Abstract Background and aim Association of coronary and renal disease has been frequently found in epidemiological studies. Whether ECG-graphic presentation of myocardial infarction S-T Elevated MI ...(STEMI) or Non S-T Elevated MI (NSTEMI) is related to the degree of renal dysfunction is still unclear. Methods and results We examined 146 patients with acute myocardial infarction, consecutively entering the Coronary Care Unit of our ward. At entry, patients underwent clinical, ECG-graphic and echocardiographic examination, and blood samples were withdrawn for cardiac markers and general biochemistry. GFR was calculated using the CKD-EPI equation. STEMI was found in 71 cases and NSTEMI in 75 cases. Renal function was normal in 61 patients (stage 1), mildly impaired (<90 mL/min/1.73 m2 and ≥60 mL/min/1.73 m2 ) in 60 (stage 2) and moderately to severely impaired (GFR <60 mL/min/1.73 m2 ) in 25 cases (stages 3–4). Patients were, thereafter, clustered into two groups (stages 1–2 and stages 3–4). Compared to stage 1–2 subjects, stages 3–4 patients were older, were more likely to be diabetic and had more frequently previous cardiovascular diseases. The probability of presentation of NSTEMI for stage 3–4 patients was 4-fold greater than for stage 1–2 patients ( p = 0.02). Conclusions These data support the evidence that 1) NSTEMI is associated with more severe kidney dysfunction, likely due to more severe and/or longer lasting exposition to risk factors; 2) cardiac and renal impairment are strongly associated. ClinicalTrials.gov Identifier: NCT01636427.
•We explored social capital (SC) and collective actions (CA) links.•Higher levels of SC are related to higher levels of CA.•Vulnerable actors do not necessarily have a higher SC or engage in more ...CA.•Actor with more power in the territory, have higher levels of SC and CA.•Vulnerable actors often perform civil, economic and judicial actions, while dominant actors, technical and political actions.
The relationships among social capital (SC) and collective actions (CA) for nature conservation and management were analyzed across five case studies characterised by specific land-use dynamics in the South American continent. Data on SC and CA were obtained through a semi-structured questionnaire to groups of selected social actors. Multivariate statistical analysis was used to identify SC components and to evaluate SC across actors and cases. The results reaffirm that: i) the multidimensional nature and complexity of SC; ii) Higher levels of SC are related to higher levels of CA; iii) social actors with developed internal and external SC can better counter adverse conditions through CA compared to actors who only have one type of SC; iv) vulnerable social actors do not necessarily have a higher SC or engage in more CA, despite their higher dependence on natural resources; v) those who hold more power or influence in the territory, have higher levels of SC and CA; vi) vulnerable actors often carry out civil/community, economic and judicial actions, while dominant and structuring actors carry out more educational/technical and political actions. Therefore, the formation and maintenance of SC of the most vulnerable actors and those who support them must be a priority for political action, in order to counteract the asymmetric power relations that lead to the exclusion and marginalization of many rural actors.
High blood pressure (BP) is one of the crucial determinants of the metabolic syndrome (MS). The extent to which MS, diagnosed according to the criteria of the International Federation of Diabetes, ...impacts on cardiovascular organ damage, independently of BP, is debated. Three hundred and forty hypertensive patients and 100 normotensive controls underwent the following procedures: (1) physical examination and resting BP measurements, (2) 24 h ambulatory BP monitoring, (3) laboratory routine examination, (4) echocardiography, (5) carotid ultrasonography and (6) ankle-brachial BP index. The syndrome was found in 104 of the 340 hypertensive patients (30.6). In comparison to those without MS, those with MS had significantly higher prevalence of left ventricular (LV) hypertrophy by mass/height(2.7) criteria (46 vs 42%, P<0.01) but not by LV mass/body surface criteria (30 vs 31%); the ratio between early-to-late peak velocities of the LV filling waves (E/A) was higher (E/A=0.99+/-0.14 vs 0.89+/-0.15, P<0.01) and left atrium was larger (3.8+/-0.3 vs 3.5+/-0.5 cm, P<0.01). Both hypertensive groups had significantly greater LVM and carotid intima-media thickness than normotensives, without between-group-difference. In this hypertension outpatient clinic almost one-third hypertensive patients have MS. They show a deterioration in structure and function of the heart in comparison to hypertensive patients without MS, but no difference was detected in the carotid and peripheral arterial circulation.
Keratinocyte growth factor (KGF) is a member of the fibroblast growth factor (FGF) family (hence the alternative designation FGF-7). It is produced by stromal cells, but acts as a mitogen for ...epithelial cells. We examined the effects of topically applied KGF on healing of wounds in a porcine model. In partial-thickness wounds, KGF stimulated the rate of reepithelialization (p < 0.0002), associated with a thickening of the epidermis (p < 0.0001). Epidermis from KGF-treated full-thickness wound sites was significantly thicker (0.31 +/- 0.22 mm) compared with mirror image control sites (0.18 +/- 0.12 mm) (p < 0.0001). Moreover, the majority (77%) of KGF-treated wounds exhibited epidermis with a deep rete ridge pattern as compared with control sites. These effects were observed as early as 14 d and persisted for at least 4 wk. KGF treatment also increased the number of serrated basal cells associated with increased deposition of collagen fibers in the superficial dermis adjacent to the acanthotic epidermis. Electron microscopy revealed better developed hemidesmosomes associated with thicker bundles of tonofilaments in the serrated cells. The pattern of epidermal thickening observed in KGF-treated wounds resembled psoriasis. Psoriasis is a disease associated with epidermal thickening, parakeratosis as well as hyperproliferation that extends beyond the basal layer. In striking contrast to psoriasis, KGF-treated wounds exhibited normal orthokeratotic maturation, and proliferation was localized to the basal cells. Our present findings have significant implications concerning the role of KGF as a paracrine modulator of epidermal proliferation and differentiation.
•Few data on virological characterisation of patients with failure to current-generation direct-acting antivirals (DAAs).•Prevalence of resistance-associated substitutions (RASs) was high in HCV NS5A ...in 61 patients who failed current DAAs.•73% of glecaprevir/pibrentasvir-treated patients did not show RASs in any HCV regions, more than with other DAAs.•All 21 patients re-treated with sofosbuvir/velpatasvir and voxilaprevir achieved SVR12.
There are few data on the virological characterisation of patients with failure to current-generation direct-acting antivirals (DAAs), namely elbasvir/grazoprevir, sofosbuvir/velpatasvir and glecaprevir/pibrentasvir. This study aimed to characterise virological patterns in patients with failure to current DAA regimens as well as the efficacy of re-treatment. All 61 consecutive hepatitis C virus (HCV) treatment-naïve patients with failure to current DAAs from January 2018 to February 2019 were enrolled. Sanger sequencing of NS3, NS5A and NS5B proteins was performed using homemade protocols. NS5A resistance-associated substitutions (RASs) were more frequent in the 17 patients treated with sofosbuvir/velpatasvir (89.5%) and 33 patients treated with elbasvir/grazoprevir (97%) compared with the 11 patients treated with glecaprevir/pibrentasvir (18.2%) (P = 0.002 and 0.000, respectively). NS3 RASs were more often detected in the 33 patients with failure to elbasvir/grazoprevir (30.3%) than in the 11 patients treated with glecaprevir/pibrentasvir (9.1%). NS3 RASs were also detected in 12% of sofosbuvir/velpatasvir-treated patients. NS5B RASs were infrequently identified. Of the glecaprevir/pibrentasvir-treated patients, 73% did not show RASs in any HCV regions, a prevalence higher than that observed in those treated with elbasvir/grazoprevir (0%; P < 0.05) or sofosbuvir/velpatasvir (12%; P < 0.05). Of the 61 patients, 21 (34.4%) were re-treated with sofosbuvir/velpatasvir and voxilaprevir. All patients achieved sustained virological response at 12 weeks (SVR12). To our knowledge, this is one of the first real-life studies describing patients who failed current-generation DAAs; the prevalence of RASs differed according to the DAA regimen used, and the efficacy of re-treatment was high.
The Na+/Ca2+ exchanger (NCX) is a membrane transporter that can switch Na+ and Ca2+ in either direction to maintain the homeostasis of intracellular Ca2+. Three isoforms (NCX1, NCX2, and NCX3) have ...been characterized in excitable cells, e.g. neurons and muscle cells. We examined the expression of these NCX isoforms in primary human lung macrophages (HLM) and blood monocytes. NCX1 and NCX3, but not NCX2, are expressed in HLM and monocytes at both mRNA and protein levels. Na+‐free medium induced a significant increase in intracellular calcium concentration (Ca2+i) in both cell types. This response was completely abolished by the NCX inhibitor 5‐(N‐4‐chlorobenzyl)‐20,40‐dimethylbenzamil (CB‐DMB). Moreover, inhibition of NCX activity during Ca2+‐signaling induced by histamine caused a delay in restoring baseline Ca2+i. Na+‐free medium induced TNF‐α expression and release in HLM comparable to that caused by LPS. TNF‐α release induced by Na+‐free medium was blocked by CB‐DMB and greatly reduced by RNAi‐mediated knockdown of NCX1. These results indicate that human macrophages and monocytes express NCX1 and NCX3 that operate in a bidirectional manner to restore Ca2+i, to generate Ca2+‐signals, and to induce TNF‐α production. Therefore, NCX may contribute to regulate Ca2+ homeostasis and proinflammatory functions in human macrophages and monocytes.
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