Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE)

Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.

The loss of the BH3-only Bcl-2 family member Bid delays T-cell leukemogenesis in Atm-/- mice

Multicellular organisms maintain genomic integrity and resist tumorigenesis through a tightly regulated DNA damage response (DDR) that prevents propagation of deleterious mutations either through DNA repair or programmed cell death. An impaired DDR leads to tumorigenesis that is accelerated when programmed cell death is prevented. Loss of the ATM (ataxia telangiectasia mutated)-mediated DDR in mice results in T-cell leukemia driven by accumulation of DNA damage accrued during normal T-cell development. Pro-apoptotic BH3-only Bid is a substrate of Atm, and Bid phosphorylation is required for proper cell cycle checkpoint control and regulation of hematopoietic function. In this report, we demonstrate that, surprisingly, loss of Bid increases the latency of leukemogenesis in Atm-/- mice. Bid-/-Atm-/- mice display impaired checkpoint control and increased cell death of DN3 thymocytes. Loss of Bid thus inhibits T-cell tumorigenesis by increasing clearance of damaged cells, and preventing propagation of deleterious mutations.

Silencing of GSTP1, a prostate cancer prognostic gene, by the estrogen receptor-β and endothelial nitric oxide synthase complex

We recently identified in prostate tumors (PCa) a transcriptional prognostic signature comprising a significant number of genes differentially regulated in patients with worse clinical outcome. Induction of up-regulated genes was due to chromatin remodeling by a combinatorial complex between estrogen receptor (ER)-β and endothelial nitric oxide synthase (eNOS). Here we show that this complex can also repress transcription of prognostic genes that are down-regulated in PCa, such as the glutathione transferase gene GSTP1. Silencing of GSTP1 is a common early event in prostate carcinogenesis, frequently caused by promoter hypermethylation. We validated loss of glutathione transferase (GST) P1-1 expression in vivo, in tissue microarrays from a retrospective cohort of patients, and correlated it with decreased disease-specific survival. Furthermore, we show that in PCa cultured cells ERβ/eNOS causes GSTP1 repression by being recruited at estrogen responsive elements in the gene promoter with consequential remodeling of local chromatin. Treatment with ERβ antagonist or its natural ligand 5α-androstane-3β,17β-diol, eNOS inhibitors or ERβ small interference RNA abrogated the binding and reversed GSTP1 silencing, demonstrating the direct involvement of the complex. In vitro, GSTP1 silencing by ERβ/eNOS was specific for cells from patients with worse clinical outcome where it appeared the sole mechanism regulating GSTP1 expression because no promoter hypermethylation was present. However, in vivo chromatin immunoprecipitation assays on fresh PCa tissues demonstrated that silencing by ERβ/eNOS can coexist with promoter hypermethylation. Our findings reveal that the ERβ/eNOS complex can exert transcriptional repression and suggest that this may represent an epigenetic event favoring inactivation of the GSTP1 locus by methylation. Moreover, abrogation of ERβ/eNOS function by 3β-adiol emphasizes the significance of circulating or locally produced sex steroid hormones or their metabolites in PCa biology with relevant clinical/therapeutic implications.

Quantum light from a whispering-gallery-mode disk resonator

Optical parametric down-conversion has proven to be a valuable source of nonclassical light. The process is inherently able to produce twin-beam correlations along with individual intensity squeezing of either parametric beam, when pumped far above threshold. Here, we present for the first time the direct observation of intensity squeezing of -1.2  dB of each of the individual parametric beams in parametric down-conversion by use of a high quality whispering-gallery-mode disk resonator. In addition, we observed twin-beam quantum correlations of -2.7  dB with this cavity. Such resonators feature strong optical confinement and offer tunable coupling to an external optical field. This work exemplifies the potential of crystalline whispering-gallery-mode resonators for the generation of quantum light. The simplicity of this device makes the application of quantum light in various fields highly feasible.

Entangling different degrees of freedom by quadrature squeezing cylindrically polarized modes

Quantum systems such as, for example, photons, atoms, or Bose-Einstein condensates, prepared in complex states where entanglement between distinct degrees of freedom is present, may display several intriguing features. In this Letter we introduce the concept of such complex quantum states for intense beams of light by exploiting the properties of cylindrically polarized modes. We show that already in a classical picture the spatial and polarization field variables of these modes cannot be factorized. Theoretically it is proven that by quadrature squeezing cylindrically polarized modes one generates entanglement between these two different degrees of freedom. Experimentally we demonstrate amplitude squeezing of an azimuthally polarized mode by exploiting the nonlinear Kerr effect in a specially tailored photonic crystal fiber. These results display that such novel continuous-variable entangled systems can, in principle, be realized.

A new echo-Doppler method to measure interatrial conduction time. Validation and clinical usefulness

AIM

The aim of this study was to assess if knowing the interatrial conduction time is useful to better program atrioventricular delay in sequential pacing. The study proposes a new echo-Doppler method to measure interatrial conduction time, correlating it with electrophysiological measures.

METHODS

The new method was tested in 30 subjects who underwent electrophysiological study. Interatrial conduction time by new method was taken during atrial pacing as the interval between the artefact of electrocardiogram pacing, shown on screen echo, and the onset of the A wave of the echo-Doppler mitral inflow. The electrophysiological measures were obtained, in the same subjects and at the same time, by a decapolar catheter in coronary sinus as intervals between the artefact of atrial pacing and the first positive left atrial deflection at proximal (C7C8) and distal (C1C2) electrodes.

RESULTS

Echo-Doppler mean time was 114±12 ms, electrophysiological time was 107±14 ms at C7C8 and 124±11 ms at C1C2. Statistical analysis showed a good correlation (r=0.92, P<0.001) and accord (mean difference=6.6 ms) between the two methods.

CONCLUSION

The new method to measure interatrial conduction time is consistent with the electrophysiological method; it could be particularly useful in programming the best AV delay in sequential and biventricular pacing, to avoid atrial contraction against a closed mitral valve.

Quadrant detector calibration for vortex beams

This Letter reports an experimental and theoretical study of the response of a quadrant detector (QD) to an incident vortex beam, specifically a Laguerre-Gaussian (LG) beam. We have found that the LG beam response depends on the vorticity index ℓ. We compare LG beams with hard-ringed beams and find that at higher ℓ values, the QD response to LG beams can be approximated by its response to hard-ringed beams. Our findings are important in view of the increasing interest in optical vortex beams.

Low-threshold optical parametric oscillations in a whispering gallery mode resonator

In whispering gallery mode (WGM) resonator light is guided by continuous total internal reflection along a curved surface. Fabricating such resonators from an optically nonlinear material one takes advantage of their exceptionally high quality factors and small mode volumes to achieve extremely efficient optical frequency conversion. Our analysis of the phase-matching conditions for optical parametric down-conversion (PDC) in a spherical WGM resonator shows their direct relation to the sum rules for photons' angular momenta and predicts a very low parametric oscillation threshold. We realized such an optical parametric oscillator (OPO) based on naturally phase-matched PDC in lithium niobate. We demonstrated a single-mode, strongly nondegenerate OPO with a threshold of 6.7 μW and linewidth under 10 MHz. This work demonstrates the remarkable capabilities of WGM-based OPOs.

Demonstration of a quasi-scalar angular Goos-Hänchen effect

We show experimentally that the angular Goos-Hänchen (GH) effect can be easily observed, also without employing its resonant enhancement at Brewster incidence. An s-polarized beam was used to decouple the polarization from the propagation dynamics of the beam. We found that, in this case, the angular GH effect can be strongly enhanced by increasing the angular aperture of the Gaussian beam. Our experiments suggest a route toward observing the angular GH effect for true scalar waves, such as acoustic waves and quantum matter waves.

Disruptive Coloration in Butterflies: Lack of Support in Anartia fatima

Experimental obliteration of high-contrast wing stripes of the neotropical butterfly Anartia fatima affected neither survival nor wing damage in a natural population over a 5-month period. There is no direct evidence supporting the hypothesis that so-called disruptive wing patterns function as protective coloration in butterflies.

Camouflage by integumentary wetting in bark bugs

Unlike most insect integuments, the body surfaces of certain bark-inhabiting bugs are wettable. A thin film of water reduces the reflectivity of the insect, resulting in a close match with the wettable bark upon which it rests. Wettability probably aids in concealing the insects from predators.

Goos-Hänchen shift for a rough metallic mirror

We investigate experimentally the dependence of the Goos-Hänchen shift on the surface properties of an air-metal interface. The shift depends on the microscopic roughness of the metal surface but it is insensitive to the large-scale variations associated with surface non-flatness. Both an effective medium model of roughness and the Rayleigh-Rice theory of scattering are used to interpret the observed phenomenon.

Brewster cross polarization

We theoretically derive the polarization-resolved intensity distribution of a TM-polarized fundamental Gaussian beam reflected by an air-glass plane interface at Brewster incidence. The reflected beam has both a dominant (TM) and a cross-polarized (TM) component, carried by a TEM(10) and a TEM(01) Hermite-Gaussian spatial mode, respectively. Remarkably, we find that the TE-mode power scales quadratically with the angular spread of the incident beam and is comparable to the TM-mode power. Experimental confirmations of the theoretical results are also presented.