Heart failure and anti tumor necrosis factor-alpha in systemic chronic inflammatory diseases.

Tumor necrosis factor alpha (TNF-alpha) antagonists have emerged as an effective therapy for patients with diseases as Crohn's disease, rheumatoid arthritis, and other chronic systemic inflammatory diseases. In the last years, there has been a growing interest in the role that inflammatory cytokines, which sustain the pathogenesis of these diseases, plays in regulating cardiac structure and function, particularly in the progression of chronic heart failure. In fact there is an increase of anti-TNF alpha levels in advanced heart failure but the treatment with anti-TNF alpha has been shown to worsen the prognosis of heart failure in randomized controlled trials. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease and anti-TNF alpha therapy seems to be beneficial on the risk of cardiovascular disease. In Crohn's disease the increased risk of cardiovascular disease is controversial and therefore it is impossible to demonstrate an effect in reduction of the risk; however, heart failure in patients treated with anti-TNF alpha, despite in a small proportion, has been observed. On the basis of this observation, anti-TNF alpha therapy is contraindicated in patients with Crohn's disease and III-IV New York Heart Association heart failure class

Karyological data of two Sicilian endemic Centaurea species

Chromosome numbers are given for 2 Centaurea species endemic to Sicily. For both studied taxa, Centaurea valdemonensis and C. virescens, the somatic chromosome number, found on material from their loci classici, is diploid (2n = 18)

An overview and update on soft tissue lesions of the head and neck

Soft tissue lesions of the head and neck encompass a broad range of pathological entities associated with different prognoses and requiring different treatments. All pathologists will encounter a wide range of soft tissue tumours in whatever specialist area they practice. Getting the diagnosis ‘right the first time’ is critical for patients to be offered optimal treatment. Molecular testing can help reach the correct diagnoses and this arena is developing fast. However, pathologists should not rely unquestioningly on special tests, whether it is immunohistochemistry or whole genome sequencing as no test is entirely specific or sensitive. Pathologists should provide a diagnosis in the context of all tests including the histology along with medical imaging and the patient's symptoms, signs and family history. This article reviews key clinical, pathological and histologic features of tumours most commonly presenting in the head and neck region, including those most recently described

Statistics of non-linear stochastic dynamical systems under L\'evy noises by a convolution quadrature approach

This paper describes a novel numerical approach to find the statistics of the non-stationary response of scalar non-linear systems excited by L\'evy white noises. The proposed numerical procedure relies on the introduction of an integral transform of Wiener-Hopf type into the equation governing the characteristic function. Once this equation is rewritten as partial integro-differential equation, it is then solved by applying the method of convolution quadrature originally proposed by Lubich, here extended to deal with this particular integral transform. The proposed approach is relevant for two reasons: 1) Statistics of systems with several different drift terms can be handled in an efficient way, independently from the kind of white noise; 2) The particular form of Wiener-Hopf integral transform and its numerical evaluation, both introduced in this study, are generalizations of fractional integro-differential operators of potential type and Gr\"unwald-Letnikov fractional derivatives, respectively.Comment: 20 pages, 5 figure

[OP.2D.05] RELATIONSHIP OF OXIDATIVE STRESS WITH CARDIAC HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. DESIGN AND METHOD: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2alpha and high sensitivity C reactive protein. RESULTS: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2alpha, high sensitivity C reactive protein, age, sex, body mass index, estimated glomerular filtration rate, serum glucose, (log)triglycerides, hemoglobin, pulse pressure or systolic blood pressure, mean or diastolic blood pressure, and antihypertensive treatment showed that in hypertensives plasma levels of 8-isoprostaglandin F2alpha were correlated with left ventricular mass (beta=0.269, p\u200a<\u200a0.0001).The bivariate relationship of left ventricular mass with 8-isoprostaglandin F2alpha in hypertensives with estimated glomerular filtration rate higher and lower than 60\u200aml/min/1.73m2 was also calculated separately, demonstrating no significant differences in both correlations coefficients and slopes of the regression lines (r\u200a=\u200a0.254, p\u200a<\u200a0.001 and r\u200a=\u200a0.226, p\u200a<\u200a0.002; respectively).In the overall group, receiver operating characteristic curves showed that 8-isoprostaglandin F2alpha and high sensitivity C reactive protein were predictors of left ventricular hypertrophy, p\u200a<\u200a0.0001. CONCLUSIONS: To the best of our knowledge, this is the first demonstration that in hypertensives oxidative stress is correlated to left ventricular hypertrophy independently of other confounding factors. Oxidative stress might participate in the development of hypertensive cardiac hypertrophy

Utility of noninvasive methods for the characterization of nonalcoholic liver steatosis in the family practice. The "VARES" Italian multicenter study.

The diagnostic utilities of ultrasonography (US), fatty liver index (FLI) and an algorithm of nine serum markers (Fibromax) were evaluated in family practice to noninvasively characterize patients with nonalcoholic fatty liver disease (NAFLD). A multicenter study was conducted by enrolling 259 consecutively observed patients (age 51 ± 10 years) with clinical and ultrasonographic features of NAFLD . Patients had mild (16.2%), moderate (69.9%), or severe (13.9%) liver steatosis and 60.2% had hypertransaminasemia. The percent of patients with overweight, obesity, diabetes, hypertension, and dyslipidemia were 42.7%, 46.5% (4.2% severe obesity), 24.7%, 40.9%, and 56.4% , respectively. Lean patients (10.8%) had normal transaminases in two/ thirds of the cases. A multivariate logistic regression (including age > 50 yrs, BMI > 30 kg/m 2 , HOMA > 3, and hypertransaminasemia) identified 12.3% of patients at risk for steatohepatitis. With a sensitivity of 50% and specificity of 94.7%, Fibromax identified 34 patients (13.1%) with likely advanced fibrosis and found that over 28% of patients with moderate (ultrasonographic) steatosis were likely to be carrying severe steatosis. Steatotest score was significantly associated with BMI, waist circumference, ALT, triglycerides, and FLI. Fibrotest correlated only with ALT. FLI identified 73.4% of patients as likely to be carrying a fatty liver. In conclusion, NAFLD should be systematically searched and characterized in all patients with metabolic disturbances and cardiovascular risk. Asymptomatic subjects at risk also should be screened for NAFLD. Fibromax is a promising noninvasive diagnostic tool in family medicine for identifying patients at risk for NAFLD who require targeted follow-up

5.16 Left Ventricular Geometry In Chronic Kidney Disease

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