Prevention of left ventricular remodeling after myocardial infarction: efficacy of physical training

Post-myocardial infarction left ventricular remodelling should be considered an important therapeutic target in patients after an acute myocardial infarction, considering the heavy prognostic implication. The therapies used in these patients should reduce the progression of the left ventricular dysfunction to refractory heart failure. In order to prevent post-myocardial infarction cardiac remodelling, different therapies have been tested, and for ACE-inhibitors and betablockers a clear demonstration of efficacy has been obtained. Losartan and valsartan, two widely used angiotensin receptor blockers, demonstrated to be safe and equally useful compared to ACEI. The addition of spironolactone to the standard therapy for heart failure has a clear beneficial effect but the clinical use has been refrained by the risk of iperkaliemia. Aerobic physical training improves the left ventricular ejection fraction in patients with systolic dysfunction, reducing the progressive enlargement after myocardial infarction. The positive effect of aerobic training on cardiac remodelling might be related to the positive effect on neurhormonal assessment, to he improvement of microcirculatory myocardial perfusion and of endothelial function

Semiquantitative Analysis of Ischemic Dysfunctional Myocardial Tissue: Comparison of Contrast Enhanced MRI and Myocardial PET

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Impact of a nutrition/educational program in a group of type 2 diabetes patients, already involved in a wider “Group Care” plan and not achieving complete target: an observational study

Type 2 diabetes is one of the most frequent chronic degenerative diseases in the world (5.4% in Italy); it has many chronic consequences with a significant impact either on expectation or quality of life. About 80-90% of type 2 diabetes patients is either overweight or obese, condition that can cause many more negative consequences than in individuals in the same conditions but with normal weight. The aim of the research is to assess if diabetic people who cannot reach the goals of glycemic control, good eating habits and weight loss can eventually obtain, with an individualized care plan, long lasting improvements. This study involved a little group of diabetic patients who did not achieve an optimal therapeutic target. These patients have been individually followed by a dietician for six months through a program of dietetic counseling and regular controls and at the end we compare the results of another group of diabetic people, involved in the Group Care Plan (but without the support of the dietitian). The nutrition educational program determined a significant weight loss (- 4.62 kg vs + 3.46 kg; p<0.05), a reduction of waist circumference (-5.34 cm vs + 4.15 cm; p<0.05), an improvement of glycemic control (Hb1Ac: - 0.67 % vs + 0.57%; p<0.05), lipidic profile (total cholesterol: - 1 mg/dl vs + 12.85 mg/dl; p<0.05) and perceived quality of life (Test Att 19: 0 subjects vs 6 subjects). An individualized nutrition educational program in patients with type 2 diabetes not achieving a therapeutic target can optimize global care of the disease.

Estrogen Induces Selective Transcription of Caveolin1 Variants in Human Breast Cancer through Estrogen Responsive Element-Dependent Mechanisms

The estrogen receptor (ER) signaling regulates numerous physiological processes mainly through activation of gene transcription (genomic pathways). Caveolin1 (CAV1) is a membrane-resident protein that behaves as platform to enable different signaling molecules and receptors for membrane-initiated pathways. CAV1 directly interacts with ERs and allows their localization on membrane with consequent activation of ER-non-genomic pathways. Loss of CAV1 function is a common feature of different types of cancers, including breast cancer. Two protein isoforms, CAV1α and CAV1β, derived from two alternative translation initiation sites, are commonly described for this gene. However, the exact transcriptional regulation underlying CAV1 expression pattern is poorly elucidated. In this study, we dissect the molecular mechanism involved in selective expression of CAV1β isoform, induced by estrogens and downregulated in breast cancer. Luciferase assays and Chromatin immunoprecipitation demonstrate that transcriptional activation is triggered by estrogen-responsive elements embedded in CAV1 intragenic regions and DNA-binding of estrogen-ER complexes. This regulatory control is dynamically established by local chromatin changes, as proved by the occurrence of histone H3 methylation/demethylation events and association of modifier proteins as well as modification of H3 acetylation status. Thus, we demonstrate for the first time, an estrogen-ERs-dependent regulatory circuit sustaining selective CAV1β expression

Infective endocarditis or myxoma? Description of a patient with new diagnosis of congestive heart failure

ABSTRACT: Infective endocarditis (IE) is an inflammatory disease which interests heart endothelium and mostly heart valves. IE is not a uniform disease, but presents in a variety of different forms that makes the diagnosis difficult. Echocardiography is a crucial diagnostic tool for the diagnosis, especially in those patients who have no typical symptoms as in the case here presented, in which the possibility of a myxoma was also considered

Efficacy of team work in health promotion and secondary prevention in patients admitted for cardiovascular rehabilitation

The object of the study was to evaluate the immediate efficacy of periodical educational meetings organized in Cardiovascular Rehabilitation Department aimed to improve knowledge about cardiovascular pathology, risk factors and correct life style. Methods: from October 2008 a multiprofessional group organized educational meetings for patients and their relatives, using two questionnaires to explore patients’ level of knowledge, before and after the meeting. Results: 124 patients (90 males) answered the questionnaire 1, while questionnaire 2 was completed by 93 subjects (70 males). From the answers to questionnaire 1, a significant improvement of knowledge about coronary anatomy and cardiovascular therapy emerged. Indeed, 99% of patients vs 81% before the meeting (p=0.001) understood the coronary artery function, 69% vs 44% (p=0,0001) of participants was familiar with coronary angioplasty, 81% vs. 64% (p=0,003) demonstrated to understand the coronary artery bypass and finally 85% vs. 52% (p=0,0001) were able to distinguish mechanical from biological prosthesis. From answers to questionnaire 2, a trend in favour to an improvement of knowledge regarding coronary risk factors and correct life style emerged. Younger patients (<70 ys) had a higher baseline level knowledge (p=0,003 and p=0.001 group 1 and 2, respectively) compared to older subjects, but in the latter a trend in favour of enhanced knowledge (p=0.06) after the educational meetings emerged. Conclusions: educational meetings are significantly correlated with an improvement of patients’ knowledge regarding cardiovascular pathology and treatments independently from patients’ age

ANMCO/ELAS/SIBioC Consensus Document: Biomarkers in heart failure

Biomarkers have dramatically impacted the way heart failure (HF) patients are evaluated and managed. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological or pathogenic processes, or pharmacological responses to a therapeutic intervention. Natriuretic peptides [B-type natriuretic peptide (BNP) and N-terminal proBNP] are the gold standard biomarkers in determining the diagnosis and prognosis of HF, and a natriuretic peptide-guided HF management looks promising. In the last few years, an array of additional biomarkers has emerged, each reflecting different pathophysiological processes in the development and progression of HF: myocardial insult, inflammation, fibrosis, and remodelling, but their role in the clinical care of the patient is still partially defined and more studies are needed before to be well validated. Moreover, several new biomarkers have the potential to identify patients with early renal dysfunction and appear to have promise to help the management cardio-renal syndrome. With different biomarkers reflecting HF presence, the various pathways involved in its progression, as well as identifying unique treatment options for HF management, a closer cardiologist-laboratory link, with a multi-biomarker approach to the HF patient, is not far ahead, allowing the unique opportunity for specifically tailoring care to the individual pathological phenotype

The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study

INTRODUCTION: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. METHODS: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. RESULTS: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. CONCLUSIONS: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies