The intensity and frequency of drought have increased considerably during the last decades in southeastern Europe, and projected scenarios suggest that southern and central Europe will be affected by more drought events by the end of the 21st century. In this context, assessing the intraspecific genetic variation of forest tree species and identifying populations expected to be best adapted to future climate conditions is essential for increasing forest productivity and adaptability. Using a tree-ring database from 60 populations of 38-year-old silver fir (Abies alba) in five trial sites established across Romania, we studied the variation of growth and wood characteristics, provenance-specific response to drought, and climate-growth relationships during the period 1997–2018. The drought response of provenances was determined by four drought parameters: resistance, recovery, resilience, and relative resilience. Based on the standardized precipitation index, ten years with extreme and severe drought were identified for all trial sites. Considerable differences in radial growth, wood characteristics, and drought response parameters among silver fir provenances have been found. The provenances’ ranking by resistance, recovery, and resilience revealed that a number of provenances from Bulgaria, Italy, Romania, and Czech Republic placed in the top ranks in almost all sites. Additionally, there are provenances that combine high productivity and drought tolerance. The correlations between drought parameters and wood characters are positive, the most significant correlations being obtained between radial growth and resilience. Correlations between drought parameters and wood density were non-significant, indicating that wood density cannot be used as indicator of drought sensitivity. The negative correlations between radial growth and temperature during the growing season and the positive correlations with precipitation suggest that warming and water deficit could have a negative impact on silver fir growth in climatic marginal sites. Silvicultural practices and adaptive management should rely on selection and planting of forest reproductive material with high drought resilience in current and future reforestation programs.

IL-6 -174CC and nt565AA genotypes and IL-10ATA haplotypes are correlated with a high short-term risk of acute postoperative cardiovascular events in patients with peripheral artery disease receiving elective surgical revascularization and with endothelial dysfunction in these patients.

Background: In Romania, 23 patients have been diagnosed with hereditary transthyretin amyloidosis (ATTRh), 18 of whom have the Glu54Gln mutation. This retrospective cohort included all patients with Glu54Gln-mutated ATTRh who were diagnosed in Romania from 2005 to 2018. Results: Of 18 patients, 10 were symptomatic, five were asymptomatic carriers and three died during the study. All originated from NorthEast Romania. Median age at symptom onset was 45 years; median age at death was 51 years. All patients had cardiac involvement, including changes in biomarkers (mean N-terminal-pro B-type natriuretic peptide: 2815.6 pg/ml), electrocardiography (15% atrial fibrillation, 38% atrioventricular block, 31% right bundle block), and echocardiography (mean interventricular septum: 16 mm, mean left ventricular ejection fraction: 49%). Scintigraphy showed myocardial radiotracer uptake in all patients. In addition, 92% of patients had polyneuropathy at diagnosis and 53% had carpal tunnel syndrome; 69% exhibited orthostatic hypotension and 31% suffered from diarrhea. No renal or liver involvement was observed. Conclusions: This is the largest Glu54Gln-mutated ATTRh cohort diagnosed to date, and to our knowledge the first describing this variant worldwide. Clinical features of this variant are early onset, neurological and cardiac involvement, aggressive disease progression and short survival. Early diagnosis and therapeutic intervention have potential to improve prognosis in ATTRh.

Rationale:Acute ST-segment elevation myocardial infarction (STEMI) is a rare complication of acute ischemic stroke (AIS) during thrombolytic therapy. We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches.Patient concerns:A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block).Diagnoses:The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion.Interventions:Four hours after the onset of STEMI, stenting was performed, normalizing the coronary blood flow.Outcomes:The patient died 2 days thereafter because of persistent cardiogenic shock.Lessons:Our case is remarkable owing to the unusually early (<1 hour) occurrence of STEMI after i.v. rtPA administration. A third-degree atrioventricular block after thrombolysis for AIS could signal a STEMI onset. New and ongoing trials are assessing whether adjunct administration of direct thrombin inhibitors of rtPA in the first 24 hours after thrombolysis for AIS can prevent early recurrent ischemic events.

Background The presence of small mobile masses on the ventricular side of the aortic valves in the absence of valvular regurgitation and signs of systemic inflammation has been previously described as marantic endocarditis and is now referred to as nonbacterial thrombotic endocarditis (NBTE). It is thought to be associated with endothelial dysfunction and procoagulative status, as is the case of acute decompensated heart failure (HF). Case description We present a series of three male patients, with similar clinical characteristics, who were admitted for acute decompensated HF. All three patients had chronic HF, due to non-ischemic dilated cardiomyopathy with severe biventricular dysfunction, with resynchronization therapy, with elevated natriuretic peptides and previous HF hospitalizations in the past year requiring prolonged intravenous treatments. Other clinical, biological criteria for the definition of advanced HF were also met. All patients were under chronic anticoagulation treatment using a direct oral anticoagulant because of persistent atrial fibrillation. Thorough echocardiographic evaluation (both transthoracic and transoesophageal ultrasound) identified small mobile masses on the ventricular side of the aortic valves, centrally, on the line of cusp coaptation, with only minor central regurgitation. The lack of progression of valve lesion and the absence of gross signs of inflammation (no fever, normal hemoleucogram, normal CRP, repeated negative blood cultures) on serial examinations during several weeks follow-up allowed for the exclusion of infective endocarditis. In one case we also identified a left atrial appendage thrombus and presumably thrombotic masses attached to right side pacing leads. No clinically systemic embolic events were identified. Conclusion We consider this to be an incidental finding in the given subclinical prothrombotic and inflammatory predisposing milieu of advanced chronic HF and the increasing high quality echocardiography imaging. Its clinical significance is still unknown, while differential diagnosis from subacute or chronic endocarditis relies largely on clinical judgment.