Abstract Background and aim Low plasma vitamin D levels have been associated with heart failure (HF). This research attempts to explain the role of vitamin D supplementation on myocardial function in ...elderly patients with HF. Methods and results Twenty-three chronic HF patients were randomized in a small parallel group, double-blind, placebo-controlled trial. All patients, with a mean age of 74 years and vitamin D levels <30 ng/mL, received 800,000 IU (4000 IU/daily) of cholecalciferol or placebo for 6 months. The outcomes measured at baseline and after 6 months were ejection fraction (EF) and other echocardiography parameters, carboxyterminal propeptide of procollagen type I (PIP), natriuretic peptides, lipid profile, renin, parathyroid hormone, blood pressure, and body mass index (BMI). In 13 patients under active treatment for 6 months, mean plasma 25-hydroxy vitamin D concentrations (15.51 vs. −1.40 ng/mL, p < 0.001) and plasma calcium (from 9.3 to 9.6 mmol/L, p < 0.05) increased significantly. However, other biomarkers of bone metabolism did not differ between the treatment and placebo groups. EF increased significantly in the intervention group (6.71 vs. −4.3%; p < 0.001), and the serum concentration of PIP increased only in the placebo group after 6 months (1140.98 vs. −145 mcg/L; p < 0.05). Systolic blood pressure was lower after 6 months of cholecalciferol treatment (from 129.6 to 122.7 mm Hg, p < 0.05). No significant variations were observed for other parameters. Conclusions Six months of vitamin D supplementation significantly improves EF in elderly patients with HF and vitamin D deficiency.
Percutaneous radiofrequency ablation (RFA) is a standard treatment for small-HCC (<3 cm). However, some features such as proximity to intrahepatic vascular structures (perivascular location) seem to ...be related to short- and long-term outcomes. The aims of the study were to investigate the features related to ablation success and local tumor progression (LTP) in patients submitted to percutaneous ablation for perivascular-HCC.
From January 2010 to May 2021, 132 perivascular-HCC nodules ablated with US-guided single probe percutaneous RFA were retrospectively analyzed. Univariate analysis and multivariable Cox regression model were used to identify factors that were independently related to ablation success and LTP-free survival.
The overall ablation success rate was 71.9% (n=95). Morbidity and mortality rates were 4.0% and 0.0%. The features related to ablation success: nodule size (≤20 mm vs. >20 mm) (OR 2.442, p=0.031), major vascular structures diameter (3–5 mm vs ≥ 5 mm) (OR 2.167, p=0.037) and liver parenchyma (cirrhosis vs no-cirrhosis) (OR 2.373, p=0.033). The following features resulted independently related to better LTP-free survival: nodule size ≤20 mm (HR 2.802, p=0.003), proximity to glissonean pedicles (HR 1.677, p=0.028), and major vascular structure diameter <5 mm (HR 1.987, p=0.041).
Perivascular location confirmed to be a difficult and unfavorable indication for percutaneous ablation for HCC nodules. However, perivascular nodules not suitable for surgery with low-risk features (size <20 mm, proximity to glissonian pedicles and vascular diameter <5 mm) may be treated with RFA with satisfactory outcomes.
•Ablation success is related to size of nodule, cirrhotic liver and proximity to vessel <5mm.•Higher LTP-free survival in small nodule, near to glissonean pedicle or vessel <5mm.•Perivascular location of HCC nodules confirmed to be unfavorable indication for RFA.•Nodules with low-risk features may be treated with RFA with satisfactory outcomes.
Abstract Patients with chronic inflammatory arthritis experience an increased incidence of cardiovascular (CV) events. In addition to visualizing atherosclerotic plaques, ultrasound examinations ...(USs) of the carotid arteries permit the measurement of subclinical markers of atherosclerosis, such as intima-media thickness (cIMT) and carotid segmental distensibility (cDC). The aims of the study were to identify the determinants of atherosclerosis acceleration (plaques, cIMT and cDC) in a sample of patients suffering from chronic arthritis and to compare these patients with a control group of people with ≤ 1 traditional risk factor (TRF) for CV disease. Methods We recruited 137 patients with rheumatoid arthritis (RA), 43 patients with psoriatic arthritis (PsA), 28 patients with ankylosing spondylitis (AS) and 48 healthy volunteers without histories of previous CV events. These patients underwent carotid artery US examinations using dedicated hardware. Results Regression and multivariate analyses demonstrated that only age ( p < 0.001) was consistently associated with cDC, cIMT and atherosclerotic plaques, both in the entire sample of patients with arthritis and in the subgroup of patients with RA. Among modifiable TRFs for cardiovascular disease, only hypertension, diabetes mellitus and smoking exhibited associations with some carotid phenotypes, with borderline significance. When patients with RA carrying ≤ 1 TRF were compared with control subjects carrying ≤ 1 TRF, only cDC was slightly lower in the RA group than in the control group. Conclusions Age is the major determinant of subclinical atherosclerosis in patients with different types of arthritis, as the contributions of other TRFs and disease activity and duration indices to the disease seem to be limited.
Objectives: Subclinical left ventricular (LV) abnormalities have been reported in echocardiographic studies of patients with psoriatic arthritis (PsA). Left ventricular systolic dysfunction (LVSD) ...often coexists with concentric LV remodelling, an unfavourable prognostic factor that is commonly found in patients at high cardiovascular risk. However, it is unclear whether PsA is associated with concentric LV remodelling. This cross-sectional study assesses the prevalence of and factors associated with concentric LV remodelling in a cohort of patients with PsA, and tests the hypothesis that concentric LV remodelling is a major determinant of LVSD in PsA.
Method: We evaluated 101 adults attending an outpatient clinic with PsA diagnosed according to the ClASsification criteria for Psoriatic ARthritis (CASPAR). All patients were free of cardiovascular disease. Patients with PsA were compared with 101 controls matched for age, gender, body mass index, hypertension, and diabetes. Echocardiography was performed: concentric LV remodelling was defined if the relative wall thickness was > 0.43; stress-corrected mid-wall shortening was used as an index of LVSD and considered impaired if < 86.5%.
Results: Concentric LV remodelling was found in 58% of patients with PsA and 18% of controls (p < 0.001). LVSD was found in a significantly higher proportion of patients with PsA (56%, p < 0.001) than controls. The presence of PsA yielded a 10-fold higher probability of having LVSD odds ratio (OR) 9.6, 95% confidence interval (CI) 4.2-21.9, p < 0.0001. In patients with PsA, concentric LV remodelling increased the risk of LVSD four-fold (OR 3.7, 95% CI 1.3-10.2, p = 0.013).
Conclusion: Most asymptomatic patients with PsA have concentric LV remodelling, which is closely associated with subclinical LVSD.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE:Epidemiologic and intervention studies suggest that dietary vegetables containing lycopene may associate with a reduction in cardiovascular risk. Lycopene has antioxidant activity, being ...the most efficient carotenoid singlet oxygen quencher. Aim of the present study was to explore the effects of lycopene on the synthesis and release of nitric oxide (NO) in endothelial cells and endothelial cells migration, a key step in angiogenesis.
DESIGN AND METHOD:Cultured human umbilical endothelial cells (HUVECs) were incubated for 30 minutes in the presence or absence of lycopene (2 micromol/L), vascular endothelial growth factor-A (VEGF-A, 10 ng/mL) and the NO-synthase inhibitor L-NAME (300 micromol/L). Confocal microscopy and Diaminofluorescein-FM diacetate (DAF-FM-DA) as NO indicator were used to analyze NO generation. Nitrite/nitrate concentration was measured in the cell culture medium using 2,3-diaminonaphthalene fluorimetric assay after 30 minutes of exposure to agonists and inhibitors. HUVECs migration was quantified by counting the number of migrated cells (10 fields per well) up to 20 hours after the addition of VEGF using the scratch wound healing assay.
RESULTS:An increase in DAF-FM-DA fluorescence was observed in HUVECs with a perinuclear pattern after exposure to lycopene (486.5 ± 142.0 Arbitrary Units, M ± SD, n = 7, p < 0.01), VEGF (472.7 ± 103.4 AU, p < 0.01) or the combination of the two agents with no synergistic effect (460.4 ± 183.2 AU, p < 0.05) compared to controls (293.5 ± 110.9 AU). Nitrite/nitrate concentration in HUVECs culture medium was higher in the presence of lycopene (35.9 ± 25.0 nmol/L, n = 4, P < 0.05), compared to controls (10.4 ± 1.0 nmol/L) and VEGF-A which had no effects. Nitrite/nitrate concentration was reduced by L-NAME (8.6 ± 2.6 nmol/L), demonstrating their generation via NO-synthase. HUVECs migration was stimulated by VEGF-A (967 ± 235 Cells/Field, control652.9 ± 118.5, n = 8, p < 0.05) and inhibited by the addition of lycopene (676.1 ± 204.8 C/F, p < 0.01 vs VEGF alone).
CONCLUSIONS:The present data demonstrate that lycopene increases NO generation and release, as shown by the increase in NO and nitrite/nitrate concentrations, by preventing peroxynitrite formation. Lycopene has biological activity, blunting the increase in cell migration induced by VEGF-A, possibly through NO-depended modulation of VEGF signaling system. The potential of lycopene bioactivity should be further investigated in the setting of vascular inflammation and pathological angiogenesis.
OBJECTIVE:Overweight and obesity lead to the clustering of cardiovascular (CV) risk factors and the metabolic syndrome (MetS) not only in adults but also in children and are often accompanied by ...non-alcoholic fatty liver disease. Quality of dietary fat, beyond the quantity, can influence CV risk profile and in particular omega-3 fatty acids (FA) have been proposed as beneficial.
DESIGN AND METHOD:The aim of this observational study was to evaluate the associations of individual CV risk factors, characterizing the MetS, with erythrocyte membrane FA (by gas-chromatography), markers of average intake, in a group of obese children.
RESULTS:We enrolled 70 children (BMI = 29.4 ± 4.4 Kg/m; percentile of BMI = 98.0 ± 1.7), aged 5–17 years. Mean content of Omega-3 FA was low (Omega-3 Index = 4.7 ± 0.8%). Omega-3 FA were not associated with MetS characteristics, whereas omega-6 FA, in particular arachidonic acid (AA), were inversely associated with several features of the MetSAA resulted inversely correlated with waist circumference (rS = −0.352), waist/hip ratio (rS = −0.311), Waist/height ratio (rS = −0.248), triglycerides (rS = −0.366), fasting insulin (rS = −0.337), 24-hour-SBP (rS = −0.313), daytime-SBP (rS = −0.267), nighttime-SBP (rS = −0,245) and nighttime DBP (rS = −0.344). On the opposite, total amount of saturated FA (SFA) and specifically, palmitic acid, correlated positively with waist circumference (rS = 0.254), waist/hip ratio (rS = 0.247), total cholesterol (rS = 0.258), triglycerides (rS = 0.373) and fasting insulin (rS = 0.287).Thirty-five children (50%) had hepatic steatosis detected by ultrasounds. Fatty Liver Index (FLI), a predictive score of steatosis based on GGT, triglycerides and anthropometric indexes, was directly correlated to SFA (rS = 0.479), palmitic acid (rS = 0.515) and inversely to omega-6 FA (rS = −0.435) and AA (rS = −0.472). AA was inversely correlated with ALT (rS = −0.331) and palmitic acid directly with GGT (rS = 0.339).
CONCLUSIONS:Omega-6 FA, and especially AA, may be protective toward CV risk factors featuring the MetS and also to indexes of hepatic steatosis in obese children, whereas SFA seems to exert opposite effects.
Background
SARS- CoV-2 virus has had dramatic consequences worldwide being able to cause acute respiratory distress syndrome (ARDS), massive thrombosis and pulmonary embolism and, finally, patients’ ...death. In COVID-19 infection, platelets have a procoagulant phenotype that can cause thrombosis in the pulmonary and systemic vascular network. Aspirin is a well-known anti-platelet drug widely used for the prevention of cardiovascular events and systematic reviews suggest a possible benefit of low-dose aspirin (LDA) use in the prevention and treatment of ARDS in patients with COVID-19 infection. However, several studies are available in the literature which do not support any benefits and no association with the patients’ outcome. Therefore, currently available data are inconclusive.
Materials and patients
Data from the nationwide cohort multicenter study of the Italian Society of Internal Medicine (SIMI) were analyzed. We conducted a propensity score-matched cohort analysis to investigate the impact of chronic assumption of LDA on mortality of adult COVID-19 patients admitted in Internal Medicine Units (IMU). Data from 3044 COVID-19 patients who referred to 41 Italian hospitals between February 3rd to May 8th 2020 were analyzed. A propensity score-matched analysis was conducted using the following variables: age, sex, hypertension, hyperlipidemia diabetes, atrial fibrillation, cerebrovascular disease, COPD, CKD and stratified upon LDA usage, excluding anticoagulant treatment. After matching, 380 patients were included in the final analysis (190 in LDA group and 190 in no-LDA group).
Results
66.2% were male, median age was 77 70–83. 34.8% of the population died during the hospitalization. Cardiovascular diseases were not significantly different between the groups. After comparison of LDA and no-LDA subgroups, we didn’t record a significant difference in mortality rate (35.7% vs 33.7%) duration of hospital stay and ICU admission. In a logistic regression model, age (OR 1.05; 95% CI 1.01–1.09), FiO2 (OR 1.024; 95% CI 1.03–1.04) and days between symptoms onset and hospitalization (OR 0.93; 95% CI 0.87–0.99) were the only variables independently associated with death
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