Publications by authors named "Giovanni Esposito"

442 Publications

Conduction delays after transcatheter aortic valve implantation with balloon-expandable prosthesis and high implantation technique.

Heart Vessels 2021 Sep 15. Epub 2021 Sep 15.

Division of Cardiology, Cardiovascular Department, "San Carlo" Regional Hospital, Potenza, Italy.

Performing transcatheter aortic valve implantation with high implantation technique, i.e. with an aorto-ventricular ratio > 60/40, reduces the need of permanent pacemaker implantation. Valve calcification and prosthesis oversizing are predictors of permanent pacemaker implantation, but there are no available data on their role when transcatheter aortic valve implantation is performed with an aorto-ventricular ratio > 60/40. The aim of this study was to evaluate the effect of leaflets/annulus calcification and prosthesis oversizing on the incidence of permanent pacemaker implantation after transcatheter aortic valve implantation with a high implantation technique. Transcatheter aortic valve implantation was performed in 48 patients implanting a balloon-expandable transcatheter heart valve with an aorto-ventricular ratio > 60/40. Calcium burden was assessed by preprocedural multidetector computed tomography. An invasive electrophysiological study was performed before and after transcatheter aortic valve implantation. Five patients (10.4%) needed permanent pacemaker implantation. At univariate analysis, baseline right bundle branch block and postprocedural PR, QRS and His-ventricular interval elongation significantly predicted permanent pacemaker implantation (p < 0.05). Receiver-operating characteristic curve analysis showed a correlation between transcatheter heart valve oversizing and permanent pacemaker implantation need, with the best cut-off being 17% (AUC = 0.72, p = 0.033). Linear regression analysis demonstrated that QRS complex elongation was related to total, left and non-coronary leaflet calcification (p < 0.05). This study demonstrates that, when transcatheter aortic valve implantation is performed using a balloon-expandable transcatheter heart valve deployed with an aorto-ventricular ratio > 60/40, the presence of leaflets/annulus calcification or the need to oversize the prosthesis correlate with the occurrence of pathological cardiac conduction delays.
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http://dx.doi.org/10.1007/s00380-021-01913-zDOI Listing
September 2021

Below the knee percutaneous transluminal angioplasty for claudicants: One vessel is enough to relieve symptoms.

Catheter Cardiovasc Interv 2021 Sep;98(3):570-571

Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Among patients with lower extremities arterial disease (LEAD), treatment of below the arteries has been historically limited to the treatment of chronic limb-threatening ischemia (CLTI), as recommended by available guidelines. In this study, the authors provided new data on the role of different endovascular revascularization anatomical strategies of the below the knee (BTK) arteries adopted in claudicant LEAD patients. The revascularization of the anterior tibial artery seems more effective for symptoms relieves than of the posterior territories and most of the adverse events occurred in the follow up period were target vessel revascularization, suggesting that revascularization of single vessel is enough to achieve clinical success.
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http://dx.doi.org/10.1002/ccd.29876DOI Listing
September 2021

Biofilm carrier type affects biogenic sulfur-driven denitrification performance and microbial community dynamics in moving-bed biofilm reactors.

Chemosphere 2021 Aug 20;287(Pt 1):131975. Epub 2021 Aug 20.

Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, via Claudio 21, 80125, Naples, Italy.

Autotrophic denitrification with biosulfur (ADBIOS) provides a sustainable technological solution for biological nitrogen removal from wastewater driven by biogenic S, derived from biogas desulfurization. In this study, the effect of different biofilm carriers (conventional AnoxK™ 1 and Z-200 with a pre-defined maximum biofilm thickness) on ADBIOS performance and microbiomics was investigated in duplicate moving bed-biofilm reactors (MBBRs). The MBBRs were operated parallelly in continuous mode for 309 days, whilst gradually decreasing the hydraulic retention time (HRT) from 72 to 21 h, and biosulfur was either pumped in suspension (days 92-223) or supplied in powder form. Highest nitrate removal rates were approximately 225 (±11) mg/L·d and 180 (±7) mg NO-N/L·d in the MBBRs operated with K1 and Z-200 carriers, respectively. Despite having the same protected surface area for biofilm development in each MBBR, the biomass attached onto the K1 carrier was 4.8-fold more than that on the Z-200 carrier, with part of the biogenic S kept in the biofilm. The microbial communities of K1 and Z-200 biofilms could also be considered similar at cDNA level in terms of abundance (R = 0.953 with p = 0.042). A relatively stable microbial community was formed on K1 carriers, while the active portion of the microbial community varied significantly over time in the MBBRs using Z-200 carriers.
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http://dx.doi.org/10.1016/j.chemosphere.2021.131975DOI Listing
August 2021

Functionally Complete Coronary Revascularisation in Patients Presenting with ST-elevation MI and Multivessel Coronary Artery Disease.

Interv Cardiol 2021 Apr 27;16:e24. Epub 2021 Jul 27.

Department of Advanced Biomedical Sciences, University of Naples Federico II Naples, Italy.

Up to half of patients undergoing primary percutaneous coronary intervention of a culprit stenosis in the context of the ST-elevation MI may present with multivessel disease. The presence of non-culprit stenoses have been shown to affect the outcomes of these patients, and the results of the more recent randomised trials highlight the importance of complete coronary revascularisation. In this paper, the authors review the main trials published on the topic and discuss tools for the assessment of non-culprit stenoses, while considering the right time for carrying out a complete coronary revascularisation.
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http://dx.doi.org/10.15420/icr.2020.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353546PMC
April 2021

Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score.

EuroIntervention 2021 Aug 11. Epub 2021 Aug 11.

Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.

Background: The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover.

Aims: We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively.

Methods: The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively.

Results: The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover.

Conclusions: The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.
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http://dx.doi.org/10.4244/EIJ-D-21-00441DOI Listing
August 2021

Transcatheter aortic valve thrombosis: The more we see the more we know.

Catheter Cardiovasc Interv 2021 Aug;98(2):363-364

Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.

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http://dx.doi.org/10.1002/ccd.29845DOI Listing
August 2021

Aspirin Monotherapy After BioFreedom Stent and 1-Month DAPT: Is Less More Even in Low-Risk Patients?

JACC Cardiovasc Interv 2021 Aug 28;14(16):1812-1814. Epub 2021 Jul 28.

Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.

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http://dx.doi.org/10.1016/j.jcin.2021.07.005DOI Listing
August 2021

Phenanthrene biodegradation in a fed-batch reactor treating a spent sediment washing solution: Techno-economic implications for the recovery of ethanol as extracting agent.

Chemosphere 2021 Jul 7;286(Pt 1):131361. Epub 2021 Jul 7.

Department of Civil, Architectural and Environmental Engineering, University of Napoli Federico II, Via Claudio 21, 80125, Napoli, Italy.

The continuous dredging of sediments contaminated by polycyclic aromatic hydrocarbons such as phenanthrene (PHE) has required the employment of high-efficiency technologies, including sediment washing (SW). However, the large amount of generated spent SW effluents requires the development of effective, eco-friendly and cost-saving approaches, which can tackle the waste formation in favor of the recovery of chemicals. This study proposes the treatment of a spent SW solution containing ethanol (EtOH) as extracting agent, by testing different initial PHE concentrations (i.e. 20-140 mg L) within six consecutive cycles in a fed-batch bioreactor under aerobic conditions. The biological process achieved a PHE removal of 63-91% after the enrichment of PHE-degrading bacteria and the proper supplementation of nutrients, and was mainly affected by the initial PHE concentration value and the excessive decrease of pH and dissolved oxygen. Achromobacter, Sphingobacterium and Dysgonomonas genera were mainly involved in PHE degradation, which followed a first-order kinetic model (R = 0.652-0.928) with a degradation rate and half-life time of 0.127-1.177 d and 0.589-2.912 d, respectively. A techno-economic assessment revealed that a virtuous operation of SW, EtOH recovery and biodegradation of the SW solution can allow the recovery of up to 1.35 tons of EtOH per ton of remediated sediment and the decrease of the overall costs by 50%.
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http://dx.doi.org/10.1016/j.chemosphere.2021.131361DOI Listing
July 2021

Single, Dual, and Triple Antithrombotic Therapy in Cancer Patients with Coronary Artery Disease: Searching for Evidence and Personalized Approaches.

Semin Thromb Hemost 2021 Jul 14. Epub 2021 Jul 14.

Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.

Improvement in life expectancy of patients suffering from oncohematologic disorders has turned cancer from an acute into a chronic condition, making the management of comorbidities problematic, especially when it comes to both acute and chronic cardiovascular diseases. Treatment-related adverse events and drug-drug interactions often influence the therapeutic approach of patients with active malignancies and cardiovascular disease. Furthermore, tumor cells and platelets maintain a complex crosstalk that on one hand enhances tumor dissemination and on the other hand induces hemostasis abnormalities. Hence, clinicians should move carefully in the intricate land mines established by patients with active cancer under antithrombotic therapy. To date, there is no consensus on the antithrombotic treatment of patients with cardiovascular diseases and concomitant malignancies. The aim of this review is to collect the available scientific evidence, including the latest clinical trials and guidelines, in order to provide guidance on the management of antithrombotic treatment (both antiplatelet and anticoagulant therapy) in cancer patients with either pre-existent or new-onset coronary artery disease. Randomized-controlled trials on antithrombotic treatment in oncologic populations, which by far have thus far been excluded, have to be promoted to supply recommendations in the oncohematologic setting.
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http://dx.doi.org/10.1055/s-0041-1726298DOI Listing
July 2021

Acute myocarditis: prognostic role of speckle tracking echocardiography and comparison with cardiac magnetic resonance features.

Heart Vessels 2021 Jun 27. Epub 2021 Jun 27.

Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy.

To evaluate longitudinal systolic function in patients with myocarditis, its correlation with cardiac magnetic resonance (CMR) features, and its predictive value in functional recovery and arrhythmias onset during follow-up (FU) on optimized medical therapy (OMT). Patients with acute myocarditis, confirmed through CMR criteria, and age- and sex-matched healthy controls were enrolled. Two-dimensional (2D) transthoracic echocardiography, including speckle tracking analysis, was performed at admission and after 6 months of FU. Patients of myocarditis group also underwent 24 h ECG Holter monitoring during FU. 115 patients with myocarditis (mean age 41 ± 17, 70% males) and 70 healthy subjects were enrolled. Global longitudinal strain (GLS) and sub-epicardial strain were markedly lower in the myocarditis group than in controls (mean GLS%: - 14.1 ± 5.1 vs - 23.1 ± 3.6, p < 0.001). A strong positive correlation between total scar burden (TSB) on CMR and baseline LV GLS was found (r = 0.67, p < 0.0001). GLS improved after 6 months of FU in myocarditis on OMT (mean GLS%: - 14.1 ± 5.1 vs - 16.5 ± 4.8, p < 0.01). By bivariate correlation analysis, baseline LVEF, GLS, and TSB were all associated with LVEF at 6 months of FU. Moreover, by multivariable linear regression analysis, these parameters confirmed to be independent predictors of functional recovery at 6 months (LVEF β 0.38, p < 0.01; GLS β - 0.35, p < 0.01; total scar burden β - 0.52, p < 0.0001). Segmental peak systolic strain was significantly different between segments with and without late gadolinium enhancement on CMR (- 13.2 ± 3.1% vs - 18.1 ± 3.5%, p < 0.001). A segmental strain of - 12% identified scar with a sensitivity of 79% and a specificity of 84% (AUC = 0.91; 95% CI 0.73-0.97; p < 0.001). In addition, baseline LV GLS in myocarditis resulted predictive of non-sustained ventricular tachycardias (cut-off value > - 12%; sensitivity84%; specificity74.4%; AUC = 0.75). Parameters of myocardial longitudinal deformation are importantly associated with the presence of a scar on CMR and are predictors of functional outcome and ventricular arrhythmias in patients with acute myocarditis. Their assessment during ultrasound examination should be considered to get more information about the prognosis and risk stratification of this subset of patients.
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http://dx.doi.org/10.1007/s00380-021-01893-0DOI Listing
June 2021

Sequential sulfur-based denitrification/denitritation and nanofiltration processes for drinking water treatment.

J Environ Manage 2021 Oct 23;295:113083. Epub 2021 Jun 23.

Bioengineering Department, Istanbul Medeniyet University, Uskudar, Istanbul, Turkey. Electronic address:

Efficient and cost-effective solutions for nitrogen removal are necessary to ensure the availability of safe drinking water. This study proposes a combined treatment for nitrogen-contaminated groundwater by sequential autotrophic nitrogen removal in a sulfur-packed bed reactor (SPBR) and excess sulfate rejection via nanofiltration (NF). Autotrophic nitrogen removal in the SPBR was investigated under both denitrification and denitritation conditions under different NO and NO loading rates (LRs) and feeding strategies (NO only, NO only, or both NO and NO in the feed). Batch activity tests were carried out during SPBR operation to evaluate the effect of different feeding conditions on nitrogen removal activity by the SPBR biofilm. Bacteria responsible for nitrogen removal in the bioreactor were identified via Illumina sequencing. Dead-end filtration tests were performed with NF membranes to investigate the elimination of excess sulfate from the SPBR effluent. This study demonstrates that the combined process results in effective groundwater treatment and evidences that an adequately high nitrogen LR should be maintained to avoid the generation of excess sulfide.
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http://dx.doi.org/10.1016/j.jenvman.2021.113083DOI Listing
October 2021

Air side-stream ammonia stripping in a thin film evaporator coupled to high-solid anaerobic digestion of sewage sludge: Process performance and interactions.

J Environ Manage 2021 Oct 23;295:113075. Epub 2021 Jun 23.

Acqua & Sole s.r.l., Via Giulio Natta, Vellezzo Bellini, PV, Italy.

Air side-stream ammonia stripping in a thin-film evaporator (TFE) is proposed for the first time to control total ammonia nitrogen (TAN) concentration in a centralized full-scale plant performing high-solid anaerobic digestion (HSAD) of sewage sludge (SS). In this process, anaerobically digesting sludge (ADS) is continuously recirculated from the digester to the TFE unit where ammonia is stripped by an air stream. The stripped ammonia reacts with sulfuric acid in an absorption unit to produce ammonium sulfate. Overall, HSAD coupled to air side-stream ammonia stripping results in a twofold production of fertilizers (i.e. ammonium sulfate and SS digestate) recycling nutrients from organic wastes in agreement with the principles of circular economy. This study evaluates the influence of different operational airflow rates, temperatures and CO concentrations on air side-stream ammonia stripping in the TFE without alkali addition and the impact of air-based ammonia stripping on HSAD performance at full-scale. The study also investigates the chemistry and the interaction between the ammonia and carbonate subsystems of ADS and clarifies the stoichiometric relationship between ammonia and CO stripping.
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http://dx.doi.org/10.1016/j.jenvman.2021.113075DOI Listing
October 2021

Myocardial hypoxic stress mediates functional cardiac extracellular vesicle release.

Eur Heart J 2021 07;42(28):2780-2792

DZHK, Munich Partner Site, Ismaninger Str. 22, 81675 Munich, Germany.

Aims: Increased shedding of extracellular vesicles (EVs)-small, lipid bilayer-delimited particles with a role in paracrine signalling-has been associated with human pathologies, e.g. atherosclerosis, but whether this is true for cardiac diseases is unknown.

Methods And Results: Here, we used the surface antigen CD172a as a specific marker of cardiomyocyte (CM)-derived EVs; the CM origin of CD172a+ EVs was supported by their content of cardiac-specific proteins and heart-enriched microRNAs. We found that patients with aortic stenosis, ischaemic heart disease, or cardiomyopathy had higher circulating CD172a+ cardiac EV counts than did healthy subjects. Cellular stress was a major determinant of EV release from CMs, with hypoxia increasing shedding in in vitro and in vivo experiments. At the functional level, EVs isolated from the supernatant of CMs derived from human-induced pluripotent stem cells and cultured in a hypoxic atmosphere elicited a positive inotropic response in unstressed CMs, an effect we found to be dependent on an increase in the number of EVs expressing ceramide on their surface. Of potential clinical relevance, aortic stenosis patients with the highest counts of circulating cardiac CD172a+ EVs had a more favourable prognosis for transcatheter aortic valve replacement than those with lower counts.

Conclusion: We identified circulating CD172a+ EVs as cardiac derived, showing their release and function and providing evidence for their prognostic potential in aortic stenosis patients.
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http://dx.doi.org/10.1093/eurheartj/ehab247DOI Listing
July 2021

An Emergent Form of Cardiotoxicity: Acute Myocarditis Induced by Immune Checkpoint Inhibitors.

Biomolecules 2021 05 22;11(6). Epub 2021 May 22.

Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy.

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. ICIs have shown great promise in the treatment of several advanced malignancies. However, therapy with these immunomodulatory antibodies may lead to a wide spectrum of immune-related adverse events in any organ and any tissue. Cardiologic immune-related events include pericarditis, pericardial effusion, various types of arrhythmias including the occurrence of complete atrioventricular block, myocardial infarction, heart failure, and myocarditis. Although relatively rare, myocarditis is associated with a very high reported mortality in comparison to other adverse events. Myocarditis often presents significant diagnostic complexity and may be under-recognized. When confronted with an unexpected change in the clinical picture, the physician must differentiate between immune-related adverse events, cancer worsening, or other causes unrelated to the cancer or its therapy. However, this is not always easy. Therefore, with the increasing use of checkpoint inhibitors in cancer, all providers who care for patients with cancer should be made aware of this rare, but potentially fatal, cardiologic immune-related adverse event, and able to recognize when prompt consultation with a cardiologist specialist is indicated. In this review, we evaluate currently available scientific evidence and discuss clinical manifestations and new potential approaches to the diagnosis and therapy of acute myocarditis induced by ICIs. Temporary or permanent discontinuation of the ICIs and high-dose steroids have been administered to treat myocarditis, but symptoms may worsen in some patients despite therapy.
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http://dx.doi.org/10.3390/biom11060785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224544PMC
May 2021

Clinical use of cangrelor: a real world multicenter experience from South Italy Insights from the M.O.Ca. registry.

Panminerva Med 2021 Jun 1. Epub 2021 Jun 1.

Cardiovascular Diseases Section, Cardiothoracic Department (DAI), University of Bari, Bari, Italy.

Background: Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and oral P2Y12 inhibitor (P2Y12-I) represents the standard of care for patients with acute coronary syndromes (ACS) or with chronic coronary syndromes (CCS) treated with percutaneous coronary intervention (PCI). Cangrelor, the first intravenous P2Y12-I, is deemed to overcome the drawbacks of the oral administration; nevertheless real world data on this new drug are scanty. We sought to investigate routine clinical use of cangrelor in four interventional centers of Italy.

Methods: We enrolled 241 consecutive patients (196 ACS, 45 CCS) treated with cangrelor during PCI. Drug administration modalities and in-hospital clinical outcomes were evaluated. A subanalysis in patients selected on the basis of the CHAMPION Phoenix trial inclusion/exclusion criteria (CHAMPION-like subpopulation) was also performed.

Results: Cangrelor was mainly utilized in ACS patients, who presented poorer clinical conditions and higher bleeding risk. Cangrelor was given only in P2Y12-I naïve patients; switch to clopidogrel was always done at the end of the infusion, while ticagrelor or prasugrel were prevalently given 30 minutes before. In-hospital mortality was 10.0% and GUSTO moderate/severe bleeding was 2.5%. Bleeding data showed nevertheless to be in line with the CHAMPION Phoenix results in the "CHAMPION-like" subpopulation.

Conclusions: Cangrelor was predominantly used in ACS with modalities substantially in accord with the label indications. Poor clinical outcomes are due to the prevalent utilization in highly challenging clinical settings, nevertheless the rate of bleeding and stent thrombosis are in line with the randomized trials if analyzed in a subpopulation of comparable risk profile.
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http://dx.doi.org/10.23736/S0031-0808.21.04437-2DOI Listing
June 2021

Phytoremediation of pyrene-contaminated soils: A critical review of the key factors affecting the fate of pyrene.

J Environ Manage 2021 Sep 27;293:112805. Epub 2021 May 27.

Department of Civil, Architectural and Environmental Engineering, University of Napoli Federico II, Via Claudio 21, 80125, Napoli, Italy.

Soil contamination by pyrene has increased over the years due to human-related activities, urgently demanding for remediation approaches to ensure human and environment safety. Within this frame, phytoremediation has been successfully applied over the years due to its green and cost-effectiveness features. The scope of this review includes the main phytoremediation mechanisms correlated with the removal of pyrene from contaminated soils and sediments to highlight the impact of different parameters and the supplement of additives on the efficiency of the treatment. Soil organic matter (SOM), plant species, aging time, environmental parameters (pH, soil oxygenation, and temperature) and bioavailability are among the main parameters affecting pyrene removal through phytoremediation. Phytoextraction only accounts for a small part of the entire phytoremediation process, but the addition of surfactants and chelating agents in planted soils could increase pyrene accumulation in plant tissues by 20% as a consequence of the increased pyrene bioavailability. Rhizodegradation is the main phytoremediation mechanism involved due to the activity of bacteria capable of degrading pyrene in the root area. Inoculated-planted soil treatments have the potential to decrease pyrene accumulation in shoots and roots by approximately 30 and 40%, respectively, further stimulating the proliferation of pyrene-degrading bacteria in the rhizosphere. Plant-fungi symbiotic association results in an enhanced accumulation of pyrene in shoots and roots of plants as well as a higher biodegradation. Finally, pyrene removal from soil can be improved in the presence of amendments, such as natural non-ionic surfactants, biochar, and bacterial mixtures.
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http://dx.doi.org/10.1016/j.jenvman.2021.112805DOI Listing
September 2021

Anorexia nervosa-related cardiopathy in children with physical instability: prevalence, echocardiographic characteristics and reversibility at mid-term follow-up.

Eur J Pediatr 2021 May 28. Epub 2021 May 28.

Child and Adolescent Neuropsychiatric Unit, Divison of Pediatrics, Dpt of Translational Medical Sciences, Federico II University, Naples, Italy.

Prompt detection of cardiovascular abnormalities in children with anorexia nervosa and physical instability requiring hospitalization is essential to identify patients at higher cardiovascular risk. We studied all anorexia nervosa children requiring admission at Paediatric Institute in the period 2015-2019. Anorexia nervosa cardiopathy at admission was defined by the presence of at least two of the following clinical findings: pericardial effusion, mitral regurgitation, bradycardia, mitral billowing, aortic regurgitation, altered LV morphology and ECG abnormalities. Echocardiographic data were compared with those registered at 3-8-month follow-up and with data from a healthy population. Thirty-eight anorexia nervosa children were examined. Prevalence of anorexia nervosa cardiopathy at admission was 63% (24 patients). Pericardial effusion, bradycardia and mitral regurgitation were present together in 26% of patients. Most cardiovascular changes recovered at follow-up. Anorexia nervosa cardiopathy was associated with significantly lower left ventricle end-diastolic diameters and mass, and higher E wave, E/A and E/e' ratios and left ventricle sphericity index values vs healthy population and vs anorexia nervosa children without cardiopathy (p<0.05). Left ventricle global longitudinal strain was significantly reduced only in anorexia nervosa cardiopathy patients but recovered, whereas end-diastolic diameters, E/A ratio and sphericity index values remained impaired.Conclusion: Among anorexia nervosa children requiring hospitalization, those presenting several cardiac findings together express an acute anorexia nervosa cardiopathy which is characterized by worse LV filling, geometry and subclinical myocardial deformation impairment. Despite treatment, in those patients, some alterations persist at mid-term follow-up. What is Known: • Cardiac and electrocardiographic changes are present in anorexia nervosa children at diagnosis or during stable disease, and most recover after body-weight treatment. • It is unknown if anorexia nervosa children with more severe cardiac impairment during hospitalization present higher cardiovascular-risk profile despite treatment. What is New: • In anorexia nervosa children needing hospitalization for physical reasons, prevalence of acute anorexia nervosa cardiopathy at admission is high, around 60%. • By advanced echocardiography, children with anorexia nervosa cardiopathy at admission have a worse cardiac filling, impaired cardiac geometry and systolic deformation that only partially recover at mid-term follow-up.
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http://dx.doi.org/10.1007/s00431-021-04130-yDOI Listing
May 2021

Predictors of adherence to composite therapy after acute coronary syndromes.

J Cardiovasc Med (Hagerstown) 2021 Aug;22(8):645-651

Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli 'Federico II', Napoli, Italy.

Aims: Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS.

Methods: We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federico II University Hospital, from 1 January 2015 to 30 June 2017, for ACS. Adherence to three classes of drugs including statins, antiplatelets [dual or single antiplatelet agent (SAPT)] and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) and their composites were assessed at 1 month, 1 and 2 years after discharge.

Results: At 30 days adherence to prescribed therapy was 94.4% for dual antiplatelet therapy (DAPT), 78.2% for statins, 92.7% for ACE-I/ARB and 70.7% for multitherapy. At 1 year, it was 91.1% for DAPT, 81.2% for ACE-I/ARB, 84.9% for statins and 71.4% for multitherapy. At 2 years, it was 97.1% for SAPT, 78.1% for ACE-I/ARB, 91.8% for statins, 72.8% for multitherapy. Multivariable logistic analysis demonstrated that at each time point, a telephone follow-up assessment predicts nonadherence to multitherapy and that a percutaneous coronary intervention at the index hospitalization is an independent predictor of adherence to composite therapy at 1 month and 1 year.

Conclusion: Up to 2 years after ACS, three out of four patients are adherent to multitherapy prescription; percutaneous coronary intervention during the index hospitalization improves a patient's adherence, whereas telephone follow-up is associated with reduced adherence to multitherapy.Campania Salute Network Registry (Clinical Trials.gov Identifier: NCT02211365).
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http://dx.doi.org/10.2459/JCM.0000000000001201DOI Listing
August 2021

Appropriate ICD Interventions for Ventricular Arrhythmias Are Predicted by Higher Syntax Scores I and II in Patients with Ischemic Heart Disease.

J Clin Med 2021 Apr 23;10(9). Epub 2021 Apr 23.

Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy.

Aims: The occurrence of ventricular arrhythmias (VAs) in ischemic heart disease (IHD) patients is related to the presence and extent of fibrotic/scar tissue. As coronary atherosclerosis is the underlying cause of myocardial ischemia and fibrosis, in IHD patients implanted with an implantable cardioverter defibrillator (ICD) we investigated the relation between the VA burden and the complexity of coronary atherosclerotic lesions.

Methods And Results: In IHD patients who underwent coronary angiography and ICD implant, the Syntax scores I and II (SSI-II), as index of the severity of the coronary atherosclerotic disease, and the occurrence of VA were assessed. Overall 144 patients were included (123 males). Of these 22 patients (15%) experienced at least one episode of VA (cycle length 298 ± 19 msec) that required ICD intervention. The number of episodes per patient and per year was 4 ± 6 and 2.8 ± 4, respectively. Patients that experienced a VA compared to those free from arrhythmic events did not have distinct baseline clinical characteristics except for a higher SS I and SS II (21 (IQR 13-38) vs. 16 (IQR 10-23); = 0.037; and 50 (IQR 39-62) vs. 42 (IQR 34-50); = 0.012). In the binary logistic regression analyses the SS I and II were the only independent predictors of VA occurrence. A higher SS II was also associated with an earlier time to first event ( = 0.005).

Conclusion: Higher SS I-II scores reflect a more severe coronary atherosclerosis and are associated with a greater VA burden. Further studies are needed to better clarify the ability of SSI-II to stratify the risk of IHD patients to develop life-threatening VA.
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http://dx.doi.org/10.3390/jcm10091843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123075PMC
April 2021

Kinetic modeling of hydrogen and L-lactic acid production by Thermotoga neapolitana via capnophilic lactic fermentation of starch.

Bioresour Technol 2021 Jul 6;332:125127. Epub 2021 Apr 6.

Institute of Biomolecular Chemistry, National Research Council, Via Campi Flegrei 34, 80078 Pozzuoli, Napoli, Italy; Department of Biology, University of Napoli "Federico II", Via Cupa Nuova Cinthia 21, 80126 Napoli, Italy. Electronic address:

This study investigated the feasibility of hydrogen (H) and L-lactic acid production from starch under capnophilic lactic fermentation (CLF) conditions by using Thermotoga neapolitana. Batch experiments were performed in 120 mL serum bottles and a 3 L pH-controlled continuous stirred-tank reactors (CSTR) system with potato and wheat starch as the substrates. A H yield of 3.34 (±0.17) and 2.79 (±0.17) mol H/mol of glucose eq. was achieved with, respectively, potato and wheat starch. In the presence of CO, L-lactic acid production by the acetyl-CoA carboxylation was significantly higher for the potato starch (0.88 ± 0.39 mol lactic acid/mol glucose eq.) than wheat starch (0.33 ± 0.11 mol lactic acid/mol glucose eq.). A kinetic model was applied to simulate and predict the T. neapolitana metabolic profile and bioreactor performance under CLF conditions. The CLF-based starch fermentation suggests a new direction to biotransform agri-food waste into biofuels and valuable biochemicals.
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http://dx.doi.org/10.1016/j.biortech.2021.125127DOI Listing
July 2021

Not-high before-treatment platelet reactivity in patients with STEMI: prevalence, clinical characteristics, response to therapy and outcomes.

Platelets 2021 Apr 15:1-8. Epub 2021 Apr 15.

Cardiology Clinic, Sassari University Hospital, Sassari, Italy.

Platelet reactivity (PR) has been indicated as a pathophysiological key element for ST-Elevation Myocardial Infarction (STEMI) development. Patients with not-high before-treatment platelet reactivity (NHPR) have been poorly studied so far. The aim of this study is to investigate the prevalence, clinical characteristics, response to therapy and outcomes of baseline prior to treatment NHPR among patients with STEMI undergoing primary PCI.We analyzed the data from 358 STEMI patients with assessment of PR by VerifyNow before P2Y inhibitor loading dose (LD). Blood samples were obtained at baseline, and after 1 hour, 2 hours, 4-6 hours and 8-12 hours after LD. High platelet reactivity (HPR) was defined as Platelet Reactivity Unit values ≥208, while patients with values <208 at baseline were defined as having NHPR.Overall, 20% patients had NHPR. Age and male gender both resulted independent predictors of NHPR, even after propensity score adjustment. The percentage of inhibition of PR after ticagrelor or prasugrel LD was similar between HPR and NHPR patients at each time point. However, patients with HPR showed worse in-hospital clinical outcomes, and the composite adverse outcome endpoint of death, reinfarction, stroke, acute kidney injury or heart failure was significantly higher (10.0% vs 1.4%; = .017) as compared with the NHPR group.In conclusion, a significant proportion of patients presenting with STEMI has a baseline NHPR that is associated with better in-hospital outcomes as compared with patients with HPR. Further studies are needed to better elucidate the potential therapeutic implications of NHPR in terms of secondary prevention.
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http://dx.doi.org/10.1080/09537104.2021.1915973DOI Listing
April 2021

Mortality after Bleeding versus Myocardial Infarction in Coronary Artery Disease: A Systematic Review and Meta-Analysis.

EuroIntervention 2021 Apr 13. Epub 2021 Apr 13.

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Background: Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD).

Aims: We aim to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD.

Methods: We searched Medline and Embase for studies that included patients with CAD and that reported both, the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratio of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularization or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularization or ACS.

Results: 141,059 patients were included across 16 studies and 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding, increased the risk of mortality to the same extent of MI (rHRbleedingvs.MI 1.10, 95%CI, 0.71-1.71, P=0.668). Early bleeding was associated with a higher risk of mortality than early MI (rHRbleedingvs.MI 1.46, 95%CI, 1.13-1.89, P=0.004), although this finding was not present when only randomized trials were included. Late bleeding was prognostically comparable to late MI (rHRbleedingvs.MI 1.14, 95%CI, 0.87-1.49, P=0.358).

Conclusions: Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality.
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http://dx.doi.org/10.4244/EIJ-D-20-01197DOI Listing
April 2021

A general framework to model the fate of trace elements in anaerobic digestion environments.

Sci Rep 2021 Apr 5;11(1):7476. Epub 2021 Apr 5.

Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Naples, Italy.

Due to the multiplicity of biogeochemical processes taking place in anaerobic digestion (AD) systems and limitations of the available analytical techniques, assessing the bioavailability of trace elements (TEs) is challenging. Determination of TE speciation can be facilitated by developing a mathematical model able to consider the physicochemical processes affecting TEs dynamics. A modeling framework based on anaerobic digestion model no 1 (ADM1) has been proposed to predict the biogeochemical fate TEs in AD environments. In particular, the model considers the TE adsorption-desorption reactions with biomass, inerts and mineral precipitates, as well as TE precipitation/dissolution, complexation reactions and biodegradation processes. The developed model was integrated numerically, and numerical simulations have been run to investigate the model behavior. The simulation scenarios predicted the effect of (i) organic matter concentration, (ii) initial TEs concentrations, (iii) initial Ca-Mg concentrations, (iv) initial EDTA concentration, and (v) change in TE binding site density, on cumulative methane production and TE speciation. Finally, experimental data from a real case continuous AD system have been compared to the model predictions. The results prove that this modelling framework can be applied to various AD operations and may also serve as a basis to develop a model-predictive TE dosing strategy.
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http://dx.doi.org/10.1038/s41598-021-85403-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021560PMC
April 2021

Engineered Producing Palmitoylethanolamide (PEA) Prevents Colitis in Mice.

Int J Mol Sci 2021 Mar 14;22(6). Epub 2021 Mar 14.

Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, 00185 Rome, Italy.

Palmitoylethanolamide (PEA) is an -acylethanolamide produced on-demand by the enzyme -acylphosphatidylethanolamine-preferring phospholipase D (NAPE-PLD). Being a key member of the larger family of bioactive autacoid local injury antagonist amides (ALIAmides), PEA significantly improves the clinical and histopathological stigmata in models of ulcerative colitis (UC). Despite its safety profile, high PEA doses are required in vivo to exert its therapeutic activity; therefore, PEA has been tested only in animals or human biopsy samples, to date. To overcome these limitations, we developed an NAPE-PLD-expressing (pNAPE-LP), able to produce PEA under the boost of ultra-low palmitate supply, and investigated its therapeutic potential in a murine model of UC. The coadministration of pNAPE-LP and palmitate led to a time-dependent release of PEA, resulting in a significant amelioration of the clinical and histological damage score, with a significantly reduced neutrophil infiltration, lower expression and release of pro-inflammatory cytokines and oxidative stress markers, and a markedly improved epithelial barrier integrity. We concluded that pNAPE-LP with ultra-low palmitate supply stands as a new method to increase the in situ intestinal delivery of PEA and as a new therapeutic able of controlling intestinal inflammation in inflammatory bowel disease.
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http://dx.doi.org/10.3390/ijms22062945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999950PMC
March 2021

Transverse aortic constriction induces gut barrier alterations, microbiota remodeling and systemic inflammation.

Sci Rep 2021 Apr 1;11(1):7404. Epub 2021 Apr 1.

Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 80131, Naples, Italy.

Accumulating evidence suggests that modifications of gut function and microbiota composition might play a pivotal role in the pathophysiology of several cardiovascular diseases, including heart failure (HF). In this study we systematically analysed gut microbiota composition, intestinal barrier integrity, intestinal and serum cytokines and serum endotoxin levels in C57BL/6 mice undergoing pressure overload by transverse aortic constriction (TAC) for 1 and 4 weeks. Compared to sham-operated animals, TAC induced prompt and strong weakening of intestinal barrier integrity, long-lasting decrease of colon anti-inflammatory cytokine levels, significant increases of serum levels of bacterial lipopolysaccharide and proinflammatory cytokines. TAC also exerted effects on microbiota composition, inducing significant differences in bacterial genera inside Actinobacteria, Firmicutes, Proteobacteria and TM7 phyla as shown by 16S rDNA sequencing of fecal samples from TAC or sham mice. These results suggest that gut modifications represent an important element to be considered in the development and progression of cardiac dysfunction in response to TAC and support this animal model as a valuable tool to establish the role and mechanisms of gut-heart crosstalk in HF. Evidence arising in this field might identify new treatment options targeting gut integrity and microbiota components to face adverse cardiac events.
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http://dx.doi.org/10.1038/s41598-021-86651-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016915PMC
April 2021

Shortcut nitrification-denitrification and biological phosphorus removal in acetate- and ethanol-fed moving bed biofilm reactors under microaerobic/aerobic conditions.

Bioresour Technol 2021 Jun 11;330:124958. Epub 2021 Mar 11.

Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, via Claudio 21, 80125 Naples, Italy.

This study investigated the feasibility of coupling simultaneous partial nitrification and denitrification (SPND) to biological phosphorus removal in continuous-flow intermittently-aerated moving bed biofilm reactors (MBBRs) fed with different carbon sources, i.e. ethanol and acetate. Bacterial cultivation at pH 8.2 (±0.2), 26-28 °C and SRT of 4 day and microaerobic/aerobic MBBR operation allowed to achieve average dissolved organic carbon (DOC), total inorganic nitrogen (TIN) and P-PO removal efficiencies (REs) of 100%, 81-88% and 83-86% at HRT of 1 day, dissolved oxygen (DO) range of 0.2-3 mg L and feed C/N and C/P ratios of 3.6 and 11, respectively. Acetate supplementation favored a diversified microbial community, while overgrowth of heterotrophs was observed when increasing feed C/N ratio in ethanol-fed MBBR. Illumina sequencing displayed the presence of putative phosphorus accumulating organisms (PAOs) such as Hydrogenophaga and Pseudomonas in MBBR biofilm and suspended biomass, whereas no typical NOB was identified during the study.
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http://dx.doi.org/10.1016/j.biortech.2021.124958DOI Listing
June 2021

Evaluation of a New Tubular Finger Oxygen-Enriched Oil Inside-Coated Dressing Device in Pediatric Patients Undergoing Distal Hypospadias Repair: A Prospective Randomized Clinical Trial Part II.

Front Pediatr 2021 2;9:638406. Epub 2021 Mar 2.

Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.

This study was the second part of a prospective randomized clinical trial and aimed to evaluate the use of a tubular finger oxygen-enriched oil inside-coated dressing device and its effect on the post-operative outcome of children undergoing distal hypospadias repair. A prospective single-blinded randomized clinical trial was carried out between September 2019 and September 2020. We included all patients with distal hypospadias, who received Snodgrass urethroplasty and preputioplasty. The patients were randomized in two groups according to the type of dressing: tubular finger oxygen-enriched oil inside-coated device (G1) and elastic net bandage with application of oxygen-enriched oil-based gel (G2). The patients were evaluated at 7, 14, 21, 30, and 60 post-operative day (POD). Sixty-four patients (median age 14 months) were included in the study and randomized in two groups, each of 32 patients. Post-operative preputial edema rate was significantly lower in G1 (3/32, 9.3%) compared with G2 (10/32, 31.2%) ( = 0.001). The median duration of preputial edema was significantly shorter in G1 compared with G2 (6 vs. 10.5 days) ( = 0.001). Penile diameter measurements at 4th, 7th, 14th POD proved that entity and duration of post-operative swelling were objectively decreased using the new dressing. The wound healing was significantly faster in G1 compared with G2 (14.2 vs. 18.5 days) ( = 0.001). The post-operative complications rate was significantly lower in G1 (0%) compared with G2 (3/32, 9.3%) ( = 0.001). Foreskin dehiscence occurred in two G2 patients (6.2%) whereas, breakdown of urethroplasty and preputioplasty occurred in one G2 patient (3.1%) due to scratching injuries. The dressing management was subjectively assessed by nurses to be easier in G1 patients compared with G2 ones (median score 1.2 vs. 3.5) ( = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (55 vs. 87 eur) ( = 0.001). No adverse skin reactions occurred. Post-operative dressing using tubular finger oxygen-enriched oil inside-coated device was highly effective, easy to manage, cheaper and associated with a lower rate of foreskin and urethral complications compared with the standard dressing method in pediatric patients undergoing distal hypospadias repair. It was also clinically safe without allergy or intolerance to the product.
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http://dx.doi.org/10.3389/fped.2021.638406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960643PMC
March 2021

SICI-GISE position document on the use of the Magmaris resorbable magnesium scaffold in clinical practice.

Cardiovasc Revasc Med 2021 Feb 5. Epub 2021 Feb 5.

Padua University Policlinico Hospital, Centro Gallucci, Padua, Italy.

Bioresorbable scaffolds have emerged as a potential breakthrough for the treatment of coronary artery lesions. The need for drug release and plaque scaffolding is temporary, and leaving a permanent stent once the process of plaque recoil and vessel healing has ended might be superfluous or even deleterious exposing the patient to the risk of very late thrombosis, eliminating vessel reactivity, impairing non-invasive imaging and precluding possible future surgical revascularization. This long-term potential limitation of permanent bare metal stents might be overcome by using a resorbable scaffold. The metallic and antithrombotic properties make the resorbable magnesium scaffold an appealing technology for the treatment of coronary artery lesions. Notwithstanding this, its mechanical properties substantially differ from those of conventional bare metal stents, and previous experience using polymer-based scaffolds has shown that a standardized implantation technique and optimal patient and lesion selection are key factors for a successful implantation. A panel of expert cardiologists gathered to find a consensus on the best practices for Magmaris implantation in a selected patient population and to discuss the rationale for new potential future indications.
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http://dx.doi.org/10.1016/j.carrev.2021.02.003DOI Listing
February 2021

Consolidating the value of the standardised ARC-HBR definition.

EuroIntervention 2021 Feb;16(14):1126-1128

Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.

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http://dx.doi.org/10.4244/EIJV16I14A202DOI Listing
February 2021
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