Combined Evaluation of ST-segment Elevation in lead AVR and ST-segment Depression in other Leads Enhances Prediction of in-hospital Cardiovascular Death in Patients with Non ST-segment Elevation Acute Coronary Syndrome

Objective: To investigate the prognostic significance of ST-segment elevation (STE) in aVR associated with ST-segment depression (STD) in other leads in patients with non-STE acute coronary syndrome (NSTE-ACS). Background: In NSTE-ACS patients, STD has been extensively associated with severe coronary lesions and poor outcomes. The prognostic role of STE in aVR is uncertain. Methods: We enrolled 888 consecutive patients with NSTE-ACS. They were divided into two groups according to the presence or not on admission ECG of aVR STE≥ 1mm and STD (defined as high risk ECG pattern). The primary and secondary endpoints were: in-hospital cardiovascular (CV) death and the rate of culprit left main disease (LMD). Results: Patients with high risk ECG pattern (n=121) disclosed a worse clinical profile compared to patients (n=575) without [median GRACE (Global-Registry-of-Acute-Coronary-Events) risk score =142 vs. 182, respectively]. A total of 75% of patients underwent coronary angiography. The rate of in-hospital CV death was 3.9%. On multivariable analysis patients who had the high risk ECG pattern showed an increased risk of CV death (OR=2.88, 95%CI 1.05-7.88) and culprit LMD (OR=4.67,95%CI 1.86-11.74) compared to patients who had not. The prognostic significance of the high risk ECG pattern was maintained even after adjustment for the GRACE risk score (OR = 2.28, 95%CI:1.06-4.93 and OR = 4.13, 95%CI:2.13-8.01, for primary and secondary endpoint, respectively). Conclusions: STE in aVR associated with STD in other leads predicts in-hospital CV death and culprit LMD. This pattern may add prognostic information in patients with NSTE-ACS on top of recommended scoring system.

Characterization of the chestnut germoplasm of Emilia-Romagna region and ancient fruit tree varieties valorization

Molecular characterization represents a valid support for the recovery of germoplasm, also motivated by the interest for the valorization of local productions in order to make their traceability possible. Molecular characterization is also fundamental for the individuation of misnomers in collection fields in which the different varieties are preserved. In particular, microsatellites have been used in this research to investigate the genetic diversity, inside a population and at an individual level, and the correct varietal correspondence. The research is mainly based on the study of European chestnut (Castanea sativa Mill.) cultivars to evaluate the genetic diversity and relationships in Emilia-Romagna region (Italy). A STRUCTURE analysis was carried out at European level with the allelic frequencies of the samples collected in Emilia-Romagna. Variation found at group and subgroup level may reflect a combination of historical migration/selection processes and adaptive factors to different environments between Italian and Spanish regions. In addition, a case study for the valorization of an old local variety and its re-introduction in the cultivation areas was proposed. This research was carried out by a morphological and molecular characterization of the local apple variety 'Rosa Romana'. The conservation of this variety entails the discrimination of different accessions with very similar phenotype that are present in the original cultivation area. The identification of historical trees and most adequate reference plants are fundamental steps for the correct propagation of this old variety and for the development of nursery activities. This will also promote and re-evaluate the exploitation and protection of such ancient Italian apple cultivars. This model could be in future also carried out for chestnut varieties. In conclusion, analysis with molecular markers is of fundamental importance for the protection and the maintenance of local and ancient varieties which allow to increase the allelic variability available for breeding programs.