Circulating Endothelial Cells: A New Possible Marker of Endothelial Damage in Kawasaki Disease, Multisystem Inflammatory Syndrome in Children and Acute SARS-CoV-2 Infection

Background: Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are pediatric diseases characterized by systemic inflammation and vascular injury, potentially leading to coronary artery lesions (CALs). Data on vascular injury occurring during acute COVID-19 (AC19) in children are still lacking. The aim of our study was to investigate endothelial injury in KD-, MIS-C- and AC19-dosing circulating endothelial cells (CECs). Methods: We conducted a multicenter prospective study. CECs were enumerated by CellSearch technology through the immunomagnetic capture of CD146-positive cells from whole blood. Results: We enrolled 9 KD, 20 MIS-C and 10 AC19. During the acute stage, the AC19 and KD patients had higher CECs levels than the MIS-C patients. From the acute to subacute phase, a significant CEC increase was observed in the KD patients, while a mild decrease was detected in the MIS-C patients. Cellular clusters/syncytia were more common in the KD patients. No correlation between CECs and CALs were found in the MIS-C patients. The incidence of CALs in the KD group was too low to investigate this correlation. Conclusions: Our study suggests a possible role of CECs as biomarkers of systemic inflammation and endothelial dysfunction in KD and MIS-C and different mechanisms of vascular injury in these diseases. Further larger studies are needed

Contrast associated acute kidney injury and mortality in older adults with acute coronary syndrome: A pooled analysis of the fraser and hulk studies

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality

Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial

Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance

Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis

Objective: Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders. Methods: Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes. Results: Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA. Conclusion: In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF. Trial registration number: CRD42015025280

Effects of atmospheric NOx on biocalcarenite coated with different conservation products

One of the most important factors of calcareous stone decay is the chemical attack caused by atmospheric pollutants dissolved in water, in particular acidic gases such as SOx, NOx and CO2. The treatment of stone artefacts with hydrophobic products reduces the water uptake of the rock and is, therefore, considered a \u2018\u2018protective treatment\u2019\u2019. The aims of the present study were the observation of the effects of NOx on a biocalcarenite (Lecce stone) and the evaluation of the performance of protective products (Paraloid B72 and a fluoroelastomer) normally used in stone conservation. A system for the simulation of accelerated ageing has been assembled and the Lecce stone samples, treated with polymeric products, have been exposed to NO2 (nearly 1 ppm) during thermo hygrometric cycles. The nitrite and nitrate salts formed on the specimens have been determined by ion chromatography. Both the polymeric products tested have given high hydrophobic properties to the stone, even if they do not assure satisfactory protection toward NO2 exposure. Actually, their protective efficacy, or ability to reduce the acidic attack of NO2, quickly decreases when the ageing period increases. Paraloid B72 seems more effective than fluoroelastomer because, on the samples treated with the latter, higher amounts of nitrites and nitrates have always been detected. In contrast, non-treated samples \u2013 used as reference \u2013 have shown a constant increase in the amount of nitrates and nitrites during ageing. However, the surface analyses of the stone samples, by environmental SEM and l-laser profilometry, did not show any change in superficial morphology after the ageing, suggesting that NO2 acts inside the pores

Effects of atmospheric NOx on biocalcarenite coated with different conservation products

One of the most important factors of calcareous stone decay is the chemical attack caused by atmospheric pollutants dissolved in water, in particular acidic gases such as SOx, NOx and CO2. The treatment of stone artefacts with hydrophobic products reduces the water uptake of the rock and is, therefore, considered a "protective treatment". The aims of the present study were the observation of the effects of NOx on a biocalcarenite (Lecce stone) and the evaluation of the performance of protective products (Paraloid B72 and a fluoroelastomer) normally used in stone conservation. A system for the simulation of accelerated ageing has been assembled and the Lecce stone samples, treated with polymeric products, have been exposed to NO2 (nearly 1 ppm) during thermo hygrometric cycles. The nitrite and nitrate salts formed on the specimens have been determined by ion chromatography. Both the polymeric products tested have given high hydrophobic properties to the stone, even if they do not assure satisfactory protection toward NO2 exposure. Actually, their protective efficacy, or ability to reduce the acidic attack of NO2, quickly decreases when the ageing period increases. Paraloid B72 seems more effective than fluoroelastomer because, on the samples treated with the latter, higher amounts of nitrites and nitrates have always been detected. In contrast, non-treated samples - used as reference - have shown a constant increase in the amount of nitrates and nitrites during ageing. However, the surface analyses of the stone samples, by environmental SEM and μ-laser profilometry, did not show any change in superficial morphology after the ageing, suggesting that NO2 acts inside the pores