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Background Ticagrelor is a reversibly binding, direct-acting, oral, P 2 Y 12 antagonist used for the prevention of atherothrombotic events in patients with coronary artery disease (CAD). Ticagrelor blocks adenosine reuptake through the inhibition of equilibrative nucleoside transporter 1 (ENT-1) on erythrocytes and platelets, thereby facilitating adenosine-induced physiological responses such as an increase in coronary blood flow velocity. Meanwhile, adenosine plays an important role in triggering ischemic preconditioning through the activation of the A1 receptor. Therefore, an increase in ticagrelor-enhanced adenosine bioavailability may confer beneficial effects through mechanisms related to preconditioning activation and improvement of coronary microvascular dysfunction. Methods To determine whether ticagrelor can trigger ischemic preconditioning and influence microvascular function, we designed this prospective, open-label, pilot study that enrolled patients with stable multivessel CAD requiring staged, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI). Participants will be randomized in 1:1 ratios either to ticagrelor (loading dose (LD) 180 mg, maintenance dose (MD) 90 mg bid) or to clopidogrel (LD 600 mg, MD 75 mg) from 3 to 1 days before the scheduled PCI. The PCI operators will be blinded to the randomization arm. The primary endpoint is the delta (difference) between ST segment elevations (in millimeters, mm) as assessed by intracoronary electrocardiogram (ECG) during the two-step sequential coronary balloon inflation in the culprit vessel. Secondary endpoints are 1) changes in coronary flow reserve (CFR), index of microvascular resistance (IMR), and FFR measured in the culprit vessel and reference vessel at the end of PCI, and 2) angina score during inflations. This study started in 2018 with the aim of enrolling 100 patients. Based on the rate of negative FFR up to 30% and a drop-out rate up to 10%, we expect to detect an absolute difference of 4 mm among the study arms in the mean change of ST elevation following repeated balloon inflations. All study procedures were reviewed and approved by the Ethical Committee of the Catholic University of Sacred Heart. Discussion Ticagrelor might improve ischemia tolerance and microvascular function compared to clopidogrel, and these effects might translate to better long-term clinical outcomes. Trial registration EudraCT No. 2016–004746-28 . No.  NCT02701140 .  Trial status Information provided in this manuscript refers to the definitive version (n. 3.0) of the study protocol, dated 31 October 2017, and includes all protocol amendments. Recruitment started on 18 September 2018 and is currently ongoing. The enrollment is expected to be completed by the end of 2019. Trial sponsor Fondazione Policlinico Universitario A. Gemelli – Roma, Polo di Scienze Cardiovascolari e Toraciche, Largo Agostino Gemelli 8, 00168 Rome, Italy.

Introduction Mucopolysaccharidosis (MPS) IIIB is a lysosomal disorder in which a deficiency in α-N-acetylglucosaminidase impairs the degradation of heparan sulphate, which accumulates in tissues causing multiple organs dysfunction. This disease is associated with significant central nervous system (CNS) abnormalities, but a presentation with a tumour-like lesion has never been reported so far. Clinical presentation The present report describes the case of a 5-year-old girl suffering from MPS IIIB who developed a cerebellar lesion with evident mass effect. She underwent surgery with a subsequent notable improvement of her clinical picture. Surprisingly, the pathological analysis revealed the lesion to have the typical MPS features. Conclusion This case would describe a neglected possible presentation of MPS IIIB with a lesion mimicking a neoplasm, which could even be successfully treated with surgery.

Near-infrared spectroscopy is a fast and easy-to-perform technique characterized by high sensitivity regarding water containing systems and for this reason it is a suitable tool for investigating structural modifications of hydrating cementing materials, even if the lack of knowledge in this field makes the interpretation of NIR vibrational bands very difficult. In this paper, the NIR spectrum of a hydrated ordinary Portland cement is extensively investigated and an interpretation of the different bands is proposed on the basis of both experimental evidence and reference to literature. The obtained results were applied to the investigation of cement hydration lasting up to 28 days, analyzing the variations detectable in the shape of the spectrum as the reaction went on. The degree of this variation, quantified through area calculations of the main significant bands, revealed a broad agreement with the degree of hydration of the paste measured by thermal methods. The findings of this research supply a solid foundation for future in-field application of NIR spectroscopy, for example, for investigations on cements with different hydration behavior, or to evaluate the effect of additives on cement pastes and, at a further level, for cement quality control.

. The present work describes a study on calcium sulfoaluminate (CSA) cement by using proton nuclear magnetic resonance. Set-retarding and set-accelerating agents were used in order to enhance differences in the performances of the cement used for the tests. The changes in the mobility of water during hydration of the cement were studied and data were compared with results obtained by X-ray diffraction analysis. The microstructural and mineralogical development of the hydrated sample were finally compared with the technical performances of a CSA-based mortar.

Calcium sulfoaluminate (CSA) cement is a sulfate-based binder whose high-performance hydraulic behavior depends on the rapid formation of ettringite, when grinded clinker is hydrated in presence of gypsum. Ettringite is a calcium aluminum sulfate mineral characterized by high water content, estimated as 32 water molecules per formula unit. Three examples of utilization of near-infrared (NIR) spectroscopy are here shown. First of all, information on water distribution in pure ettringite was deduced and compared with infrared analyses. Then its thermal behavior has been followed up to 400 °C, allowing to improve the knowledge about water loss and thermal decomposition of this hydrated phase. Finally, the obtained results have been employed in order to follow hydration of CSA cement sample, demonstrating thus that NIR spectroscopy, being highly sensitive to water amount and distribution, can be an extremely useful tool for hydration studies.

Purpose of ReviewThe aim of this report is to describe the main aspects of sex-related differences in non-ischemic dilated cardiomyopathies (DCM), focusing on chemotherapy-induced heart failure (HF) and investigating the possible therapeutic implications and clinical management applications in the era of personalized medicine.Recent FindingsIn cardio-oncology, molecular and multimodality imaging studies confirm that sex differences do exist, affecting the therapeutic cardioprotective strategies and, therefore, the long-term outcomes. Interestingly, compelling evidences suggest that sex-specific characteristics in drug toxicity might predict differences in the therapeutic response, most likely due to the tangled interplay between cancer and HF, which probably share common underlying mechanisms.SummaryCardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestations, from sex-determined differential gene expression to sex hormone interaction with their receptors in the heart. Non-ischemic DCM is an umbrella definition that incorporates several etiologies, including chemotherapy-induced cardiomyopathies. The role of sex as a risk factor for cardiotoxicity is poorly explored. However, understanding the various features of disease manifestation and outcomes is of paramount importance for a prompt and tailored evaluation.

Abstract Background Ticagrelor improves clinical outcomes in patients with acute coronary syndromes compared with clopidogrel. Ticagrelor also inhibits cell uptake of adenosine and has been associated with cardioprotective effects in animal models. We sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention (PCI). Methods and results This was a Prospective Randomized Open Blinded End-points (PROBE) trial enrolling stable patients with coronary artery disease (CAD) requiring fractional flow reserve–guided PCI of intermediate epicardial coronary lesions. ST-segment elevation at intracoronary electrocardiogram (IC-ECG) during a two-step sequential coronary balloon inflations in the reference vessel during PCI was used as an indirect marker of cardioprotection induced by ischemic preconditioning (IPC). The primary endpoint of the study was the comparison of the delta (Δ) (difference) ST-segment elevation measured by IC-ECG during two-step sequential coronary balloon inflations. Results Fifty-three patients were randomized to either clopidogrel or ticagrelor. The study was stopped earlier because the primary endpoint was met at a pre-specified interim analysis. ΔST-segment elevation was significantly higher in ticagrelor as compared to clopidogrel arms (P < 0.0001). Ticagrelor was associated with lower angina score during coronary balloon inflations. There was no difference in coronary microvascular resistance between groups. Adenosine serum concentrations were increased in patients treated with ticagrelor as compared to those treated with clopidogrel. Conclusions Ticagrelor enhances the cardioprotective effects of IPC compared with clopidogrel in stable patients with CAD undergoing PCI. Further studies are warranted to fully elucidate the mechanisms through which ticagrelor may exert cardioprotective effects in humans. Clinical Trial Registration http://www.clinicaltrials.gov. Unique Identifier: NCT02701140. Graphical Abstract Graphical Abstract Patients treated with ticagrelor showed increased delta difference in the intracoronary ST-segment elevation during two-step sequential balloon inflations and reduced angina score, compared to clopidogrel.

Calcium sulphoaluminate (CSA) cement is considered the third series cement besides ordinary Portland cement (OPC) and calcium aluminate (CA) cement. It is produced from gypsum, bauxite and limestone at 1,300 °C and consists of yeelimite, belite and anhydrite as main mineral phases. In the last years, many attempts have been made in applying Raman spectroscopy for the characterization of cement, clinker minerals and supplementary cementing materials (SCMs), revealing that this technique is a valuable tool for the identification of different phases in cements. In this work micro-Raman spectroscopy has been used, together with X-ray diffraction, for the characterization of CSA cement and its main minerals. In order to identify which mineral phase is responsible for the different bands, Raman spectra have been acquired from synthesized yeelimite and belite phases (whose purity degree was checked by X-ray diffraction) and from calcium sulphate di-hydrate and anhydrous (gypsum and anhydrite, respectively). On these bases, Raman spectra collected on CSA clinker and cement have been successfully assigned. Moreover, Raman spectroscopy, together with X-ray diffraction, proved useful to follow the hydration process of CSA cement up to 28 days.

Background: the RIGENERA trial assessed the efficacy of granulocyte-colony stimulating factor (G-CSF) in the improvement of clinical outcomes in patients with severe acute myocardial infarction. However, there is no evidence available regarding the long-term safety and efficacy of this treatment. Methods: in order to evaluate the long-term effects on the incidence of major adverse events, on the symptom burden, on the quality of life and the mean life expectancy and on the left ventricular (LV) function, we performed a clinical and echocardiographic evaluation together with an assessment using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Heart Failure Model (SHFM) at 10-years follow-up, in the patients cohorts enrolled in the RIGENERA trial. Results: thirty-two patients were eligible for the prospective clinical and echocardiography analyses. A significant reduction in adverse LV remodeling was observed in G-CSF group compared to controls, 9% vs. 48% (p = 0.030). The New York Heart Association (NYHA) functional class was lower in G-CSF group vs. controls (p = 0.040), with lower burden of symptoms and higher quality of life (p = 0.049). The mean life expectancy was significantly higher in G-CSF group compared to controls (15 ± 4 years vs. 12 ± 4 years, p = 0.046. No difference was found in the incidence of major adverse events. Conclusions: this longest available follow-up on G-CSF treatment in patients with severe acute myocardial infarction (AMI) showed that this treatment was safe and associated with a reduction of adverse LV remodeling and higher quality of life, in comparison with standard-of-care treatment.

The oncologic involvement of the spinal cord in neurofibromatosis type 1 (NF1) is not a typical feature of the disease. Here, we present a case of ganglioglioma of the spinal cord in a child with NF1 and try to define if this tumor can be considered coincidental or not. A 4-year-old boy affected by NF1 was diagnosed with a spinal cord-enhancing tumor extending from C4 to D3, with a disappearance in the T2 MRI sequences of the cerebrospinal fluid signal. The patient underwent a subtotal resection. The pathological exam revealed a ganglioglioma. To the best of our knowledge, only 1 other case of spinal cord ganglioglioma has been described in an NF1 patient. We suggest considering ganglioglioma in the differential diagnosis of an NF1 patient with a spinal cord tumor due to its favorable survival rate, especially in relation to the anatomical and surgical issues of this tumor that do not always entail a gross total resection.