Cholesterol remnants, triglyceride-rich lipoproteins and cardiovascular risk

Randomized clinical trials with statins and other lipid-lowering drugs have shown the presence of a "residual cardiovascular risk" in those treated to "target" for LDL-cholesterol. This risk is mainly associated to lipid components other than LDL and in particular to remnant cholesterol (RC) and to lipoproteins rich in triglycerides in fasting and non-fasting conditions. During fasting, RCs correspond to the cholesterol content of the VLDL and their partially depleted triglyceride remnant containing apoB-100. Conversely, in non-fasting conditions, RCs include also cholesterol present in chylomicrons containing apoB-48. Therefore, RCs refer to total plasma cholesterol minus HDL-cholesterol and LDL-cholesterol, that is, all the cholesterol present in the VLDL, chylomicrons and in their remnants. A large body of experimental and clinical data suggests a major role of RCs in the development of atherosclerosis. In fact, RCs easily pass the arterial wall and bind to the connective matrix stimulating the progression of smooth muscle cells and the proliferation of resident macrophages. RCs are a causal risk factor for cardiovascular events. Fasting and non-fasting RCs are equivalent for predicting vascular events. Further studies on drugs effect on RC levels and clinical trials to evaluate the efficacy of RC reduction on cardiovascular events are needed

Soluble CD40 ligand predicts ischemic stroke and myocardial infarction in patients with nonvalvular atrial fibrillation

OBJECTIVE - Atrial fibrillation (AF) is associated with a high incidence of vascular disease that may be related to a prothrombotic and inflammatory state. Soluble CD40 ligand (sCD40L), which stems essentially from platelet activation, possesses inflammatory and prothrombotic properties. The aim of the study was to assess whether sCD40L is a predictor of stroke or myocardial infarction (MI) in patients with nonvalvular AF. METHODS AND RESULTS - Plasma levels of sCD40L were measured in 231 patients (177 [77%] had permanent or persistent AF, and 54 [23%] had paroxysmal AF). Patients were followed for a mean period of 27.8±8.8 months, and cardiovascular events such as fatal and nonfatal stroke and MI were recorded. AF population was divided in 2 groups according to sCD40L level above or below the median (4.76 ng/mL). The 2 patients' groups had similar distribution of cardiovascular risk factors, age, gender, medications, or serum C-reactive protein levels. During the follow-up period, vascular events occurred in 6 (2 nonfatal MI and 4 nonfatal ischemic strokes) of 116 patients with low levels of sCD40L (5.1%) and in 29 (11 fatal and 3 nonfatal MI; 3 fatal and 12 nonfatal ischemic strokes) of 115 patients with high levels (25.2%) (log-rank test: P<0.001). Using the COX proportional Hazards model, patients with sCD40L above the median were 4.63 times more likely to experience a vascular event (95% C.I.: 1.92 to 11.20). CONCLUSIONS - This study shows that enhanced soluble CD40L level is a predictor of vascular events in patients with nonvalvular AF, thus suggesting that enhanced platelet activation may play a role in its clinical progression. © 2007 American Heart Association, Inc

Epilepsy and suicide: pathogenesis, risk factors, and prevention

Depression and suicide tendencies are common in chronic diseases, especially in epilepsy and diabetes. Suicide is one of the most important causes of death, and is usually underestimated. We have analyzed several studies that compare mortality as a result of suicide in epileptic patients and in the general population. All the studies show that epileptic patients have a stronger tendency toward suicide than healthy controls. Moreover it seems that some kinds of epilepsy have a higher risk for suicide (temporal-lobe epilepsy). Among the risk factors are surgery therapy (suicide tendency five times higher than patients in pharmacological therapy), absence of seizures for a long time, especially after being very frequent, and psychiatric comorbidity (major depression, anxiety-depression disorders, personality disorders, substance abuse, psychoses). The aim of the review was to analyze the relationship between suicide and epilepsy, to identify the major risk factors, and to analyze effective treatment options

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Influence of biochar additions on the fracture behavior of foamed concrete

The present study concerns the experimental investigation of foamed concretes with 1600 kg/m3 density that incorporate biochar additions in the mix. A series of small notched beams are prepared to determine the fracture energy in CMOD (crack mouth opening displacement) mode and the mechanical properties in terms of flexural and compressive strength. Besides the evaluation of such properties for classical foamed concrete, the influence of the addition of biochar in the lightweight cementitious paste is comparatively investigated. Two different concentrations of biochar are analyzed, namely 2% and 4% of the cement weight, and two different curing conditions are studied, namely in air and in water at controlled temperature for 28 days. The results demonstrate that better fracture behavior are obtained with 2% biochar and air curing conditions. The biochar additions in moderate concentrations (e.g. 2%) seems to make the fracture surface more tortuous, thus justifying the numerical outcomes, and does not impair the flexural strength. Further microstructural investigation is underway to confirm the experimental observations. This research paves the way for a promising construction material that is more environmentally friendly and sustainable than traditional materials used in the building industry

Investigation on the fracture behavior of foamed concrete

Abstract The fracture behavior of lightweight foamed concrete (LWFC) is significantly influenced by microstructural properties, which are ascribed to the arrangement of air bubbles and pores as well as to the presence of different hydration products. In this contribution, an experimental investigation on the fracture behavior of LWFC is performed. Notched beams made of LWFC were tested in three-point bending to determine the fracture energy based on the load-CMOD (Crack Mouth Opening Displacement) curve. The influence of the dry density is explored considering one density for non-structural purposes (equal to 800 kg/m3) and another density for structural applications (1600 kg/m3). Moreover, two curing conditions are considered (air and water). The load-CMOD curves reveal that for lower dry densities the fracture behavior of LWFC is particularly affected by the curing conditions, with better results achieved in air curing conditions, but this influence decreases with higher dry densities. The improved performance in air curing conditions for lower dry densities is also observed in terms of flexural strength, but is not particularly evident for the compressive strength. Micrographs across the crack surface determined via Scanning Electron Microscopy (SEM) are finally presented to analyze the experimental findings and justify the results in terms of microstructural configuration of the specimens

Increased levels of polychlorobiphenyls in Italian women with endometriosis

Endometriosis has been hypothesised to be linked to persistent and toxic organochlorinated chemicals. Dioxins and dioxin-like compounds have in particular been associated with the disease, mainly on the basis of experimental studies. Data in women are conflicting. A case-control study on 80 Italian nulliparous women of reproductive age was carried out to assess whether there is a correlation between the presence of endometriosis and blood levels of polychlorobiphenyls (PCBs), a family of ubiquitary environmental pollutants which comprises congeners with dioxin-like activity. Higher levels of PCBs were found in women with endometriosis. A mean cumulative value of 410 ng g(-1), lipid base, was found in cases versus the value of 250 ng g(-1) observed in the control group (odds ratio for upper tertile 4.0, CI 95% 1.3-13; p = 0.0003). PCB increase involved both dioxin-like (PCBs 105, 118, 156, and 167) and non-dioxin-like congeners (PCBs 101, 138, 153, 170, 180). (c) 2005 Elsevier Ltd. All rights reserved

Sparse Decomposition and Modeling of Anatomical Shape Variation

Recent advances in statistics have spawned powerful methods for regression and data decomposition that promote sparsity, a property that facilitates interpretation of the results. Sparse models use a small subset of the available variables and may perform as well or better than their full counterparts if constructed carefully. In most medical applications, models are required to have both good statistical performance and a relevant clinical interpretation to be of value. Morphometry of the corpus callosum is one illustrative example. This paper presents a method for relating spatial features to clinical outcome data. A set of parsimonious variables is extracted using sparse principal component analysis, producing simple yet characteristic features. The relation of these variables with clinical data is then established using a regression model. The result may be visualized as patterns of anatomical variation related to clinical outcome. In the present application, landmark-based shape data of the corpus callosum is analyzed in relation to age, gender, and clinical tests of walking speed and verbal fluency. To put the data-driven sparse principal component method into perspective, we consider two alternative techniques, one where features are derived using a model-based wavelet approach, and one where the original variables are regressed directly on the outcome

The role of anaemia in oxidative and genotoxic damage in transfused β-thalassaemic patients.

Redox imbalance and genotoxic damage are commonly observed in β thalassaemic patients. The aim of this study was to assess the role of anaemia in oxidative and genotoxic damage in regularly transfused thalassaemic patients, undergoing iron chelation therapy.We studied the relationships of haematological, biochemical and clinical parameters with oxidative (reactive oxygen species and 8-oxo-7,8-dihydro-2'-deoxyguanosine) and genotoxic biomarkers (Comet assay and cytokinesis-block micronucleus test) in blood samples from 105 patients. To reduce the early effect of redox-active iron, samples were collected when pharmacokinetics of the iron chelators ensured their maximum effectiveness. The transfusion regimen, cardiac and hepatic magnetic resonance imaging T2* were evaluated to characterize the patient cohort. Labile plasma iron (LPI) was also assayed.Haemoglobin level had a significant effect on ROS, %DNA in the tail and micronuclei-micronucleated cell frequency (p  0.05). Higher Hb values reduced redox imbalance. LPI, detectable in 50.5% of patients, was related to the number of apoptotic and necrotic lymphocytes (p = 0.03), demonstrating the cytotoxic effect of iron.The results highlight that an adequate transfusion regimen is essential to limit oxidative and genotoxic damage in β-thalassemic patients undergoing chelation therapy.Owing to the higher risk of cancer in the thalassaemic cohorts, specific genotoxicity/oxidative biomarkers should be monitored in order to ameliorate and formulate more personalized disease management