Hyperhomocysteinemia and Mortality after Coronary Artery Bypass Grafting

BACKGROUND: The independent prognostic impact, as well as the possible causal role, of hyperhomocysteinemia (HHcy) in coronary artery disease (CAD) is controversial. No previous study specifically has addressed the relationship between HHcy and mortality after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the prognostic impact of HHcy after CABG surgery. METHODOLOGY AND PRINCIPAL FINDINGS: We prospectively followed 350 patients who underwent elective CABG between May 1996 and May 1999. At baseline, fasting total homocysteine (tHcy) levels were measured in all participants, and a post-methionine loading (PML) test was performed in 77.7% of them (n = 272). After a median follow-up of 58 months, 33 patients (9.4%) had died, 25 because of cardiovascular events. HHcy, defined by levels higher than the 90(th) percentile (25.2 µmol/L) of the population's distribution, was significantly associated to total and cardiovascular mortality (P = 0.018 [log-rank test 5.57]; P = 0.002 [log-rank test 9.76], respectively). The PML test had no prognostic value. After multiple adjustment for other univariate predictors by Cox regression, including statin therapy (the most powerful predictor in uni-/multivariate analyses), high-sensitivity C Reactive Protein (hs-CRP) levels, and all known major genetic (MTHFR 677C→T polymorphism) and non-genetic (B-group vitamin status and renal function) tHcy determinants, HHcy remained an independent prognostic factor for mortality (HRs: 5.02, 95% CIs 1.88 to 13.42, P = 0.001). CONCLUSIONS: HHcy is an important prognostic marker after CABG, independent of modern drug therapy and biomarkers

Vitamin B6 and cardiovascular disease

While overt vitamin B6 deficiency is not a frequent finding nowadays in medical practice, evidence suggests that insufficiency of this vitamin is rather widespread in a quite large portion of the population such as the elderly or in not unusual conditions such as that of alcohol addiction. Moreover, a mild deficiency in B6 vitamin is a state that may be associated with an increased risk of cardiovascular disease. Epidemiologic evidence from case control and prospective studies have suggested that low dietary intake or reduced blood concentrations of vitamin B6 is associated with an increased risk of cardiovascular disease, although most recent trials demonstrated the ineffectiveness of vitamin B6 supplementation on the prevention of cardiovascular events recurrence. Due to limited and somewhat inconsistent data together with the ample variety of critical functions in which vitamin B6 is involved in the human body, it is very challenging to attempt at establishing a cause and effect relationship between vitamin B6 and risk of cardiovascular disease as it is to delineate the exact mechanism(s) by which vitamin B6 may modulate such risk. In the present chapter we review the currently available knowledge deriving from both epidemiological and mechanistic studies designed to define potential candidate mechanisms for the association of vitamin B6 impairment and risk of cardiovascular disease development

Problem Setting on Energy Risk and Climate Change Adaptation: Topics and Tools

Energy risk management and climate change adaptation strategies have long been targeted as individual and independent challenges, having emerged separately along the European Union (EU) and international agenda and policy history. Nevertheless, the most recent EU initiative in this field, the Global Covenant of Mayors (GCoM), faces mitigation and adaptation strategies simultaneously within the framework of the Sustainable Energy and Climate Action Plans (SECAP) design. A similar approach may lead to a re-definition of energy-related and climate change vulnerability and consequently to developing multi-risk territorial analysis. This would require building a complex and detailed knowledge of the territorial context, thus developing a strongly data-driven local risk and vulnerability assessment (RVA). Moreover, it must be remembered that SECAPs are drawn at the municipal scale, where geometry shows to be extremely various, and large metropolitan areas, as well as fragmented hamlets, coexist. This integrated approach may prove to be particularly critical for small municipalities. The present contribution aims at providing a methodology to plan mitigation and adaptation of local actions based on land use municipal assets and consequent multi-risk territorial mapping

Bone mineral density improvement after successful parathyroidectomy in pre- and postmenopausal women with primary hyperparathyroidism. A prospective study.

The aim of this study was to evaluate the short-term (1 year) changes of the lumbar spine (L2\u2013L4) bone mineral density (LS-BMD) after parathyroidectomy (PTx) in pre- and postmenopausal women with primary hyperparathyroidism (PHPT). A series of 48 women (median age 56 years, range 23\u201382 years) with confirmed PHPT were prospectively enrolled in the study.Patientswho received both oral contraceptives less than 2 years before the diagnosis and estrogen replacement therapy have previously been excluded. All patients underwent LS-BMD by dual energy x-ray absorptiometry before surgery. Patients were divided into two groups: group A (n = 12) premenopausal, and group B (n = 36) postmenopausal patients. The LS-BMD was repeated 12 months after successful PTx. Basal LS-BMD (0.852 \ub1 0.061 vs. 0.748 \ub1 0.142 g/cm2), serum calcium (2.95 \ub1 0.23 vs. 2.94 \ub1 0.26 mmol/L), creatinine (69.2 \ub1 17.5 vs. 82.0 \ub1 24.2 mol/L), alkaline phosphatase (107.4 \ub1 43.6 vs. 151.3\ub195.7 U/L), osteocalcin (28.6\ub19.3 vs. 28.2\ub18.3 g/L), and PTH (192.7 \ub1 133.2 vs. 175.2 \ub1 132.1 ng/L) levels did not differ significantly (P = NS) between groups. The 1-year LS-BMD was 0.921 \ub1 0.048 and 0.825 \ub1 0.151 g/cm2 in group A and B, respectively. In group B patients, the 1-yearLS-BMDvalue did not improve significantly (P=NS),while in group A patients the difference between basal and postsurgical LS-BMD was significant (P < 0.01). In conclusion, PTx should be considered for all patients with PHPT and loss of bone density, but in premenopausal patients a greatest improvement of BMD may be found, suggesting the need of endogenous estrogens in complete lumbar bone recovery after surgery

Low plasma vitamin B-6 concentrations and modulation of coronary artery disease risk.

BACKGROUND: Low concentrations of pyridoxal-5'-phosphate (PLP), the active metabolite of vitamin B-6, are associated with high C-reactive protein (CRP) concentrations. Both low PLP and elevated inflammatory markers, such as high-sensitivity CRP (hs-CRP) and fibrinogen, are related to higher risk of coronary artery disease (CAD). OBJECTIVES: The objectives were to evaluate the relation between PLP and acute-phase reactants in affecting CAD risk and to estimate the risk of CAD related to low plasma PLP, either alone or in combination with high concentrations of acute-phase reactants and other classic risk factors for CAD. DESIGN: A case-control study was conducted with 742 participants: 475 with severe multivessel CAD and 267 free from coronary atherosclerosis (CAD-free). We measured plasma PLP, fibrinogen, hs-CRP, and serum lipid concentrations and all major biochemical CAD risk factors, including total homocysteine. RESULTS: A significant, inverse, graded relation was observed between PLP and both hs-CRP and fibrinogen (P < 0.001). The prevalence of PLP concentrations in the lower half of the population (<50th percentile: 36.3 nmol/L) was significantly higher among CAD patients than among CAD-free subjects (P < 0.001). The odds ratio for CAD risk related to low PLP concentrations after adjustments for the major classic CAD risk factors, including hs-CRP and fibrinogen, was 1.89 (95% CI: 1.18, 3.03; P = 0.008). The CAD risk as a result of low PLP was additive when considered in combination with elevated hs-CRP concentrations or with an increased ratio of LDL to HDL. CONCLUSION: Low plasma PLP concentrations are inversely related to major markers of inflammation and independently associated with increased CAD risk

Epigenetic regulation of coagulation factor VII gene promoter in relationship with 5’F7 polymorphism modulate factor VII levels and myocardial infarction risk

Study of the epigenetic regulation of coagulation factor VII gene promoter methylation and its relationship with 5’F7 polymorphism at promoter site: effects of this relationship on how promoter methyaltion regulates factor VII levels and myocardial infarction ris

"Paesaggio connesso intimo e collettivo" - Riqualificazione area Oltradda - Lodi

Il Comune di Lodi bandisce un concorso di idee per il disegno urbano della parte di città situata oltre l’Adda. La finalità del concorso è la valorizzazione degli insediamenti e della campagna circostante attraverso la costruzione di un nuovo sistema di spazi ed attrezzature pubbliche, la valorizzazione dell’ambiente fluviale, la qualificazione del paesaggio agricolo e del suo reticolo di corsi d’acqua naturali e artificial

Who is likely to vacillate in their COVID-19 vaccination decision? Free-riding intention and post-positive reluctance

Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are still vacillating in their decision to vaccinate. In this study, we considered the effect of two relevant contextual issues on vaccination intention: the number of people infected with COVID-19 is increasing, and the pace of vaccination is gaining speed. Specifically, we hypothesized that having already contracted SARS-CoV-2 (post-positive reluctance) could lead people to underestimate the importance of vaccination. Moreover, as the number of vaccinated people increases, more hesitant people could fall into the free-riding intention category, benefitting from the immunity provided by others' vaccinations. Vaccine hesitancy becomes more critical as the vaccination campaign proceeds: at one point, it will be inevitable to deal with hesitant people. This study is part of a WHO Regional Office for Europe project and involved a representative sample of 5006 Italians interviewed in January–February 2021. In case of post-positive reluctance, both young age and female gender increase vaccine hesitancy, while a high level of education reduces free-riding intention. Considering post-positive reluctance and free riding, a protective effect on hesitancy is associated with negative affective states, adherence to protective behaviors, trust in health information sources, and resilience. In contrast, increased vaccine hesitancy is associated with a high level of conspiracy-mindedness and trust in media information sources. Recognizing and studying the post-positive reluctance and the phenomenon of free-riding people can help us to become more efficient in combatting the virus