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Background: Cardiovascular comorbidities such as hypertension and inflammatory response dysregulation are associated with worse COVID-19 prognoses. Different cytokines have been proposed to play vital pathophysiological roles in COVID-19 progression, but appropriate prognostic biomarkers remain lacking. We hypothesized that the combination of immunological and clinical variables at admission could predict the clinical progression of COVID-19 in hypertensive patients. Methods: The levels of biomarkers, including C-reactive protein, lymphocytes, monocytes, and a panel of 29 cytokines, were measured in blood samples from 167 hypertensive patients included in the BRACE-CORONA trial. The primary outcome was the highest score during hospitalization on the modified WHO Ordinal Scale for Clinical Improvement. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and biomarkers associated significantly with the primary outcome. Results: During hospitalization, 13 (7.8%) patients showed progression to more severe forms of COVID-19, including three deaths. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography examination, the C-reactive protein level, levels of 15 cytokines, and lymphopenia on admission were associated with progression to severe COVID-19. Elevated levels of interleukin-10 and interleukin-12 (p70) combined with two or three of the abovementioned clinical comorbidities were associated strongly with progression to severe COVID-19. The risk of progression to severe disease reached 97.5% in the presence of the five variables included in our model. Conclusions: This study demonstrated that interleukin-10 and interleukin-12 (p70) levels, in combination with clinical variables, at hospital admission are key biomarkers associated with an increased risk of disease progression in hypertensive patients with COVID-19.

Cardiovascular comorbidities and immune-response dysregulation are associated with COVID-19 severity. We aimed to explore the key immune cell profile and understand its association with disease progression in 156 patients with hypertension that were hospitalized due to COVID-19. The primary outcome was progression to severe disease. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome. Obesity; diabetes; oxygen saturation; lung involvement on computed tomography (CT) examination; the C-reactive protein concentration; total lymphocyte count; proportions of CD4+ and CD8+ T cells; CD4/CD8 ratio; CD8+ HLA-DR MFI; and CD8+ NKG2A MFI on admission were all associated with progression to severe COVID-19. This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of the functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.

Ship accidents that entail flooding may lead to disastrous consequences which could be avoided or mitigated based on the knowledge of damaged ship dynamics. The dynamic behaviour of a damaged hull is a complex phenomenon involving the interaction of the flooded water and the ship motions. The presence of a damage opening allows water flow into and out from the compartment, which further complicates the mathematical description of the problem. A fast simulation method, based on the lumped mass approach, is developed and presented. The lumped mass path in space depends on free-surface inclinations that differ from the ship angles of the roll and pitch. The viscous effects in the floodwater dynamics are implemented based on the model for the dissipation of the energy of standing waves in rectangular rooms. The method applies to both the transient stage of flooding and to the dynamic behaviour of a flooded ship in regular waves. In the first case, viscous effects are implemented considering the water in the compartment variable with time. Several case studies are carried out on three different hull models: Transient stage of flooding, roll decay of the damaged hull, and steady state responses in waves are simulated and compared with available experimental data.

Amid a global effort in reducing the shipping ecologic impact, the study of the particular case of added resistance of high speed vessels cruising in a seaway has been approached by a very limited number of authors. In this study, we provide a comprehensive and systematic assessment of the added resistance of a planing hull in regular waves. The data are analyzed in both the time and frequency domains in order to fully characterize the added resistance and highlight its correlation with hull motions. It is found that peak added resistance modulation occurs for shorter waves with respect to the peak average added resistance, and slenderness is beneficial only in terms of modulation. Nonlinearity of both the average and first harmonic amplitude is also shown. In addition, results of the phase analysis show a correlation between the added resistance phase and average added resistance.

This paper reviews a state-of-the-art zero emission propulsion system for a battery-powered small craft. The main aspects considered are the available propulsion systems, energy storage, and dock battery charging. This underlying activity is part of the KISS project, a research and development program in the frame of the EU-funded “Piano Operativo Regionale CALABRIA FESR-FSE 2014–2020 ASSE I–PROMOZIONEDELLA RICERCA E DELL’INNOVAZIONE”, which is aimed at designing and building a physical prototype. Its hull form is based on previous research conducted by the authors, and the powering performances were preliminarily predicted by CFD simulation. The KISS project represents a successful example of an electric small craft with performances and a mission profile comparable to competitors with conventional propulsion. Such a target has been achieved by a concurrent design that considers the hull form, engine, propulsion system, and energy storage onboard. Safety issues and the regulatory frame are also highlighted.

Background Pharmacists play a crucial role in the COVID-19 pandemic scenario, performing frontline roles for the community, and supporting the healthcare system. This study aimed at investigating stress and its correlates among this category of workers at a high risk of SARS-CoV-2 infection. Methods The participants for this study were employees of the “Municipal Pharmaceutical Company” of L’Aquila (Italy). Data were collected using an anonymous, web-based, self-administered questionnaire. Two independent surveys were conducted, from June to July 2020, and in January 2021. Results Two separate groups of respondents were involved: a total of 37 workers participated in the first survey (mean age 44.9 ± 10.7, 75.7% women) and 18 in the second survey (mean age 45.9 ± 9.2, 94.4% women). The average total scores of the perceived stress (GHQ-12 score) increased significantly from 15.5 to 18.2 ( p  = 0.0438), showing a moderate level of stress in the category investigated. Conclusions We observed a strong emotional exhaustion in the study sample of pharmacists, who reported high-risk perceptions and fear. A comprehensive assistance should be granted to support the well-being of healthcare workers who provide an essential service, despite the high risk of infection.

Fewer studies compared the improvement of plasma lipid levels after different types of surgery, in particular compared to one-anastomosis gastric bypass (OAGB). The aim of our study was to investigate how laparoscopic sleeve gastrectomy (LSG) and OAGB impact on weight loss and lipid profile 18 months after surgery, in patients with severe obesity. Forty-six patients treated with OAGB were matched to eighty-eight patients submitted to LSG. Weight loss after OAGB (33.2%) was more evident than after LSG (29.6%) (p = 0.024). The difference in the prevalence of dyslipidemia showed a statistically significant reduction only after OAGB (61% versus 22%, p < 0.001). After adjustment for delta body mass index (BMI), age and sex, we demonstrated a statistically significant decrease of the differences between the changes before and after (delta Δ) the two surgery procedures: Δ total cholesterol values (p < 0.001), Δ low density lipoprotein-cholesterol values (p < 0.001) and Δ triglycerides values (p = 0.007). Patients with severe obesity undergoing to OAGB presented a better improvement of lipid plasma values than LSG patients. The reduction of lipid plasma levels was independent of the significant decrease of BMI after surgery, of age and of sex.

Erectile dysfunction (ED) is defined as the inability to get and maintain a sufficient erection to ensure an acceptable sexual activity for the subject and the partner. Although ED does not represent per se a serious disease, it carries a notable and severe influence on quality of life, with significant implications on familiar and social relationship; DE may cause depression, shame, impairment of personal esteem and relational problems. Among many possible etiologies of ED, atherosclerotic disease of penile arteries represents one of the most frequent causes, so it should always be looked for in patients with multiple risk factors for cardiovascular disease or an established coronary or peripheral artery disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendus-penile artery system, deputy to perfusion of male genital organ. Recently the potential treatment of this pathologic condition by percutaneous approach has emerged with valid angiographic results and with a significant improvement in symptoms and quality of life. This review focuses on the normal anatomy and physiology of erection, the pathophysiology of ED, the common points between ED and ischemic cardiomyopathy and, lastly, the new chance of endovascular intervention for ED, to give our cardiologist colleagues the opportunity to screen and adequately treat patients with vascular ED.

La disfunzione erettile (DE) è “l’inabilità persistente ad avere e mantenere un’erezione sufficiente a garantire un’attività sessuale soddisfacente sia per il soggetto che per il suo partner”. Sebbene la DE non rappresenti di per sé una condizione patologica grave, essa presenta un notevole e severo impatto sulla qualità di vita, con rilevanti ricadute sulle relazioni familiari e interpersonali; essa può causare depressione, vergogna, riduzione dell’autostima e problematiche di coppia. Tra le molteplici cause della DE, la patologia aterosclerotica delle arterie peniene rappresenta una tra le più frequenti e pertanto dovrebbe essere quindi sempre ricercata nei pazienti che presentano molteplici fattori di rischio cardiovascolare ed anamnesi positiva per cardiopatia ischemica o malattia aterosclerotica periferica. Fino al 75% dei pazienti affetti da DE presenta una stenosi del sistema ileo-pudendo-penieno, deputato all’irrorazione dell’organo genitale maschile. Negli ultimi anni è emersa la possibilità di trattare tale patologia per via percutanea con validi risultati angiografici e rilevante miglioramento sintomatico e della qualità di vita. Questa breve rassegna si focalizzerà sulla normale anatomia e fisiologia del meccanismo dell’erezione, sulla fisiopatologia della DE, sugli aspetti comuni tra DE e cardiopatia ischemica, ed in ultimo sulle recenti possibilità di trattamento interventistico per questa patologia, per dare ai colleghi cardiologhi la possibilità di inquadrare e trattare adeguatamente i pazienti affetti da DE di natura vasculogenica.

Summary Background Paroxysmal supraventricular tachycardia (SVT) in premenopausal women is often judged to be related to anxiety, and may be associated with the menstrual cycle. The aim of this study was to determine whether a cyclical variation of episodes of SVT exists and to correlate such variation with cyclical variation in plasma ovarian hormones. Methods 26 women (mean age 36 [SD 8]) years; with paroxysmal SVT were screened; those with regular menses who experienced at least three episodes of paroxysmal SVT in two consecutive 48-hour ambulatory ECG recordings were included. 13 patients (aged 32 [6] years) met these criteria. Patients underwent 48-hour ambulatory ECG monitoring and determination of plasma concentrations of oestradiol-17β and progesterone on day 7, 14, 21, and 28 of their menstrual cycle. Findings An increase in the number and duration of episodes of paroxysmal SVT was observed on day 28 as compared to day 7 of the menstrual cycle. A significant positive correlation was found between plasma progesterone and number of episodes and duration of SVT (5·6 [2·2] ng/mL; r=0·83, p=0·0004; and r=0·82, p=0·0005), while a significant inverse correlation was found between plasma oestradiol-17β and number of episodes and duration of SVT (155 [22] pg/mL; r=-0·89, p<0·0001; and r=-0·81, p=0·0007). Interpretation Women with paroxysmal SVT and normal menses exhibit a cyclical variation in the occurrence of the arrhythmia with their menstrual cycle. There is a close correlation between the episodes of paroxysmal SVT and the plasma concentrations of ovarian hormones. These data suggest that changes in plasma levels of ovarian hormones (and their interaction) may be of importance in determining episodes of arrhythmia in such patients. The mechanisms of these effects are unknown.