Prevalence and pharmacologic management of familial hypercholesterolemia in an unselected contemporary cohort of patients with stable coronary artery disease

INTRODUCTION: Familial hypercholesterolemia (FH) is an inherited disorder characterized by elevated plasma levels of low-density lipoprotein cholesterol (LDL-C) associated with premature cardiovascular disease. METHODS: Using the data from the START (STable Coronary Artery Diseases RegisTry) study, a nationwide, prospective survey on patients with stable coronary artery disease (CAD), we described prevalence and lipid lowering strategies commonly employed in these patients. The study population was divided into "definite/probable FH," defined as a Dutch Lipid Clinic Network (DLCN) score ≥6, "possible FH" with DLCN 3-5, and "unlikely FH" in presence of a DLCN <3. RESULTS: Among the 4030 patients with the DLCN score available, 132 (3.3%) were classified as FH (2.3% with definite/probable and 1.0% with possible FH) and 3898 (96.7%) had unlikely FH. Patients with both definite/probable and possible FH were younger compared to patients not presenting FH. Mean on-treatment LDL-C levels were 107.8 ± 41.5, 84.4 ± 40.9, and 85.8 ± 32.3 (P < 0.0001) and a target of ≤70 mg/dL was reached in 10.9%, 30.0%, and 22.0% (P < 0.0001) of patents with definite/probable, possible FH, and unlikely FH, respectively. Statin therapy was prescribed in 85 (92.4%) patients with definite/probable FH, in 38 (95.0%) with possible FH, and in 3621 (92.9%) with unlikely FH (P = 0.86). The association of statin and ezetimibe, in absence of other lipid-lowering therapy, was more frequently used in patients with definite/probable FH compared to patients without FH (31.5% vs 17.5% vs 9.5%; P < 0.0001). CONCLUSIONS: In this large cohort of consecutive patients with stable CAD, FH was highly prevalent and generally undertreated with lipid lowering therapies

Fifteen years trends of cardiogenic shock and mortality in patients with diabetes and acute coronary syndromes

PURPOSE: Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus. METHODS: We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units. RESULTS: Of 28,225 participants, 8521 (30.2%) had diabetes: as compared with patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all P &lt; .0001). Prevalence of diabetes and comorbidities increased over time (P for trend &lt; .0001). Cardiogenic shock rates were higher in patients with diabetes, as compared with those without diabetes (7.8% vs 2.8%, P &lt; .0001), and decreased significantly over time only in patients without diabetes (P = .007). Revascularization rates increased over time in patients both with and without diabetes (both P for trend &lt; .0001), although with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs 2.5%, respectively, P &lt; .0001) and decreased more consistently in patients without diabetes (P for trend = .007 and &lt; .0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock (odds ratio 2.03; 95% confidence interval, 1.77-2.32; P &lt; .0001) and mortality (odds ratio 1.95; 95% confidence interval, 1.69-2.26; P &lt; .0001). CONCLUSIONS: Despite significant mortality reductions observed over 15 years in acute coronary syndromes, patients with diabetes continue to show threefold higher rates of cardiogenic shock and lower revascularization rates as compared with patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes

Experimental assessment of heavy metal extraction from contaminated italian harbour sediment by rhamnolipid

This study presents the results of laboratory scale experimental tests of contaminants extraction from marine sediment slurries. The sediment was collected in a harbour situated in a high density industrial area, characterized by a high pollution level of heavy metals. The contamination of the sediment used in this experimentation was artificially increased to reach final values of 1250 mg/Kg of Cu and 2026 mg/Kg of Pb. The objective of this study was to investigate the effectiveness of selected chelating agents (Rhamnolipid, EDDS and Acid Citric) in heavy metals removal from contaminated sediments. The investigated parameters during the washing tests were the chelants concentration and the overall washing time. To evaluate sediments characteristics COD and acid digestion were performed, while TOC and heavy metal’s concentration were determined on the solutions extracted. Results show that the use of EDDS and EDTA allows the reaching of good extraction efficiencies (up to 95 %) unlike lower removal rates reached by the Acid Citric and Rhamnolipid, probably due to very low values of constants of the corresponding metal-additive complexes. Finally, major cations, above all Fe and Ca, were found to be strong competitors with the target metals for the metal-ligand complexes formation

Application of membrane technology in activated sludge process

In this work the performances of the Step Sludge Recirculation (SSR) activated sludge process were improved. The process consists of an anoxic stage where denitrification occurs and four aerobic stages where the nitrifications occur. The conventional system was compared with a second system where the secondary clarifier was substituted by a submerged membrane module. Two different types of flat sheet membrane were fitted into the membrane module. The performances were measured by means of a microscopic observation of the microfauna in the activated sludge and other physical-chemical analysis such as solids, TOC, O.U.R. test, total nitrogen, ion determination. The main objective of the work was to optimize the process in order to obtain a maximum in the removal of ammoniacal nitrogen