Inflammation as a cause of acute myocardial infarction in patients with myeloproliferative neoplasm

Myeloproliferative neoplasms(MPN)are a group of diseases characterized by the clonal proliferation of hematopoietic progenitor or stem cells.They are clinically classifiable into four main diseases:chronic myeloid leukemia,essential thrombocythemia,polycythemia vera,and primary myelofibrosis.These pathologies are closely related to cardio-and cerebrovascular diseases due to the increased risk of arterial thrombosis,the most common underlying cause of acute myocardial infarction.Recent evidence shows that the classical Virchow triad(hypercoagulability,blood stasis,endothelial injury)might offer an explanation for such association.Indeed,patients with MPN might have a higher number and more reactive circulating platelets and leukocytes,a tendency toward blood stasis because of a high number of circulating red blood cells,endothelial injury or overactivation as a consequence of sustained inflammation caused by the neoplastic clonal cell.These abnormal cancer cells,especially when associated with the JAK2V617F mutation,tend to proliferate and secrete several inflammatory cytokines.This sustains a pro-inflammatory state throughout the body.The direct consequence is the induction of a pro-thrombotic state that acts as a determinant in favoring both venous and arterial thrombus formation.Clinically,MPN patients need to be carefully evaluated to be treated not only with cytoreductive treatments but also with cardiovascular protective strategies.

Facing ethical concerns in the age of precise gene therapy:Outlook on inherited arrhythmias

This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited arrhythmias.As monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their treatment.Patients with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic sports.While genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the disease.However,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited arrhythmias.Genomic off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable accessibility.Meanwhile,the costeffectiveness may further limit an equal distribution of gene therapies.The economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as well.Altogether,those aspects strongly indicate a need of regulatory entities to manage those issues.

Role of cytokines and chemokines in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) includes a variety of histological conditions (ranging from liver steatosis and steatohepatitis, to fibrosis and hepatocarcinoma) that are characterized by an increased fat content within the liver. The accumulation/deposition of fat within the liver is essential for diagnosis of NAFLD and might be associated with alterations in the hepatic and systemic inflammatory state. Although it is still unclear if each histological entity represents a different disease or rather steps of the same disease, inflammatory processes in NAFLD might influence its pathophysiology and prognosis. In particular, non-alcoholic steatohepatitis (the most inflamed condition in NAFLDs, which more frequently evolves towards chronic and serious liver diseases) is characterized by a marked activation of inflammatory cells and the upregulation of several soluble inflammatory mediators. Among several mediators, cytokines and chemokines might play a pivotal active role in NAFLD and are considered as potential therapeutic targets. In this review, we will update evidence from both basic research and clinical studies on the potential role of cytokines and chemokines in the pathophysiology of NAFLD.

Overview of hepatitis B virus mutations and theirimplications in the management of infection

Hepatitis B virus(HBV)affects approximately two billion people worldwide and more than 240 million people in the world are currently chronic carrier that could develop serious complications in the future,like liver cirrhosis and hepatocellular carcinoma.Although an extended HBV immunization program is being carried out since the early‘80s,representing effective preventive measure,leading to a dramatic reduction of HBV hepatitis incidence,globally HBV infection still represents a major public health problem.The HBV virus is a DNA virus belongs to the Hepadnaviridae family.The HBV-DNA is a circular,partial double strand genome.All coding information is on the minus DNA strand and it is organized into four open reading frames.Despite hepatitis B virus is a DNA virus,it has a high mutation rate due to its replicative strategy,that leads to the production of many nonidentical variants at each cycle of replication.In fact,it contains a polymerase without the proofreading activity,and uses an RNA intermediate(pg RNA)during its replication,so error frequencies are comparable to those seen in retroviruses and other RNA viruses rather than in more stable DNA viruses.Due to the low fidelity of the polymerase,the high replication rate and the overlapping reading frames,mutations occur throughout the genome and they have been identified both in the structural and not structural gene.The arise of mutations being to develop of a whole of viral variants called"quasi-species"and the prevalent population,which favors virus replication,was selected by viral fitness,host’s immune pressure and external pressure,i.e.,vaccination or antiviral therapy.Naturally occurring mutations were found both in acute and chronic subjects.In the present review we examine and discuss the most recent available data about HBV genetic variability and its significance.

Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis

AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between June 1, 2005 and November 30, 2010, 46 patients(62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR(n = 24), while those with poorer liver function and multiple tumors were referred for LRFA(n = 22), and they were then followed for similar durations(44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival(OS) and disease-free survival(DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group(LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS(LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules(LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS(hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.

Alcohol and hepatocellular carcinoma:A review and a point of view

It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma(HCC)is alcohol consumption.Research in Italy and the United States concludes that the most common cause of HCC(responsible for 32%to 45%of HCC)is alcohol.It has recently been shown that a significant relationship between alcohol intake,metabolic changes,and hepatitis virus infection does exist.Alcohol may be a factor in the development of HCC via direct(genotoxic)and indirect mechanisms(cirrhosis).There is only one way of diagnosing HCC,which is early identification through surveillance,when curative treatments become possible.After stopping alcohol intake the risk of liver cancer decreases by 6%to 7%a year,and an estimated time period of 23 years is also needed.Therefore,surveillance is also important in former drinkers and,in our opinion,independently from the presence of compensated cirrhosis.In cases of very early stage(VES)and early stage with portal hypertension,liver transplantation is the optimal option;and in cases of associated disease,percutaneous ethanol injections,radiofrequency and microwave ablation are the ideal treatments.Despite the possibility of detecting microvascular invasion with HR,several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR.Therefore,ablation can be regarded as a firstline choice for patients with VES HCC.It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.

Hepatitis C virus in the new era:Perspectives in epidemiology,prevention,diagnostics and predictors of response to therapy

Despite the great successes achieved in the fields of virology and diagnostics,several difficulties affect improvements in hepatitis C virus(HCV)infection control and eradication in the new era.New HCV infections still occur,especially in some of the poorest regions of the world,where HCV is endemic and long-term sequelae have a growing economic and health burden.An HCV vaccine is still no available,despite years of researches and discoveries about the natural history of infection and host-virus interactions:several HCV vaccine candidates have been developed in the last years,targeting different HCV antigens or using alternative delivery systems,but viral variability and adaption ability constitute major challenges for vaccine development.Many new antiviral drugs for HCV therapy are in preclinical or early clinical development,but different limitations affect treatment validity.Treatment predictors are important tools,as they provide some guidance for the management of therapy in patients with chronic HCV infection:in particular,the role of host genomics in HCV infection outcomes in the new era of direct-acting antivirals may evolve for new therapeutic targets,representing a chance for modulated and personalized treatment management,when also very potent therapies will be available.In the present review we discuss the most recent data about HCV epidemiology,the new perspectives for the prevention of HCV infection and the most recent evidence regarding HCV diagnosis,therapy and predictors of response to it.

Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome

Several studies indicate a significant degree of overlap between irritable bowel syndrome(IBS)and gastroesophageal reflux disease(GERD).Likewise,both functional heartburn(FH)and IBS are functional digestive disorders that may occur in the same patients.However,data establishing a solid link between FH and IBS are lacking,mainly because the clinical definition of FH has undergone substantial changes over the years.The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS.In particular,several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH(as defined by the RomeⅢcriteria)from GERD via pathophysiological investigations.Independent of these critical issues,there is preliminary evidence supporting a significantdegree of FH-IBS overlap.This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications,particularly to distinguish FH from GERD.This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m 2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients(2 ERD and 3 NERD);11/41 patients had a normal AET and a positive association between symptoms and refluxes(HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes(no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus(29.7 ± 3.6) and hoarseness(21.5 ± 7.4) than in patients with heartburn or regurgitation(7.8 ± 6.2).Gas refluxes were positively associated with extraesophageal symptoms(P < 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients(ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS(P = 0.028 andP = 0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.

Therapeutic potential of curcumin in digestive diseases

Curcumin is a low-molecular-weight hydrophobic polyphenol that is extracted from turmeric,which possesses a wide range of biological properties including anti-inflammatory,anti-oxidant,anti-proliferative and anti-microbial activities.Despite its diverse targets and substantial safety,clinical applications of this molecule for digestive disorders have been largely limited to case series or small clinical trials.The poor bioavailability of curcumin is likely the major hurdle for its more widespread use in humans.However,complexation of curcumin into phytosomes has recently helped to bypass this problem,as it has been demonstrated that this new lecithin formulation enables increased absorption to a level 29-fold higher than that of traditional curcuminoid products.This allows us to achieve much greater tissue substance delivery using significantly lower doses of curcumin than have been used in past clinical studies.As curcumin has already been shown to provide good therapeutic results in some small studies of both inflammatory and neoplastic bowel disorders,it is reasonable to anticipate an even greater efficacy with the advent of this new technology,which remarkably improves its bioavailability.These features are very promising and may represent a novel and effective therapeutic approach to both functional and organic digestive diseases.

Effect of Cambering on the Aerodynamic Performance of Heaving Airfoils

In the present work,a parametric numerical study is conducted in order to assess the effect of airfoil cambering on the aerodynamic performance of rigid heaving airfoils.The incompressible Navier-Stokes equations are solved in their velocity-pressure formulation using a second-order accurate in space and time finite-difference scheme.To tackle the problem of moving boundaries,the governing equations are solved on overlapping structured grids.The numerical simulations are performed at a Reynolds number of Re=1100 and at different values of Strouhal number and reduced frequency.The results obtained show that the airfoil cambering geometric parameter has a strong influence on the average lift coefficient,while it has a smaller impact on the average thrust coefficient and propulsive efficiency of heaving airfoils.

Cambro-Silurian magmatisms at the northern Gondwana margin(Penninic basement of the Ligurian Alps)

The Early Paleozoic evolution of the northern margin of Gondwana is characterized by several episodes of bimodal magmatism intruded or outpoured within thick sedimentary basins. These processes are well recorded in the Variscan blocks incorporated in the Ligurian Alps because they experienced low temperature Alpine metamorphism. During the Paleozoic, these blocks, together with the other Alpine basements, were placed between the Corsica-Sardinia and the Bohemian Massif along the northern margin of Gondwana. In this framework, they host several a variegated lithostratigraphy forming two main complexes(Complexs I and II) that can be distinguished by both the protoliths and their crosscutting relationships, which indicate that the acidic and mafic intrusives of Complex II cut an already folded sequence made of sediments, basalts and granitoids of Complex I. Both complexes were involved in the Variscan orogenic phases as highlighted by the pervasive eclogite-amphibolite facies schistosity(foliation II). However, rare relicts of a metamorphic foliation at amphibolite facies conditions(foliation I)is locally preserved only in the rocks of Complex I. It is debatable if this schistosity was produced during the early folding event e occurred between the emplacement of Complex I and II e rather than during an early stage of the Variscan metamorphic cycle.New SHRIMP and LA ICP-MS Ue Pb zircon dating integrated with literature data, provide emplacement ages of the several volcanic or intrusive bodies of both complexes. The igneous activity of Complex I is dated between 507 ± 15 Ma and 494 ± 5 Ma, while Complex II between 467 ± 12 Ma and 445.5 ± 12 Ma.The folding event recorded only by the Complex I should therefore have occurred between 494 ± 5 Ma and 467 ± 12 Ma. The Variscan eclogite-amphibolite facies metamorphism is instead constrained between ~420 Ma and ~300 Ma. These ages and the geochemical signature of these rocks allow constraining the Early Paleozoic tectono-magmatic evolution of the Ligurian blocks, from a middleeupper Cambrian rifting stage, through the formation of an Early Ordovician volcanic arc during the Rheic Ocean subduction, until a Late Ordovician extension related to the arc collapse and subsequent rifting of the PaleoThetys. Furthermore, the ~420-350 Ma ages from zircon rims testify to thermal perturbations that may be associated with the Silurian rifting-related magmatism, followed by the subduction-collisional phases of the Variscan orogeny.

The Impact of Delay in Software-Defined Integrated Terrestrial-Satellite Networks

Satellite communication networks have been evolving from standalone networks with ad-hoc infrastructures to possibly interconnected portions of a wider Future Internet architecture. Experts belonging to the fifth-generation(5 G) standardization committees are considering satellites as a technology to integrate in the 5 G environment. Software Defined Networking(SDN) is one of the paradigms of the next generation of mobile and fixed communications. It can be employed to perform different control functionalities, such as routing, because it allows traffic flow identification based on different parameters and traffic flow management in a centralized way. A centralized set of controllers makes the decisions and sends the corresponding forwarding rules for each traffic flow to the involved intermediate nodes that practically forward data up to the destination. The time to perform this process in integrated terrestrial-satellite networks could be not negligible due to satellite link delays. The aim of this paper is to introduce an SDN-based terrestrial satellite network architecture and to estimate the mean time to deliver the data of a new traffic flow from the source to the destination including the time required to transfer SDN control actions. The practical effect is to identify the maximum performance than can be expected.

Sofosbuvir/velpatasvir: A promising combination

Hepatitis C virus(HCV) affects 3% of the world population. It represents the main cause of chronic liver disease and is responsible for extra-hepatic complications, such as type 2 diabetes and cardiovascular diseases. HCV includes 7 genotypes differing in the nucleotide sequence variability, the geographic distribution, the rates of viral clearance, the risk of progression to liver fibrosis and to hepatocellular carcinoma, and the response to therapy. Last years have seen remarkable advances in the field of HCV infection with the approval of direct antiviral agents(DAAs) targeting key viral proteins involved in the HCV replication. Several oral regimens combining DAAs from different families have been developed and these regimens showed increased and sustained virological response rates to above 90% reducing the treatment duration to 12 wk or less. In particular, sofosbuvir, a nucleotide analogue nonstructural(NS)5B polymerase inhibitor, and velpatasvir, a NS5 A inhibitor, have been tested in two phase 3 trials, the ASTRAL-2(against HCV genotype 2) and the ASTRAL-3(against HCV genotype 3), demonstrating to be effective, safe, and well tolerated in patients who were 18 years of age or older and had at least a 6-mo history of HCV infection with a compensated liver disease.

U-Pb geochronology and geochemistry of late Palaeozoic volcanism in Sardinia(southern Variscides)

The latest Carboniferous to lower Permian volcanism of the southern Variscides in Sardinia developed in a regional continental transpressive and subsequent transtensile tectonic regime.Volcanism produced a wide range of intermediate-silicic magmas including medium-to high-K calc-alkaline andesites,dacites,and rhyolites.A thick late Palaeozoic succession is well exposed in the four most representative Sardinian continental basins(Nurra,Perdasdefogu,Escalaplano,and Seui-Seulo),and contains substantial stratigraphic,geochemical,and geochronological evidence of the area's complex geological evolution from the latest Carboniferous to the beginning of the Triassic.Based on major and trace element data and LA-ICP-MS U-Pb zircon dating,it is possible to reconstruct the timing of postVariscan volcanism.This volcanism records active tectonism between the latest Carboniferous and Permian,and post-dates the unroofing and erosion of nappes in this segment of the southern Variscides.In particular,igneous zircon grains from calc-alkaline silicic volcanic rocks yielded ages between299±1 and 288±3 Ma,thereby constraining the development of continental strike-slip faulting from south(Escalaplano Basin)to north(Nurra Basin).Notably,andesites emplaced in medium-grade metamorphic basement(Mt.Cobingius,Ogliastra)show a cluster of older ages at 332±12 Ma.Despite the large uncertainty,this age constrains the onset of igneous activity in the mid-crust.These new radiometric ages constitute:(1)a consistent dataset for different volcanic events;(2)a precise chronostratigraphic constraint which fits well with the biostratigraphic data and(3)insights into the plate reorganization between Laurussia and Gondwana during the late Palaeozoic evolution of the Variscan chain.

Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement:Report of a case

We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.

Resistance and Seakeeping Numerical Performance Analyses of a Semi-Small Waterplane Area Twin Hull at Medium to High Speeds

新半小的 waterplane 区域双胞胎壳(一行) 的水动力学分析对象小、中等的尺寸旅客渡船那样的各种各样的应用合适被介绍。这可以是源于合并二古典形状的一种吸引人的转线路配置：常规一行和快长筏。最后的壳设计与最大的横梁展出像楔的吃水线形状在严厉；壳与一个很狭窄的入口角度结束，有典型地代表一行容器的一个突出的球状的弓，并且展示完整对严厉安排 waterjet 推进器。我们与如此的建筑群执行对壳的水动力学表演的一个初步的评价的分析目的在常规头波浪在平静的水和经得起海上风浪的能力里以壳的抵抗塑造两个并且把表演与常规一行的作比较。分析用 preliminarily 在一个常规一行容器上被验证的一个边界元素方法被执行。

Evaluation of response to immune checkpoint inhibitors: Is there a role for positron emission tomography?

Strategies targeting intracellular negative regulators such as immune checkpoint inhibitors(ICPIs) have demonstrated significant antitumor activity across a wide range of solid tumors. In the clinical practice, the radiological effect of immunotherapeutic agents has raised several more relevant and complex challenges for the determination of their imaging-based response at single patient level. Accordingly, it has been suggested that the conventional Response Evaluation Criteria in Solid Tumors assessment alone, based on dimensional evaluation provided by computed tomography(CT), tends to underestimate the benefit of ICPIs at least in a subset of patients, supporting the need of immunerelated response criteria. Different from CT, very few data are available for the evaluation of immunotherapy by means of 18F-fluoro-2-deoxy-D-glucose positron emission tomography(FDG-PET). Moreover, since the antineoplastic activity of ICPIs is highly related to the activation of T cells against cancer cells, FDG accumulation might cause false-positive findings. Yet, discrimination between benign and malignant processes represents a huge challenge for FDG-PET in this clinical setting. Consequently, it might be of high interest to test the complex and variegated response to ICPIs by means of PET and thus it is worthwhile to ask if a similar introduction of immune-related PET-based criteria could be proposed in the future. Finally, PET might offer a new insight into the biology and pathophysiology of ICPIs thanks to a growing number of non-invasive immunediagnostic approaches based on non-FDG tracers.

Vibration Analysis for the Comfort Assessment of Superyachts

Comfort levels on modern superyachts have recently been the object of specific attention of the most important Classification Societies, which issued new rules and regulations for evaluating noise and vibration maximum levels. These rules are named "Comfort Class Rules" and set the general criteria for noise and vibration measurements in different vessels' areas, as well as the maximum noise and vibration limit values. As far as the vibration assessment is concerned, the Comfort Class Rules follow either the ISO 6954:1984 standard or the ISO 6954:2000. After an introduction to these relevant standards, the authors herein present a procedure developed to predict the vibration levels on ships. This procedure builds on finite element linear dynamic analysis and is applied to predict the vibration levels on a 60 m superyacht considered as a case study. The results of the numerical simulations are then benchmarked against experimental data acquired during the sea trial of the vessel. This analysis also allows the authors to evaluate the global damping ratio to be used by designers in the vibration analysis of superyachts.

Coronary stenting:A matter of revascularization

In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention(PCI) and the use of balloon catheters, bare metal stents(BMSs), and drug-eluting stents(DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion restenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of instent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a renarrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced restenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and antiproliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy(DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.