Pulmonary Hypertension

Pulmonary hypertension (PH) is a complex and multifactorial syndrome, partly unknown, characterized by a profound alteration of pulmonary vasculature and, consequentially, a rise in the pulmonary vascular load, leading to hypertrophy and remodeling of the right heart chambers. The World Health Organization assembles the several forms of PH into five clinical groups: group 1 includes pulmonary arterial hypertension, previously defined as idiopathic forms, group 2 is PH due to left-sided heart diseases, group 3 PH due to lung diseases, hypoxia, or both, group 4 due to pulmonary-artery obstruction, and group 5 PH, which includes forms with multifactorial or unclear mechanisms. In this chapter, we would like to delineate the clinical and hemodynamic definitions of PH and, for each group, we will describe the pathophysiological mechanisms, the diagnostic pathway, and the pharmacological approach and treatment. Finally, we would also like to focus on the latest trials and future therapeutic perspectives for this disease

New insight into microbial degradation of mycotoxins during anaerobic digestion

Abstract Anaerobic digestion represents an interesting approach to produce biogas from organic waste materials contaminated by mycotoxins. In this study a shotgun metagenomic analysis of lab-scale bioreactors fed with mycotoxin-contaminated silage has been carried out to characterize the evolution of microbial community under the operating conditions and the key enzymatic activities responsible for mycotoxin degradation. The study was conducted at two different level of contamination for fumonisins and aflatoxin B1. After 15 days biogas production was not influenced by the presence of mycotoxins. Metagenomic analysis revealed that a high contamination rate of mycotoxins interfere with microbial diversity. Degradation of mycotoxins accounted in about 54% for aflatoxin B1 and 60% for fumonisins. The degradation activity of fumonisins resulted in the presence of partially hydrolyzed forms in both tested contamination levels. Accordingly, metagenomic functional analysis revealed the presence of two new carboxylesterase genes belonging to D. bacterium and P. bacterium putatively involved in fumonisin degradation

Psychological counselling interventions to improve perceived quality of life and counter anxiety and depression in pulmonary-arterial-hypertension patients. a clinical trial

Introduction: Pulmonary Arterial Hypertension (PAH) is a rare and progressive disease, frequently associated with a worsening of perceived quality of life as well as anxiety and depression symptomatology. Psychological counselling helps the patient understand the diagnosis and prevent the onset of psychopathologies. This study evaluates the effect of counselling sessions on anxiety and depression as well as the impact on self-reported quality of life in patients with PAH. Methods: Patients with a diagnosis of PAH were recruited at the Monaldi Hospital (Naples). An EQ-5D 3L questionnaire was administered to all patients at baseline (pre-session), three months (post-session) after the last session to patients who received psychological counselling (experimental group, EG) and after the first questionnaire to patients who did not (control group, CG). The EQ-5D index and EQ-VAS score were analysed in both groups. Results: A sample of 50 patients with a PAH diagnosis was evaluated; among them 6% had mild PAH, 66% moderate PAH, and 28% severe PAH. The majority (53%) did not receive psychological counselling. All patients showed no significant difference in EQ-5D index (P > 0.05), EQ-VAS score (P > 0.05), and the anxiety/depression dimension (P>.05) at baseline. However, between pre- and post-session evaluations, the analysis showed a significant change in the EQ-VAS score (P = 0.00) and the anxiety/depression dimension (P = 0.02) in the EG. In the CG, there was a similar change in the anxiety/depression dimension (P = 0.00) but not in the EQ-VAS score (P = 0.05) in CG. The z-test revealed significant intergroup relations, showing that the EG had a 37% increase in perceived quality of life and a 9% reduction in anxiety and depression, while a 12% reduction was observed for the CG’s perceived quality of life and a 44% increase in anxiety and depression. Discussion and Conclusions: This study showed that patients with PAH who received psychological support improved their health-related quality of life by reducing anxiety and depression symptomatology. Our findings highlight the impact of psychological support in the treatment of patients with PAH

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

CAPITOLO 6: Flussi ionici e potenziali transmembranari

Il testo presenta un “taglio” espositivo diverso dal tradizionale verticalismo con cui viene solitamente impartita la didattica della Fisiologia. Non integrativo, secondo il solito programma di partire dall’alto, cioè dalle funzioni dei grandi sistemi ed apparati (la respirazione, la digestione, ecc.), e “scendere verso il basso”, affinando progressivamente l’analisi dei processi fisiologici sino al livello cellulare e molecolare. Non riduzionista, secondo l’idea di partire dal basso, cioè dagli atomi e dalle molecole costituitivi della materia vivente, e “salire verso l’alto” secondo un gradiente di complessità strutturale e funzionale che magari arrivasse fino al cervello ed alla mente dell’uomo. Il proposito è piuttosto quello di partire dal cuore della materia fisiologica, e cioè dal livello delle cellule, che stanno alla base di tutte le strutture e di tutte le funzioni dei viventi, e da lì espandersi in tutte le direzioni

Fisiologia e Biofisica delle cellule

Il testo presenta un “taglio” espositivo diverso dal tradizionale verticalismo con cui viene solitamente impartita la didattica della Fisiologia. Non integrativo, secondo il solito programma di partire dall’alto, cioè dalle funzioni dei grandi sistemi ed apparati (la respirazione, la digestione, ecc.), e “scendere verso il basso”, affinando progressivamente l’analisi dei processi fisiologici sino al livello cellulare e molecolare. Non riduzionista, secondo l’idea di partire dal basso, cioè dagli atomi e dalle molecole costituitivi della materia vivente, e “salire verso l’alto” secondo un gradiente di complessità strutturale e funzionale che magari arrivasse fino al cervello ed alla mente dell’uomo. Il proposito è piuttosto quello di partire dal cuore della materia fisiologica, e cioè dal livello delle cellule, che stanno alla base di tutte le strutture e di tutte le funzioni dei viventi, e da lì espandersi in tutte le direzioni

Lung membrane conductance and capillary volume derived from the NO and CO transfer in high-altitude newcomers.

Acute exposure to high altitude may induce changes in carbon monoxide (CO) membrane conductance (DmCO) and capillary lung volume (Vc). Measurements were performed in 25 lowlanders at Brussels (D0), at 4,300 m after a 2- or 3-day exposure (D2,3) without preceding climbing, and 5 days later (D7,8), before and after an exercise test, under a trial with two arterial pulmonary vasodilators or a placebo. The nitric oxide (NO)/CO transfer method was used, assuming both infinite and finite values to the NO blood conductance (θNO). Doppler echocardiography provided hemodynamic data. Compared with sea level, lung diffusing capacity for CO increased by 24% at D2,3 and is returned to control at D7,8. The acute increase in lung diffusing capacity for CO resulted from increases in DmCO and Vc with finite and infinite θNO assumptions. The alveolar volume increased by 16% at D2,3 and normalized at D7,8. The mean increase in systolic arterial pulmonary pressure at rest at D2,3 was minimal. In conclusion, the acute increase in Vc may be related to the increase in alveolar volume and to the increase in capillary pressure. Compared with the infinite θNO value, the use of a finite θNO value led to about a twofold increase in DmCO value and to a persistent increase in DmCO at D7,8 compared with D0. After exercise, DmCO decreased slightly less in subjects treated by the vasodilators, suggesting a beneficial effect on interstitial edema

Multicenter retrospective analysis of clinical outcome of adult patients with mixed-phenotype acute leukemia treated with acute myeloid leukemia-like or acute lymphoblastic leukemia-like chemotherapy and impact of allogeneic stem cell transplantation: a Campus ALL study

: Mixed-phenotype acute leukemia (MPAL) is a rare disease. Treatment is often similar to that of acute lymphoblastic leukemia (ALL), but the outcome in adults and the role of allogeneic stem cell transplantation (AlloSCT) are not well defined. We report on 77 adult patients diagnosed with MPAL over the last 10 years and treated with a curative intent. Median age was 49 years; 7.6% of cases had a BCR::ABL1 rearrangement. Thirty patients (39%) were treated with an acute myeloid leukemia (AML)-like induction and 47 (61%) with an ALL-like scheme. The complete remission (CR) rate was 67.6% and an ALL-like therapy was associated with a better CR rate (P = 0.048). The median OS was 41.9 months; age ≤ 60 years was associated with a better OS (67 vs 26 months, P = 0.014). An AlloSCT was performed in 50 patients (65%). The 5-year OS of transplanted patients was 54%. The OS post-AlloSCT was better in patients who were minimal residual disease (MRD)-negative prior to transplant (75.8% vs 45.2%, P = 0.06). This study shows that MPAL patients respond better to an ALL-like induction therapy; that consolidation therapy should include, whenever possible, an AlloSCT and that MRD negativity should be a primary endpoint of treatment