Diabetes does not impact the diagnostic performance of contrast-based fractional flow reserve: insights from the CONTRAST study

Background: Adenosine-free coronary pressure wire metrics have been proposed to test the functional significance of coronary artery lesions, but it is unexplored whether their diagnostic performance might be altered in patients with diabetes. Methods: We performed a post-hoc analysis of the CONTRAST study, which prospectively enrolled an international cohort of patients undergoing routine fractional flow reserve (FFR) assessment for standard indications. Paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, contrast-based FFR, and FFR) were made. A central core laboratory analyzed blinded pressure tracings in a standardized fashion. Results: Of 763 subjects enrolled at 12 international centers, 219 (29%) had diabetes. The two groups were wellbalanced for age, clinical presentation (stable or unstable), coronary vessel studied, volume and type of intracoronary contrast, and volume of intracoronary adenosine. A binary threshold of cFFR ≤ 0.83 produced an accuracy superior to both Pd/Pa and iFR when compared with FFR ≤ 0.80 in the absence of significant interaction with diabetes status; indeed, accuracy in subgroups of patients with or without diabetes was similar for cFFR (86.7 vs 85.4% respectively; p = 0.76), iFR (84.2 vs 80.0%, p = 0.29) and Pd/Pa (81.3 vs 78.9%, p = 0.55). There was no significant heterogeneity between patients with or without diabetes in terms of sensitivity and specificity of all metrics. The area under the receiver operating characteristic (ROC) curve was largest for cFFR compared with Pd/Pa and iFR which were equivalent (cFFR 0.961 and 0.928; Pd/Pa 0.916 and 0.870; iFR 0.911 and 0.861 in diabetic and non-diabetic patients respectively). Conclusions: cFFR provides superior diagnostic performance compared with Pd/Pa or iFR for predicting FFR irrespective of diabetes (clinicaltrials.gov identifier NCT02184117)

Ankle/brachial index to everyone.

In the last years significant attention has been paid in identifying markers of subclinical atherosclerosis or of increased cardiovascular risk. Method An abnormal ankle/brachial index (ABI) identifies patients affected by lower extremity peripheral arterial disease, and even more important, represents a powerful predictor of the development of future ischemic cardiovascular events. Conclusions In our opinion, ABI is a cardiovascular risk prediction tool with very desirable properties that might become a routine measurement in clinical practice

Identification of a 4.3 billion year old asteroid family and planetesimal population in the Inner Main Belt

After performing a reassessment of the known dynamical asteroid families in the inner main belt, we report a newly discovered ancient asteroid family with an estimated age of $4.3\pm1.7$ billion years. Additionally, we report the most comprehensive list of planetesimals, which are asteroids that survived since the planet forming days of the solar system.Comment: 21 pages, 13 figure

LADE: a mobile habitat paving the way for sustained lunar exploration

Since Apollo missions, robotic exploration of deep space has seen decades of technological advancement and scientific discoveries. Today, NASA’s Artemis Program is envisioning a plan to drive humanity to live on the Moon. Indeed, the possibility of building a permanent settlement on the Moon is still a major challenge. In this framework, Alta Scuola Politecnica and Thales Alenia Space partnered to design a novel agile habitat through a holistic multidisciplinary approach to allow crewed surface exploration missions. Lunar Architecture Design Exploration (LADE) project’s output is a mobile space architecture system that enables human presence on the Moon, allowing medium to long-term missions. This module is the key movable part to build a more complex system of hybrid class II and class III shelters that aim at the construction of a lunar village. The goal of the design effort is to allow the permanence of four astronauts on the South Pole of the Moon, next to Shackleton crater. The location is strategic for surface exploration goals and provides favorable environmental conditions for a future permanent settlement. To achieve this, a combination between a mobile habitat and a network of robotically constructed shelters will be necessary. The design of both systems aims at satisfying all habitability and mobility requirements in the harsh and extreme lunar environment while exploiting ISRU, through the demonstration of 3D printing capabilities for micrometeoroids and radiation shielding purposes. The presence of a sheltering system concurs with a series of minimum infrastructure requirements, which can be reached through a first robotic mission. The aim is to define the first mission elements necessary to sustain a human settlement, including the construction of solid foundations, roads, and landing pads, stabilizing the soil, and providing energy production and storage sub-systems. The iterative process of function allocation within the module and its overall architecture have been guided by the principle of human-centered design. The different mission constraints led to the development of an adaptive system, able to change according to the astronauts’ needs and provided with a combination of rigid pre-integrated elements and deployable spaces through pressurization. The implementation of LADE’s functionality into the Artemis mission architecture enables the shift from early exploration phases to a continuous human presence on the lunar surface

Abdominal aortic aneurysm in patients affected by intermittent claudication: prevalence and clinical predictors

BACKGROUND: Abdominal aortic aneurysm (AAA) is a frequent cause of death among elderly. Patients affected by lower extremity peripheral arterial disease (LE-PAD) seem to be particularly at high risk for AAA. We aimed this study at assessing the prevalence and the clinical predictors of the presence of AAA in a homogeneous cohort of LE-PAD patients affected by intermittent claudication. METHODS: We performed an abdominal ultrasound in 213 consecutive patients with documented LE-PAD (ankle/brachial index ≤ 0.90) attending our outpatient clinic for intermittent claudication. For each patient we registered cardiovascular risk factors and comorbidities, and measured neutrophil count. RESULTS: The ultrasound was inconclusive in 3 patients (1.4%), thus 210 patients (169 males, 41 females, mean age 65.9 ± 9.8 yr) entered the study. Overall, AAA was present in 19 patients (9.0%), with a not significant higher prevalence in men than in women (10.1% vs 4.9%, p = 0.300). Patients with AAA were older (71.2 ± 7.0 vs 65.4 ± 9.9 years, p = 0.015), were more likely to have hypertension (94.7% vs 71.2%, p = 0.027), and greater neutrophil count (5.5 [4.5 - 6.2] vs 4.1 [3.2 - 5.5] x 10(3)/μL, p = 0.010). Importantly, the c-statistic for neutrophil count (0.73, 95% CI 0.60 - 0.86, p = 0.010) was higher than that for age (0.67, CI 0.56-0.78, p = 0.017). The prevalence of AAA in claudicant patients with a neutrophil count ≥ 5.1 x 10(3)/μL (cut-off identified at ROC analysis) was as high as 29.0%. CONCLUSIONS: Prevalence of AAA in claudicant patients is much higher than that reported in the general population. Ultrasound screening should be considered in these patients, especially in those with an elevated neutrophil count

Activity of Mannich bases of 7-hydroxycoumarin against Flaviviridae

Abstract-Some Mannich bases of 7-hydroxycoumarin (2) and their simple derivatives (3 and 4) were prepared and tested against viruses containing single-stranded, positive-sense RNA genomes (ssRNA + ). This study was directed toward Flaviviridae and, in particular, HCV surrogate viruses (BVDV, YFV). The 7-hydroxy derivatives 2 were generally devoid of activity, but when position 7 was propylated, the resulting 7-propyloxy derivatives 3 were in some cases endowed with an interesting activity against BVDV. The formation of 7-benzoyl derivatives 4 gave compounds generally lacking in activity against Flaviviridae, whereas the appearance of activity against RSV has been observed. Also some unsymmetrical methylene derivatives 5-7 (namely coumarins bridged to chromones or indoles) were found moderately active in antiviral tests. Derivatives 3 were submitted to a molecular modeling study using DNA polymerase of HCV as a target. The good correlation between calculated molecular modeling IC 50 and experimental EC 50 indicates that DNA polymerase is potentially involved in the inhibition of surrogate HCV viruses