[Strategies for reducing door to balloon time in patients with acute myocardial infarction undergoing primary angioplasty: the Pavia experience]

BACKGROUND

Primary percutaneous coronary intervention (pPCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) if performed by an experienced team within 120 min of first medical contact. The door to balloon time (DTB) has become a performance measure and is the focus of local, regional and national quality improvement initiatives. The primary objective of the present study was to evaluate whether the implementation of reperfusion strategies could result in shorter DTB times.

METHODS

In 2007, at the cath lab of the IRCCS Policlinico San Matteo (a hub of a network including 7 spoke centers), 245 pPCI were performed with a median DTB time of 116 (25th-75th percentile, 96-155) min, and <90 min only in 20% of cases. To improve time to reperfusion, the following strategies were adopted in 2010 and 2011: direct access to the cath lab without initial coronary care unit admission; activation of the cath lab based on pre-hospital ECG; a faster triage with ECG performed within 10 min and use of a dedicated ambulance for patients presenting directly to the emergency room (ER) of the hub.

RESULTS

Overall, 226 and 258 pPCI were performed in 2010 and 2011, respectively, with no differences in type of hospital admission (emergency medical service, ER, or spoke) compared with 2007. A significant DTB reduction was observed (2007 vs 2010 vs 2011: 116 [96-155] vs 99 [77-129] vs 97 [80-125] min, p<0.0001), with a significant improvement in the number of patients treated within 90 min (20 vs 41 vs 40%, p<0.0001) as a result of a significant reduction in the time from first medical contact to cath lab (86 [64-124] vs 66 [50-93] vs 62 [46-93] min, p<0.0001). By analyzing only data from 2010 and 2011, median DTB was 88 (73-104) min for patients arriving through the emergency medical service, 139 (116-179) min for patients presenting to spoke centers, and 96 (75-126) min for patients presenting to the ER, with pPCI performed within 90 min in 55%, 8% e 42% of cases, respectively. The longer DTB time of the spoke centers was solely due to transportation to the hub (emergency medical service vs spoke: 56 [42-68] vs 106 [86-147] min, p<0.0001), with no differences in time to reperfusion once the cath lab was reached.

CONCLUSIONS

Based on our strategies and experience including 729 STEMI patients treated with pPCI in 2007, 2010 and 2011, a significant improvement in DTB time was achieved. The main factor affecting our results is transportation to the cath lab for patients with direct access to spoke centers. Further exploration and advocacy for DTB implementation in these patients are warranted.

Measurement of power spectral density of broad-spectrum visible light with heterodyne near field scattering and its scalability to betatron radiation

We exploit the speckle field generated by scattering from a colloidal suspension to access both spatial and temporal coherence properties of broadband radiation. By applying the Wiener-Khinchine theorem to the retrieved temporal coherence function, information about the emission spectrum of the source is obtained in good agreement with the results of a grating spectrometer. Experiments have been performed with visible light. We prove more generally that our approach can be considered as a tool for modeling a variety of cases. Here we discuss how to apply such diagnostics to broad-spectrum betatron radiation produced in the laser-driven wakefield accelerator under development at SPARC LAB facility in Frascati.

Analogical optical modeling of the asymmetric lateral coherence of betatron radiation

By exploiting analogical optical modeling of the radiation emitted by ultrarelativistic electrons undergoing betatron oscillations, we demonstrate peculiar properties of the spatial coherence through an interferometric method reminiscent of the classical Young's double slit experiment. The expected effects due to the curved trajectory and the broadband emission are accurately reproduced. We show that by properly scaling the fundamental parameters for the wavelength, analogical optical modeling of betatron emission can be realized in many cases of broad interest. Applications to study the feasibility of future experiments and to the characterization of beam diagnostics tools are described.

Two-Color Radiation Generated in a Seeded Free-Electron Laser with Two Electron Beams

We present the experimental evidence of the generation of coherent and statistically stable two-color free-electron laser radiation obtained by seeding an electron beam double peaked in energy with a laser pulse single spiked in frequency. The radiation presents two neat spectral lines, with time delay, frequency separation, and relative intensity that can be accurately controlled. The analysis of the emitted radiation shows a temporal coherence and a shot-to-shot regularity in frequency significantly enhanced with respect to the self-amplified spontaneous emission.

[ST-elevation acute myocardial infarction with a coronary artery aneurysm as the culprit lesion]

The incidence of coronary artery aneurysms (CAA) in the general population ranges from 0.3% to 5.3%. Although CAA may cause thrombus formation or undergo progressive expansion with subsequent rupture, their natural history remains largely unknown. Appropriate treatment, including percutaneous, surgical or conservative management, may be challenging, particularly in acute settings. We describe the acute management of two patients with ST-elevation myocardial infarction where CAA was identified as the culprit lesion.

Novel schemes for the optimization of the SPARC narrow band THz source

A pulsed, tunable, narrow band radiation source with frequency in the THz region can be obtained collecting the coherent transition radiation produced by a train of ultra-short electron bunches having picosecond scale inter-distance. In this paper, we review the techniques feasible at the SPARC_LAB test facility to produce and manipulate the requested train of electron bunches and we examine the dynamics of their acceleration and compression. In addition, we show how the performances of the train compression and the radiation intensity and bandwidth can be significantly improved through the insertion of a fourth order harmonic cavity, working in the X-band and acting as a longitudinal phase space linearizer.

Performance analysis of communication links based on VCSEL and silicon photonics technology for high-capacity data-intensive scenario

To face the increased demand for bandwidth, cost-effectiveness and simplicity of future Ethernet data communications, a comparison between two different solutions based on directly-modulated VCSEL sources and Silicon Photonics technologies is carried out. Also by exploiting 4-PAM modulation, the transmission of 50-Gb/s and beyond capacity per channel is analyzed by means of BER performance. Applications for optical backplane, very short reach and in case of client-optics networks and intra and inter massive data centers communications (up to 10 km) are taken into account. A comparative analysis based on the power consumption is also proposed.

Dosimetry of very high energy electrons (VHEE) for radiotherapy applications: using radiochromic film measurements and Monte Carlo simulations

Very high energy electrons (VHEE) in the range from 100-250 MeV have the potential of becoming an alternative modality in radiotherapy because of their improved dosimetry properties compared with MV photons from contemporary medical linear accelerators. Due to the need for accurate dosimetry of small field size VHEE beams we have performed dose measurements using EBT2 Gafchromic® film. Calibration of the film has been carried out for beams of two different energy ranges: 20 MeV and 165 MeV from conventional radio frequency linear accelerators. In addition, EBT2 film has been used for dose measurements with 135 MeV electron beams produced by a laser-plasma wakefield accelerator. The dose response measurements and percentage depth dose profiles have been compared with calculations carried out using the general-purpose FLUKA Monte Carlo (MC) radiation transport code. The impact of induced radioactivity on film response for VHEEs has been evaluated using the MC simulations. A neutron yield of the order of 10(-5) neutrons cm(-2) per incident electron has been estimated and induced activity due to radionuclide production is found to have a negligible effect on total dose deposition and film response. Neutron and proton contribution to the equivalent doses are negligible for VHEE. The study demonstrates that EBT2 Gafchromic film is a reliable dosimeter that can be used for dosimetry of VHEE. The results indicate an energy-independent response of the dosimeter for 20 MeV and 165 MeV electron beams and has been found to be suitable for dosimetry of VHEE.

Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data

BACKGROUND

Erythropoiesis-stimulating agents (ESAs) have been investigated in small studies in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Erythropoiesis-stimulating agents did not show a clear effect on left ventricular function or clinical outcome, but some studies suggested an increased risk of thromboembolic events.

METHODS

A systematic literature search in MEDLINE was performed, until December 2012. We included randomized clinical trials investigating the effect of ESAs in STEMI patients undergoing primary PCI, with ≥30 days of follow-up. The primary end point was a composite of all-cause mortality, myocardial infarction, and stent thrombosis after PCI. Secondary end point was all-cause mortality.

RESULTS

Individual patient data were obtained from 10 of 11 trials, including 97.3% (1,242/1,277) of all patients randomized to control (n = 600) or to ESAs (n = 642). Baseline characteristics were well balanced between the treatment allocations. Mean follow-up time was 248 (±131) days. The primary end point occurred in 3.5% (20/577) in the control group and in 2.1% (13/610) in the ESA group (hazard ratio for ESAs, 0.63; 95% CI [0.31-1.27]; P = .20). Mortality occurred in 13 (2.3%) in the control group and 5 (0.8%) in the ESA group (hazard ratio for ESAs, 0.38; 95% CI [0.13-1.06]; P = .06).

CONCLUSIONS

Erythropoiesis-stimulating agent administration does not result in an increased risk of adverse cardiac events in STEMI patients undergoing primary PCI. Results of ongoing studies may provide further insight to the potential beneficial clinical effects of ESAs in STEMI patients.

Coronary plaque ulceration documented at sequential angiography and confirmed by optical coherence tomography in a patient with recurrent acute coronary syndrome

: A 51-year-old man was hospitalized for recurrence of acute coronary syndrome after few months. Coronary angiography during first hospitalization showed no significant coronary stenosis, while the second time, right coronary artery presented an expansion at the proximal segment. Optical coherence tomography documented a long fibroatheroma with an ulceration and residual white thrombus.

Liver transplantation in children weighing less than 10 kg: Chilean experience

BACKGROUND

Orthotopic liver transplantation is the treatment of choice for most terminal liver diseases in children. In small children (≤ 10 kg), this procedure is challenging and has special considerations. The aim of this study is to describe the experience of a Chilean liver transplantation program in this subgroup of patients.

METHODS

The liver transplant database of Hospital Luis Calvo Mackenna and Clinica Las Condes was reviewed. All children less than 10 kg undergoing liver transplantation between January 1994 and July 2011 were included. Patient and graft outcomes and main complications were analyzed.

RESULTS

We have performed 230 pediatric liver transplantations, 49 of them in 41 patients weighing less than 10 kg. The first indication for transplantation was biliary atresia in 25 patients (61%). A living related donor was used in 23 cases (51%). Actuarial survival was 75.7% at 1 year and 67.1% at 5 years. The main cause of death was infection, and the leading cause of graft loss was vascular complication.

DISCUSSION

Our transplant program includes 2 centers that perform more than 90% of pediatric liver transplantations in Chile, including public health pediatric patients from all around the country. Patients weighing less than 10 kg represent the most challenging group in pediatric liver transplantation due to higher rates of vascular and biliary complications and postoperative infections.

Remote ischemic post-conditioning of the lower limb during primary percutaneous coronary intervention safely reduces enzymatic infarct size in anterior myocardial infarction: a randomized controlled trial

OBJECTIVES

This study sought to evaluate whether remote ischemic post-conditioning (RIPC) could reduce enzymatic infarct size in patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI).

BACKGROUND

Myocardial reperfusion injury may attenuate the benefit of pPCI. In animal models, RIPC mitigates myocardial reperfusion injury.

METHODS

One hundred patients with anterior ST-segment elevation myocardial infarction and occluded left anterior descending artery were randomized to pPCI + RIPC (n = 50) or conventional pPCI (n = 50). RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb. The primary endpoint was infarct size assessed by the area under the curve of creatinine kinase-myocardial band release (CK-MB). Secondary endpoints included the following: infarct size assessed by cardiac magnetic resonance delayed enhancement volume; T2-weighted edema volume; ST-segment resolution >50%; TIMI (Thrombolysis In Myocardial Infarction) frame count; and myocardial blush grading.

RESULTS

Four patients (2 RIPC, 2 controls) were excluded due to missing samples of CK-MB. A total of 96 patients were analyzed; median area under the curve CK-MB was 8,814 (interquartile range [IQR]: 5,567 to 11,325) arbitrary units in the RIPC group and 10,065 (IQR: 7,465 to 14,004) arbitrary units in control subjects (relative reduction: 20%, 95% confidence interval: 0.2% to 28.7%; p = 0.043). Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after randomization, and 66 patients repeated a second scan after 4 months. T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects (p = 0.049). ST-segment resolution >50% was 66% in RIPC and 37% in control subjects (p = 0.015). We observed no significant differences in TIMI frame count, myocardial blush grading, and delayed enhancement volume.

CONCLUSIONS

In patients with anterior ST-segment elevation myocardial infarction, RIPC at the time of pPCI reduced enzymatic infarct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution >50%. (Remote Postconditioning in Patients With Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention [PCI] [RemPostCon]; NCT00865722).

Application of dynamical analyses of heart rate to rhythm classification and prognosis

We have developed numerical approaches to dynamical analysis of heart rates, measured as interbeat or RR, intervals, based on entropy and fluctuation analyses in a large data base of consecutive Holter monitor recordings. In Part I, we present a RR interval-based classifier that distinguishes normal sinus rhythm (NSR), atrial fibrillation (AF) and sinus rhythm with ectopy with an accuracy of 99%, 81% and 77%respectively, using 10-minute segments. In Part II, we present 2-year mortality estimation based on the entropy calculations. The major finding is that normal dynamics identify a very low risk group. Taken together, these results point to automated analysis of heart rate time series with important clinical applications.

Two color free-electron laser and frequency beating

We review the theory of two color high gain free-electron laser emission, derive the integral equation characterizing the evolution of the optical intensities, and provide a description of the relevant dynamics. The characteristic feature of this regime is the existence of a mutual bunching, whose origin and role are discussed.

Observation of time-domain modulation of free-electron-laser pulses by multipeaked electron-energy spectrum

We present the experimental demonstration of a new scheme for the generation of ultrashort pulse trains based on free-electron-laser (FEL) emission from a multipeaked electron energy distribution. Two electron beamlets with energy difference larger than the FEL parameter ρ have been generated by illuminating the cathode with two ps-spaced laser pulses, followed by a rotation of the longitudinal phase space by velocity bunching in the linac. The resulting self-amplified spontaneous emission FEL radiation, measured through frequency-resolved optical gating diagnostics, reveals a double-peaked spectrum and a temporally modulated pulse structure.

Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center

BACKGROUND

The prevalence and natural history of Graves' orbitopathy (GO) are poorly documented.

METHODS

A large series of 346 patients with newly diagnosed and recent onset Graves' hyperthyroidism seen at a single (nontertiary referral) center over an 8-year period were enrolled in an observational prospective study and evaluated for GO activity and severity according to the EUGOGO (European Group on Graves' Orbitopathy) criteria. After excluding patients immediately treated for moderate-to-severe GO, patients undergoing total thyroidectomy or radioactive iodine treatment, and patients lost to follow-up, 237 patients were submitted to antithyroid drug (ATD) treatment, with ocular evaluation at 6, 12, and 18 months.

RESULTS

Among the whole cohort, at presentation 255 (73.7%) had no ocular involvement, 70 (20.2%) had mild and inactive GO, 20 (5.8%) had moderate-to-severe and active GO, and 1 (0.3%) had sight-threatening GO with dysthyroid optic neuropathy. Of the 237 patients who completed the 18-month follow-up during or after ATD treatment, 194 (81.9%) had no GO at baseline. Progression to moderate-to-severe GO occurred in 5 (2.6%) of these patients. Of the 43 (18.1%) patients with mild and inactive GO at baseline, 1 (2.4%) progressed to moderate-to-severe GO, and 25 (58.1%) experienced complete remission.

CONCLUSIONS

Most patients with newly diagnosed Graves' disease have no ocular involvement. Moderate-to-severe and active GO or sight-threatening GO are rare at presentation and rarely develop during ATD treatment. Most patients (>80%) with no GO at baseline do not develop GO after an 18-month follow-up period. Remission of mild GO occurs in the majority of cases.

Characterization of the THz radiation source at the Frascati linear accelerator

The linac driven coherent THz radiation source at the SPARC-LAB test facility is able to deliver broadband THz pulses with femtosecond shaping. In addition, high peak power, narrow spectral bandwidth THz radiation can be also generated, taking advantage of advanced electron beam manipulation techniques, able to generate an adjustable train of electron bunches with a sub-picosecond length and with sub-picosecond spacing. The paper reports on the manipulation, characterization, and transport of the electron beam in the bending line transporting the beam down to the THz station, where different coherent transition radiation spectra have been measured and studied with the aim to optimize the THz radiation performances.

Superradiant cascade in a seeded free-electron laser

We report measurements demonstrating the concept of the free-electron laser (FEL) superradiant cascade. Radiation (λ(rad) = 200 nm) at the second harmonic of a short, intense seed laser pulse (λ(seed) = 400 nm) was generated by the cascaded FEL scheme at the transition between the modulator and radiator undulator sections. The superradiance of the ultrashort pulse is confirmed by detailed measurements of the resulting spectral structure, the intensity level of the produced harmonics, and the trend of the energy growth along the undulator. These results are compared to numerical particle simulations using the FEL code GENESIS 1.3 and show a satisfactory agreement.

Differences in Expression, Content, and Activity of 11β-HSD1 in Adipose Tissue between Obese Men and Women

Cortisol production in adipose tissue is regulated by 11β-HSD1. Objective. To determine whether there are differences in gene expression, enzyme activity, and protein content of the 11β-HSD1 enzyme in VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) from obese compared to nonobese adults. Methods. VAT and SAT samples were obtained from 32 obese subjects (BMI > 30 Kg/m²) who underwent bariatric surgery and 15 samples from controls submitted to elective surgery. Fasting serum glucose, insulin, and lipids were measured. The expression of 11β-HSD1 was determined by RT-PCR, the enzyme activity by thin-layer chromatography, and the protein content by Western blot. Results. Obese patients had higher cholesterol, insulin, and HOMA-IR compared to nonobese. There were no differences in VAT or SAT expression of 11β-HSD1 between obese and nonobese patients. However, we found lower 11β-HSD1 activity and protein content in VAT, in obese women versus nonobese women (P < 0.05). BMI and 11β-HSD1 enzyme activity and protein content in VAT correlated inversely in women. Conclusions. Regulation of 11β-HSD1 activity in VAT from obese subjects appears to be gender specific, suggesting the existence of a possible protective mechanism modulating this enzyme activity leading to a decrease in the production of cortisol in this tissue.

Early onset of puberty in young girls: an Italian cross-sectional study

BACKGROUND

International literature and clinical practice have referred to Marshall and Tanner data to define the physiological age at onset of puberty. A study in the United States (1997) showed an anticipation in pubertal onset, whereas several European studies did not confirm this trend.

AIM

To describe the onset of secondary sexual characteristics in a large Italian population of girls and to compare it to reference literature data.

SUBJECTS AND METHODS

A cross-sectional study on 7311 2-14-yr-old girls who spontaneously requested a clinical evaluation for routine health check-up or acute illness by family pediatrician's offices in a northern Italian region (Lombardy), between September 2005 and November 2006. Trained family pediatricians performed a complete physical examination; pubertal status was evaluated following Tanner's criteria; breast development was assessed by palpation.

RESULTS

Mean age of thelarche (B2), pubarche (PH2), menarche were 9.75, 10.09, and 12.49 yr, respectively. The prevalence of B2 and PH2 at ages 7-7.99 was 5.9% and 5.6%, respectively, at ages 8-8.99 was 15.5% and 13.8%, respectively. Mean time lapse from B2 to B3 and B2 to menarche was 1.46 and 2.74 yr, respectively. Mean age at menarche of our population and their respective mothers was almost identical.

CONCLUSIONS

Our population presented earlier clinical signs of pubertal development than those defined by Marshall and Tanner. Mean age of menarche was not different in comparison to the previous generation. A different progression of pubertal development was found, in which the shift to B3 may have more clinical relevance.

Telefetalcare: a first prototype of a wearable fetal electrocardiograph

Fetal heart rate monitoring is fundamental to infer information about fetal health state during pregnancy. The cardiotocography (CTG) is the most common antepartum monitoring technique. Abdominal ECG recording represents the most valuable alternative to cardiotocography, as it allows passive, non invasive and long term fetal monitoring. Unluckily fetal ECG has low SNR and needs to be extracted from abdominal recordings using ad hoc algorithms. This work describes a prototype of a wearable fetal ECG electrocardiograph. The system has flat band frequency response between 1-60 Hz and guarantees good signal quality. It was tested on pregnant women between the 30(th) and 34(th) gestational week. Several electrodes configurations were tested, in order to identify the best solution. Implementation of a simple algorithm for FECG extraction permitted the reliable detection of maternal and fetal QRS complexes. The system will allow continuative and deep screening of fetal heart rate, introducing the possibility of home fetal monitoring.

Advances in monitoring cardiovascular signals. Contribution of nonlinear signal processing

Monitoring procedures are the basis to evaluate the clinical state of patients and to assess changes in their status, thus providing necessary interventions in time. To obtain this important objective it is necessary to integrate technological development with systems performing biomedical knowledge extraction and classification. Methods extracting non linear characteristics from HRV signal are presented and discussed to stress that integrated and multiparametric signal processing approaches can contribute to new diagnostic and classification indices. Examples report heart rate variability analysis in long periods in patients with cardiovascular disease. Fetal ECG monitoring is another example. In this case, coupling nonlinear parameters and linear time and frequency techniques increases diagnostic power and reliability of the monitoring. The paper shows that integrated signal analysis is very helpful to describe pathophysiological mechanisms involved in the cardiovascular and neural system control. It is a reliable basis to set up knowledge-based monitoring systems.

High-order-harmonic generation and superradiance in a seeded free-electron laser

Higher order harmonic generation in a free-electron laser amplifier operating in the superradiant regime [R. H. Dicke, Phys. Rev. 93, 99 (1954).] has been observed. Superradiance has been induced by seeding a single-pass amplifier with the second harmonic of a Ti:sapphire laser, generated in a β-Barium borate crystal, at seed intensities comparable to the free-electron laser saturation intensity. Pulse energy and spectral distributions of the harmonics up to the 11th order have been measured and compared with simulations.

Percutaneous hepatic pseudoaneurysm exclusion using a pericardium covered stent

Visceral artery pseudoaneurysms (PA) are a rare complication of abdominal surgery. Their natural history is generally unknown and unpredictable, so a repair is recommended. We report the case of a 77-year-old male with a huge PA of the hepatic artery diagnosed by computed tomography (CT) and treated successfully with percutaneous exclusion using a pericardium-covered stent. A staged CT confirmed the good result of the procedure.

Predictive modeling of cardiovascular complications in incident hemodialysis patients

The administration of hemodialysis (HD) treatment leads to the continuous collection of a vast quantity of medical data. Many variables related to the patient health status, to the treatment, and to dialyzer settings can be recorded and stored at each treatment session. In this study a dataset of 42 variables and 1526 patients extracted from the Fresenius Medical Care database EuCliD was used to develop and apply a random forest predictive model for the prediction of cardiovascular events in the first year of HD treatment. A ridge-lasso logistic regression algorithm was then applied to the subset of variables mostly involved in the prediction model to get insights in the mechanisms underlying the incidence of cardiovascular complications in this high risk population of patients.

High-gain harmonic-generation free-electron laser seeded by harmonics generated in gas

The injection of a seed in a free-electron laser (FEL) amplifier reduces the saturation length and improves the longitudinal coherence. A cascaded FEL, operating in the high-gain harmonic-generation regime, allows us to extend the beneficial effects of the seed to shorter wavelengths. We report on the first operation of a high-gain harmonic-generation free-electron laser, seeded with harmonics generated in gas. The third harmonics of a Ti:sapphire laser, generated in a gas cell, has been amplified and up-converted to its second harmonic (λ(rad)=133 nm) in a FEL cascaded configuration based on a variable number of modulators and radiators. We studied the transition between coherent harmonic generation and superradiant regime, optimizing the laser performances with respect to the number of modulators and radiators.

Influence of 9p21.3 genetic variants on clinical and angiographic outcomes in early-onset myocardial infarction

OBJECTIVES

The purpose of this study was to test whether the 9p21.3 variant rs1333040 influences the occurrence of new cardiovascular events and coronary atherosclerosis progression after early-onset myocardial infarction.

BACKGROUND

9p21.3 genetic variants are associated with ischemic heart disease, but it is not known whether they influence prognosis after an acute coronary event.

METHODS

Within the Italian Genetic Study of Early-onset Myocardial Infarction, we genotyped rs1333040 in 1,508 patients hospitalized for a first myocardial infarction before the age of 45 years who underwent coronary angiography without index event coronary revascularization. They were followed up for major cardiovascular events and angiographic coronary atherosclerosis progression.

RESULTS

Over 16,599 person-years, there were 683 cardiovascular events and 492 primary endpoints: 77 cardiovascular deaths, 223 reoccurrences of myocardial infarction, and 383 coronary artery revascularizations. The rs1333040 genotype had a significant influence (p = 0.01) on the primary endpoint, with an adjusted hazard ratio of 1.19 (95% confidence interval [CI]: 1.08 to 1.37) for heterozygous carriers and 1.41 (95% CI: 1.06 to 1.87) for homozygous carriers. Analysis of the individual components of the primary endpoints provided no significant evidence that the rs1333040 genotype influenced the hazard of cardiovascular death (p = 0.24) or the reoccurrence of myocardial infarction (p = 0.57), but did provide significant evidence that it influenced on the hazard of coronary revascularization, with adjusted heterozygous and homozygous ratios of 1.38 (95% CI: 1.17 to 1.63) and 1.90 (95% CI: 1.36 to 2.65) (p = 0.00015), respectively. It also significantly influenced the angiographic endpoint of coronary atherosclerosis progression (p = 0.002).

CONCLUSIONS

In early-onset myocardial infarction, the 9p21.3 variant rs1333040 affects the progression of coronary atherosclerosis and the probability of coronary artery revascularization during long-term follow-up.

Body composition and heart rate variability to achieve dry weight and tolerance

Autonomic dysfunction in patients with end- stage renal disease is associated with poor prognosis. Heart rate variability (HRV), determined by the standard deviation of the normal R- R interval, has been reported to be a useful evaluation of cardiac autonomic modulation. The relationship between HRV and hydration status (HS) can be analyzed by whole body bioimpedance spectroscopy. This allows a classification of patients according the combination of HS with predialysis systolic blood pressure. Differences in HRV can be studied in patients with high over hydration, but normal or low blood pressure, with respect to fluid-overloaded/hypertensive patients and normohydrated/normotensive patients. In conclusion, the assessment of the autonomic nervous system response to the hemodialysis treatment in end- stage renal disease patients, classified according to a reliable and quantitative measurement of their fluid overload, could permit better management of both arterial blood pressure and HS.

Self-amplified spontaneous emission free-electron laser with an energy-chirped electron beam and undulator tapering

We report the first experimental implementation of a method based on simultaneous use of an energy chirp in the electron beam and a tapered undulator, for the generation of ultrashort pulses in a self-amplified spontaneous emission mode free-electron laser (SASE FEL). The experiment, performed at the SPARC FEL test facility, demonstrates the possibility of compensating the nominally detrimental effect of the chirp by a proper taper of the undulator gaps. An increase of more than 1 order of magnitude in the pulse energy is observed in comparison to the untapered case, accompanied by FEL spectra where the typical SASE spiking is suppressed.

Familial aggregation of early-onset myocardial infarction

BACKGROUND

An inherited predisposition is an important factor in the etiology of myocardial infarction (MI) at a young age. However, the extent of the risk for early-onset MI in relatives of young patients is still unclear, due to the paucity of family history data. Hence familial aggregation of early-onset MI was investigated in a cohort of relatives of Italian patients who had survived MI who occurred at the age of 45 or earlier.

METHODS

In the framework of a case-control study, lifetime data and early-onset MI status for 11,696 relatives of cases and 8897 relatives of controls were collected using a standardized questionnaire.

RESULTS

Occurrence of early-onset MI in females was very uncommon (Kaplan-Meier risk=0.6%, 95% confidence interval (CI): 0.38-0.82%, for female case relatives), and significantly lower than that for male case relatives (5.0%, 95% CI: 4.41-5.56%). The hazard ratio (HR) for case relatives was approximately 3-fold greater than that for control aunts (taken as reference category). Risk for early-onset MI to siblings (HR=1.7, 95% CI: 1.33-2.18) was significantly different from that to parents (HR=0.9, 95% CI: 0.71-1.16). The familial risk ratio λ(R) was 2.6 (95% CI: 2.30-2.89) for case relatives, using control parents as reference population for early-onset MI risk estimates (i.e. 37 per 100,000 in fathers and 7 per 100,000 in mothers).

CONCLUSION

We evaluated the risk of early-onset MI by category of relatives, obtaining evidence for familial aggregation of the disease in this Italian sample and providing figures for genetic counselling and planning genetic epidemiological studies.

Chilean experience in liver transplantation for acute liver failure in children

BACKGROUND

Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results.

PATIENTS AND METHODS

Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted.

RESULTS

Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%.

CONCLUSION

We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.

Impact of time-interleaving on directly-detected 100-Gb/s POLMUX RZ-DQPSK robustness to PDL-induced crosstalk

The impact of PDL-induced crosstalk on 100-Gb/s POLMUX RZ-DQPSK performance is investigated both experimentally and through numerical simulations in direct detection systems. We found that RZ time-interleaving, contrary to what happens with PMD, features a strong robustness to PDL. The detrimental effect of optical narrow filtering on PDL-induced penalty is also analyzed; RZ time-interleaving still proves the best solution to deal with the PDL issue.

Multiphoton photoemission from a copper cathode illuminated by ultrashort laser pulses in an RF photoinjector

In this Letter we report on the use of ultrashort infrared laser pulses to generate a copious amount of electrons by a copper cathode in an rf photoinjector. The charge yield verifies the generalized Fowler-Dubridge theory for multiphoton photoemission. The emission is verified to be prompt using a two pulse autocorrelation technique. The thermal emittance associated with the excess kinetic energy from the emission process is comparable with the one measured using frequency tripled uv laser pulses. In the high field of the rf gun, up to 50 pC of charge can be extracted from the cathode using a 80 fs long, 2 microJ, 800 nm pulse focused to a 140 mum rms spot size. Taking into account the efficiency of harmonic conversion, illuminating a cathode directly with ir laser pulses can be the most efficient way to employ the available laser power.

Experimental demonstration of emittance compensation with velocity bunching

In this Letter we report the first experiments aimed at the simultaneous demonstration of the emittance compensation process and velocity bunching in a high brightness electron source, the SPARC photoinjector in INFN-LNF. While a maximum compression ratio up to a factor 14 has been observed, in a particular case of interest a compression factor of 3, yielding a slice current of 120 A with less than 2 microm slice emittance, has been measured. This technique may be crucial in achieving high brightness beams in photoinjectors aiming at optimized performance of short wavelength single-pass free electron lasers or other advanced applications in laser-plasma accelerators.

All-optical wavelength conversion of a 100-Gb/s polarization-multiplexed signal

We present the results of an in-depth experimental investigation about all-optical wavelength conversion of a 100-Gb/s polarization-multiplexed (POLMUX) signal. Each polarization channel is modulated at 25 Gbaud by differential quadrature phase-shift keying (DQPSK). The conversion is realized exploiting the high nonlinear chi((2)) coefficient of a periodically poled lithium niobate waveguide, in a polarization-independent configuration. We find that slight non-idealities in the polarization independent setup of the wavelength converter can significantly impair the performance of POLMUX systems. We show that high-quality wavelength conversion can be nevertheless achieved for both the polarization channels, provided that an accurate optimization of the setup is performed. This is the first demonstration, to the best of our knowledge, of the possibility to obtain penalty-free all-optical wavelength conversion in a 100-Gb/s POLMUX transmission system using direct-detection.

Impact of Rayleigh backscattering on Stimulated Brillouin Scattering threshold evaluation for 10 Gb/s NRZ-OOK signals

At bit rates comparable with the Brillouin shift, i.e. higher than 10 Gbit/s, the signal and the Brillouin backscattered spectra partially overlap. This implies an interaction between different scattering phenomena occurring through out the optical fiber. In particular we believe that an evaluation of how Rayleigh backscattered components of the modulated signal are subjected to Stokes gain is required. This interaction may lead to an increased backscattered power, which in turn will affect Brillouin threshold estimation. We experimentally verified a decrease of Stimulated Brillouin Scattering (SBS) threshold for 10 Gb/s NRZ-OOK signals with respect to theoretical predictions. Simulations carried out with a numerical model of SBS, accounting for Rayleigh contributions, well predict measured backscattered power levels. On the other hand we also experimentally verified that this SBS threshold decrease does not degrade transmission system performance. Indeed, measured BER curves put into evidence a penalty reduction for signal powers just before the saturation regime, which should be usefully taken into consideration in optical systems power budget planning.

Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells

Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.

Mortality and coronary events in two Italian MONICA areas: area Latina and area Brianza

In Italy three areas have been enrolled in the MONICA Project, two being located in Northern Italy (Area Brianza and Area Friuli) and one in Central Italy (Area Latina). This report concerns the comparison of the first year mortality and registration data of two areas, Area Latina (1983) and Area Brianza (1985), for men and women aged 25-64. In Area Latina, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 483, 83 and 42 per 100,000 for males, and 252, 14 and 32 per 100,000 for females. In Area Brianza, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 541, 94 and 38 per 100,000 for males, and 249, 19 and 24 per 100,000 for females. For males the attack rate for coronary events is similar in Area Latina and Area Brianza but the distribution of events in the several diagnostic categories is different. For females the coronary attack rate is higher in Area Latina than in Area Brianza. The implications of these data are discussed mainly from the methodological point of view.