seem to be the most frequent and benign findings, complete bundle blocks and fascicular blocks are often seen in children with congenital/acquired cardiac conditions. This study aims to delineate the prevalence and the diagnostic accuracy of IVCD in children admitted to a paediatric cardiology unit. Methods: Children admitted to the paediatric cardiology unit between January 2010 and December 2020 who had an ECG were included in the study. IVCDs were diagnosed according to standard criteria adjusted for age. Results: Three thousand nine hundred and ninety-three patients were enrolled. The median age was 3.1 years (IQR: 0.0-9.2 years), and 52.7% were males. IVCDs were present in 22.5% of the population: 17.4% of the population presented with IRBBBs, 4.8% with a complete right bundle branch block (CRBBB), 0.1% with a complete left bundle branch block (CLBBB), 0.2% with a left anterior fascicular block (LAFB) and 0.2% with a combination of CRBBB and LAFB. Also, 26% of children with congenital heart disease had an IVCD, and 18% of children with an IVCD had previous cardiac surgery. The overall sensitivity of IVCD in detecting a cardiac abnormality was 22.2%, with a specificity of 75.5%, a PPV of 83.1% and an NPV of 15.1%, but the values were higher for CLBBB and LAFB. Conclusions: IVCDs were present in one-fifth of children admitted to the cardiology unit. IRBBB was the most frequent disturbance, while CRBBB, CLBBB and fascicular blocks were much rarer, though they had a higher predictive value for cardiac abnormalities.

[Clinical and genetic manifestations of left ventricular non-compaction in children]. / Caratteristiche cliniche e genetiche del ventricolo sinistro non compatto in età pediatrica.

Left ventricular non-compaction (LVNC) is a myocardial disease characterized by a two-layered structure typically seen at the apical and lateral left portions of the ventricular myocardium, distal to the papillary muscles. While considered a rare disease, its prevalence in children is increasing due to the increased awareness of this condition and improved resolution of imaging techniques. The etiology is heterogeneous, ranging from inherited conditions to acquired diseases. Although many patients are asymptomatic, some patients may experience adverse events, including heart failure, arrhythmias, or thromboembolic events. Several echocardiographic or cardiac magnetic resonance imaging diagnostic criteria have been proposed for diagnosing LVNC. However, their application in children is significantly limited. This review aims to describe the clinical and genetic characteristics of children with LVNC and discuss the role of the proposed diagnostic criteria.

Valve-in-Valve Transcatheter Aortic Valve Replacement: From Pre-Procedural Planning to Procedural Scenarios and Possible Complications.

Over the last decades, bioprosthetic heart valves (BHV) have been increasingly implanted instead of mechanical valves in patients undergoing surgical aortic valve replacement (SAVR). Structural valve deterioration (SVD) is a common issue at follow-up and can justify the need for a reintervention. In the evolving landscape of interventional cardiology, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has emerged as a remarkable innovation to address the complex challenges of patients previously treated with SAVR and has rapidly gained prominence as a feasible technique especially in patients at high surgical risk. On the other hand, the expanding indications for TAVR in progressively younger patients with severe aortic stenosis pose the crucial question on the long-term durability of transcatheter heart valves (THVs), as patients might outlive the bioprosthetic valve. In this review, we provide an overview on the role of ViV TAVR for failed surgical and transcatheter BHVs, with a specific focus on current clinical evidence, pre-procedural planning, procedural techniques, and possible complications. The combination of integrated Heart Team discussion with interventional growth curve makes it possible to achieve best ViV TAVR results and avoid complications or put oneself ahead of time from them.

Foliar Nutrition Influences Yield, Nut Quality and Kernel Composition in Hazelnut cv Mortarella.

In hazelnut, foliar nutrition is utilized globally to integrate microelement deficiencies and optimize their assimilation and effects on yield performances. Nevertheless, nut quality and kernel composition can be positively affected by foliar nutrition. Recently, several studies pointed out the need for increasing the sustainability of orchard nutrition by proposing the management of not only micronutrients, but also main components, such as nitrogen, through foliar spraying. In our study, different foliar fertilizers were used to understand the effectiveness of supporting hazelnut productivity and nut and kernel quality. Water was used as a control. Foliar fertilizations affected tree annual vegetative growth, improved kernel weight and decreased the incidence of blanks compared to the control. Differences in fat, protein, and carbohydrate concentration were also found among treatments, with increased fat concentrations and total polyphenols content in fertilized treatments. Foliar fertilization improved the oil composition of the kernels, though fatty acid composition responded differently to nutrients spray. Oleic acid concentration was promoted, while palmitic acid concentration was reduced in fertilized plants compared to control trees. Furthermore, CD and B trees were characterized by an increase in the ratio of unsaturated/saturated fatty acids compared to untreated trees. Finally, foliar spraying improved lipid stability compared to the control due to higher total polyphenol concentration.

Hydroponic and Aquaponic Floating Raft Systems Elicit Differential Growth and Quality Responses to Consecutive Cuts of Basil Crop.

Basil crops are appreciated for their distinct flavour and appeal to various cuisines globally. Basil production is mainly implemented in controlled environment agriculture (CEA) systems. Soil-less cultivation (e.g., hydroponic) is optimal for producing basil, while aquaponics is another technique suitable for leafy crops such as basil. Shortening the production chain through efficient cultivation techniques reduces basil production's carbon footprint. While the organoleptic quality of basil demonstrably benefits from successive cuts, no studies have compared the impact of this practice under hydroponic and aquaponic CEA conditions. Hence, the present study evaluated the eco-physiological, nutritional, and productive performance of Genovese basil cv. Sanremo grown in hydroponic and aquaponic systems (combined with tilapia) and harvested consecutively. The two systems showed similar eco-physiological behaviour and photosynthetic capacity, which were on average 2.99 µmol of CO2 m-2 s-1, equal numbers of leaves, and fresh yields of on average 41.69 and 38.38 g, respectively. Aquaponics yielded greater dry biomass (+58%) and dry matter content (+37%), while the nutrient profiles varied between the systems. The number of cuts did not influence yield; however, it improved dry matter partitioning and elicited a differential nutrient uptake. Our results bear practical and scientific relevance by providing useful eco-physiological and productive feedback on basil CEA cultivation. Aquaponics is a promising technique that reduces chemical fertiliser input and increases the overall sustainability of basil production.

Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study.

OBJECTIVES: The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. DESIGN: Observational retrospective study. SETTING: The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. PARTICIPANTS: Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated.No exclusion criteria applied.Three hundred patients were enrolled and completed the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. RESULTS: Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). CONCLUSIONS: In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU.

Protein Hydrolysates from Animal or Vegetal Sources Affect Morpho-Physiological Traits, Ornamental Quality, Mineral Composition, and Shelf-Life of Chrysanthemum in a Distinctive Manner.

Protein hydrolysates (PHs) are a prominent category of plant biostimulants, mainly constituted of amino acids, oligopeptides and polypeptides, obtained by partial hydrolysis of animal or plant protein sources. Despite scientific evidence supporting the biostimulant action of PHs on vegetables, the morphological, physiological, and shelf-life performances underlying the PH action on cut flowers are still poorly explored. Accordingly, the aim of this research is to assess the effects of three commercial biostimulants, one animal PH (PH A, Hicure®) and two plant PHs (PH V1, Trainer® and PH V2, Vegamin©), on two chrysanthemum (Chrysanthemum morifolium) cultivars (Pinacolada and Radost). In both cultivars, only the plant-derived PH (V1 and V2) treatments recorded significantly higher fresh plant biomass than the control (on average +18%, in both cultivars). The foliar application of the vegetal-derived PHs but not the animal one, particularly in Pinacolada, improved the status of plants, stimulating stem elongation and the apical flower diameter. In Pinacolada, applications with PH V1 resulted in a significant increase in nitrate and P concentration in leaves and Ca content in flowers compared with the control (+43%, +27%, and +28% for nitrate, P, and Ca, respectively). In Radost, PH A and PH V2 applications caused a significant reduction in nitrate concentration in both leaves and flowers compared with the control. One week after harvest, in both cultivars, PH A applications caused flower stems to wilt faster than the control. In contrast, plants treated with PH V1 revealed significantly slower flower stem senescence compared to the control. Flower wilting during vase life was correlated to a decrease in the K-to-Na ratio in flowers due to an inability to transport K to the flowers from the leaves rather than an increase in Na in the flowers themselves.

Interaction between VA-ECMO and the right ventricle.

BACKGROUND: The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is currently unpredictable. We hypothesized that the presence of uni- or bi-ventricular failure before implantation and the cannulation strategy may influence this interaction. We sought to assess the RV performance during VA-ECMO support and identify RV-related predictors of successful weaning. METHODS: Changes in RV size and function during VA-ECMO support by echocardiography were retrospectively analyzed in 87 consecutive adult patients between February 2008 and June 2017. Predictors of successful weaning due to myocardial recovery were evaluated by multivariable logistic regression. RESULTS: RV echocardiographic parameters did not vary significantly during VA-ECMO support and neither after stratification by the type of cannulation or the presence of isolated or biventricular failure. Successful weaning was conditioned by the absence of RV dysfunction before implantation (OR, 14.7; 95% CI, 13.3-140.3; p = 0.025) or in the last day of support (OR, 9.5; 95% CI, 1.6-54; p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR, 6.2; 95%CI, 1.7-22.4; p = 0.005). RV improvement was more often observed in patients with acute RV failure and longer support, while VA-ECMO configuration, additional mechanical support, or pharmacological therapy had no effect. CONCLUSIONS: Preservation or improvement of RV function during VA-ECMO is essential for successful weaning. RV echocardiographic performance does not change significantly during VA-ECMO support and is not influenced by cannulation type or the presence of uni- or bi-ventricular failure before implantation.

How Leaf Vein and Stomata Traits Are Related with Photosynthetic Efficiency in Falanghina Grapevine in Different Pedoclimatic Conditions.

The increase in severe drought events due to climate change in the areas traditionally suitable for viticulture is enhancing the need to understand how grapevines regulate their photosynthetic metabolism in order to forecast specific cultivar adaptive responses to the changing environment. This study aims at evaluating the association between leaf anatomical traits and eco-physiological adjustments of the 'Falanghina' grapevine under different microclimatic conditions at four sites in southern Italy. Sites were characterized by different pedoclimatic conditions but, as much as possible, were similar for plant material and cultivation management. Microscopy analyses on leaves were performed to quantify stomata and vein traits, while eco-physiological analyses were conducted on vines to assess plant physiological adaptation capability. At the two sites with relatively low moisture, photosynthetic rate, stomatal conductance, photosystem electron transfer rate, and quantum yield of PSII, linear electron transport was lower compared to the other two sites. Stomata size was higher at the site characterized by the highest precipitation. However, stomatal density and most vein traits tended to be relatively stable among sites. The number of free vein endings per unit leaf area was lower in the two vineyards with low precipitation. We suggest that site-specific stomata and vein traits modulation in Falanghina grapevine are an acclimation strategy that may influence photosynthetic performance. Overall in-depth knowledge of the structure/function relations in Falanghina vines might be useful to evaluate the plasticity of this cultivar towards site-specific management of vineyards in the direction of precision viticulture.

First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19.

Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King's Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85-9.60]; P<0.001) unadjusted and 4.83 ([95% CI, 2.35-9.95], P<0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P=0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.

Endophytic Fungi and Ecological Fitness of Chestnuts.

Chestnuts (Castanea spp.) are plants of relevant economic interest in the agro-sylvicultural contexts of mountain regions throughout the temperate zone, particularly in the northern hemisphere. In recent years, several biological adversities have repeatedly endangered species belonging to this genus, calling for coordinated actions addressed to contrast their decline. These actions have mainly focused on the control of key pests/pathogens and the improvement of resistance/tolerance by the plant host, while the role of microorganisms as mediators of interactions between plants and the noxious agents has been less considered, essentially by reason of a limited knowledge on their ecological impact. In line with the increasing awareness of the basic importance of microbial symbionts in regulating plant fitness in both natural and crop contexts, this paper offers an overview on the occurrence and effects of endophytic fungi of chestnuts.

Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care.

Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalized with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitted during a 7-week period in 2020; 176 were included (90% received invasive ventilation). hs-TnT at admission was 16.5 (9.0 to 49.3) ng/L, 56% had concentrations >ULN. 56 patients (31.8%) died during the index admission. Admission hs-TnT level was lower in survivors (12.0 (8.0-27.8) vs 28.5 (14.0 to 81.0) ng/L, p = 0.001). Univariate predictors of mortality were age, APACHE-II Score and admission hs-TnT (HR 1.73, p = 0.007). By multivariate regression, only age (HR 1.33, CI: 1.16.to 1.51, p < 0.01) and admission hs-TnT (HR 1.94, CI: 1.22 to 3.10, p = 0.006) remained predictive. Survival was significantly lower when admission hs-TnT was >ULN (log-rank p-value<0.001). Peak hs-TnT was higher in those who died but was not predictive of death after adjustment for other factors. In conclusion, in critically ill patients with COVID-19 pneumonitis, the hs-TnT level at admission is a powerful independent predictor of the likelihood of surviving to discharge from ICU. In most cases, hs-TnT elevation does not represent major myocardial injury but acts as a sensitive integrated biomarker of global stress. Whether stratification based on admission Troponin level could be used to guide prognostication and management warrants further evaluation.

Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of intramyocardial haemorrhage in patients with ST-elevation myocardial infarction.

OBJECTIVES: T2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated. METHODS AND RESULTS: Between April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent head-to-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2w-STIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixed-effects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p < 0.05 for both scores). For IMH quantification, hypocore on T2 map and T1 map strongly correlated (Spearman's r > 0.7, p < 0.001 for both) with IMH extent on T2*w and presented an overall excellent agreement on Bland-Altman analysis. By linear mixed model analysis, absolute hypocore size did not differ among T1-, T2 map, and T2*w. T2/T1 maps had the best intra- and inter-observer reproducibility among CMR techniques. CONCLUSION: Hypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in post-STEMI patients. KEY POINT: • Mapping techniques are the best alternatives for diagnosing post-infarction intramyocardial haemorrhage. • Mapping techniques are valuable tools for imaging intramyocardial haemorrhage.

Endophytic Fungi of Olive Tree.

In addition to the general interest connected with investigations on biodiversity in natural contexts, more recently the scientific community has started considering occurrence of endophytic fungi in crops in the awareness of the fundamental role played by these microorganisms on plant growth and protection. Crops such as olive tree, whose management is more and more frequently based on the paradigm of sustainable agriculture, are particularly interested in the perspective of a possible applicative employment, considering that the multi-year crop cycle implies a likely higher impact of these symbiotic interactions. Aspects concerning occurrence and effects of endophytic fungi associated with olive tree (Olea europaea) are revised in the present paper.

Biochemical, Physiological and Anatomical Mechanisms of Adaptation of Callistemon citrinus and Viburnum lucidum to NaCl and CaCl2 Salinization.

Callistemon citrinus and Viburnum lucidum are appreciated and widespread ornamental shrubs for their abundant flowering and/or brilliant foliage. The intrinsic tolerance to drought/salinity supports their use in urban areas and in xeriscaping. Despite adaptive responses of these ornamental species to sodium chloride (NaCl) have been extensively explored, little is known on the effects of other salt solution, yet iso-osmotic, on their growth, mineral composition and metabolism. The present research was aimed to assess responses at the biochemical, physiological and anatomical levels to iso-osmotic salt solutions of NaCl and CaCl2 to discriminate the effects of osmotic stress and ion toxicity. The two ornamental species developed different salt-tolerance mechanisms depending on the salinity sources. The growth parameters and biomass production decreased under salinization in both ornamental species, independently of the type of salt, with a detrimental effect of CaCl2 on C. citrinus. The adaptive mechanisms adopted by the two ornamental species to counteract the NaCl salinity were similar, and the decline in growth was mostly related to stomatal limitations of net CO2 assimilation rate, together with the reduction in leaf chlorophyll content (SPAD index). The stronger reduction of C. citrinus growth compared to V. lucidum, was due to an exacerbated reduction in net photosynthetic rate, driven by both stomatal and non stomatal limitations. In similar conditions, V. lucidum exhibited other additional adaptive response, such as modification in leaf functional anatomical traits, mostly related to the reduction in the stomata size allowing plants a better control of stomata opening than in C. citrinus. However, C. citrinus plants displayed an increased ability to retain higher Cl- levels in leaves than in roots under CaCl2 salinity compared to V. lucidum, thus, indicating a further attempt to counteract chloride toxicity through an increased vacuolar compartmentalization and to take advantages of them as chip osmotica.

Ameliorating a Complex Urban Ecosystem Through Instrumental Use of Softscape Buffers: Proposal for a Green Infrastructure Network in the Metropolitan Area of Naples.

Green Infrastructure (GI) definition, deriving from the United States green infrastructure for hydro-geological rebalancing through imitating the nature stormwater management, was consolidated in Europe by GI Planning Guide. Nowadays GI can be considered a valid and meaningful approach for ameliorating urban complex ecosystems, and could also be considered as mitigation action of land consumption, according to the guidelines on the soil sealing of the European Commission (2012). The metropolitan area of Naples located in south Italy is characterized by an unauthorized and chaotic urban development. The land-use map reported an average of 30% of urbanization in the metropolitan area, rising up to 50-60% and as high as 98% in the north core area of the city. This high level of urbanization is directly related to the habitat fragmentation. The National Biodiversity Conservation Strategy defines several challenges and targets to counteract the biodiversity loss in Italy, identifying urban areas as places exposed to the greatest pressures on ecosystems. Therefore, the integration of different policies limiting habitat fragmentation, heat island effect and natural soil hydro-geological degradation into spatial planning, especially through green corridors and ecosystem enhancement in urban areas is an urgent need for the society. Spatial planning has to be renewed in metropolitan areas, where threats and weaknesses to biodiversity conservation are stronger than in any other place, according to the Law n. 56/2014, (Gazzetta Ufficiale della Repubblica Italiana, 2014) committing metropolitan cities to the enactment of General Territorial Plan. In the current paper, we aim at designing an ecological network for the metropolitan area of Naples one of the biggest city of southern Italy. The analyses include the adopted methodological procedure, i.e., ecological network analysis and design, and the introductory elements of a spatial analysis on a pilot ecological network of several patches. Finally, the paper illustrates the network analysis conceived as a monitoring system and also in future perspective, as a planning support system.

Extracorporeal Circulatory Support in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.

OBJECTIVES: Extracorporeal circulatory support is a life-saving technique, and its use is increasing in acute coronary syndromes. A meta-analysis on pooled event rate of short-term mortality and complications of acute coronary syndrome patients treated with extracorporeal circulatory support was performed. DATA SOURCES: Articles were searched in MEDLINE, Cochrane Library, Google Scholar, and Biomed Central. STUDY SELECTION: Inclusion criteria were observational studies on acute coronary syndrome patients treated with extracorporeal circulatory support. Primary outcome was short-term mortality. Secondary outcomes were extracorporeal circulatory support-related complications, causes of death, long-term mortality, and bridge therapy. DATA EXTRACTION: Sixteen articles were selected. Data about clinical characteristics, acute coronary syndrome diagnosis and treatment, extracorporeal circulatory support setting, outcome definitions, and event rate were retrieved from the articles. Random effect meta-analytic pooling was performed reporting results as a summary point estimate and 95% CI. DATA SYNTHESIS: A total of 739 patients were included (mean age, 59.8 ± 2.9). The event rate of short-term mortality was 58% (95% CI, 51-64%), 6-month mortality was affecting 24% (95% CI, 5-63%) of 1-month survivors, and 1-year mortality 17% (95% CI, 6-40%) of 6-month survivors. The event rates of extracorporeal circulatory support-related complications were acute renal failure 41%, bleeding 25%, neurologic damage in survivors 21%, sepsis/infections 21%, and leg ischemia 12%. Between causes of death, multiple organ failure and brain death affected respectively 40% and 27% of patients. Bridge to ventricular assistance device was offered to 14% of patients, and 7% received a transplant. CONCLUSIONS: There is still a high rate of short-term mortality and complications in acute coronary syndrome patients treated with extracorporeal circulatory support. New studies are needed to optimize and standardize extracorporeal circulatory support.

Association between left ventricular perfusion defects and myocardial deformation indexes in heart transplantation recipients.

The aim of the study was to analyze possible correlations between strain echocardiography (STE) and PET myocardial perfusion in a population of heart transplantation (HTx) recipients showing preserved left ventricular (LV) ejection fraction. By STE, LV global longitudinal strain (LV GLS) was lower in HTx. PET showed no transient or chronic ischemia in 83 of 115 HTx (73%). Fixed perfusion defects were observed in 17% of HTx and reversible ischemia in 10%. Significant coronary stenosis was observed only in 10 cases. GLS was independently associated with age at HTx and fixed perfusion defects (HR 0.41; P<.001). Such relationships underline STE ability to early identify HTx pts with subclinical myocardial dysfunction during long-term follow-up.

Fruit position within the canopy affects kernel lipid composition of hazelnuts.

BACKGROUND: The aim of this research was to study the variability in kernel composition within the canopy of hazelnut trees. RESULTS: Kernel fresh and dry weight increased linearly with fruit height above the ground. Fat content decreased, while protein and ash content increased, from the bottom to the top layers of the canopy. The level of unsaturation of fatty acids decreased from the bottom to the top of the canopy. Thus, the kernels located in the bottom layers of the canopy appear to be more interesting from a nutritional point of view, but their lipids may be more exposed to oxidation. The content of different phytosterols increased progressively from bottom to top canopy layers. CONCLUSION: Most of these effects correlated with the pattern in light distribution inside the canopy. The results of this study indicate that fruit position within the canopy is an important factor in determining hazelnut kernel growth and composition. © 2017 Society of Chemical Industry.