Parameters derived by ultrasonic myocardial characterization in dialysis patients are associated with mortality

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The potentiality of herbal remedies in Primary Sclerosing Cholangitis: from in vitro to clinical studies

Primary sclerosing cholangitis is a complex pathological condition, characterized by chronic inflammation and fibrosis of the biliary epithelium. Without proper clinical management, progressive bile ducts and liver damage lead to cirrhosis and, ultimately, to liver failure. The known limited role of current drugs for treating this cholangiopathy has driven researchers to assess alternative therapeutic options. Some herbal remedies and their phytochemicals have shown anti-fibrotic properties in different experimental models of hepatic diseases and, occasionally, in clinical trials in primary sclerosing cholangitis patients; however their mechanism of action is not completely understood. This review briefly examines relevant studies focusing on the potential anti-fibrotic properties of Silybum marianum, Curcuma longa, Salvia miltiorrhiza, and quercetin. Each natural product is individually reviewed and the possible mechanisms of action discussed

Characterizing the hydrogeochemistry of two low-temperature thermal systems in Central Mexico

Two low-temperature geothermal systems located at the Trans-Mexican Volcanic Belt with presence of fluoride and arsenic were studied with the aim to determine hydrogeochemical indicators of the toxic elements' presence, and to propose adequate geothermometers. The hydrogeological and geochemical study was carried out in Ixtapan de la Sal and Tonatico (IxS-T) and Santa Cruz de Juventino Rosas (JR), both located at the limits of the Trans-Mexican Volcanic Belt (TMVB). In these regions, low-temperature geothermal activity is present (T = 32–47 °C), and various fault and fracture systems have been identified. Several faults are active, enabling the upward flow of deep geothermal water. The geothermal waters of IxS-T manifest in the form of springs and have high Na+ and Cl− concentrations, whereas those of JR are captured in wells and mainly present high Na+ and HCO3 – concentrations. The hydrochemistry of water samples was analyzed to determine the dominant hydrogeochemical processes in both regions. These data were also useful for understanding the natural origin of the high levels of arsenic and fluoride reported in the water, which are likely due to mineral dissolution processes. The concentrations of these elements surpassed the permissible limits according to Mexican law (Astot = 0.025 mg/L; F− = 1.5 mg/L) and represent a toxicity risk for the local populations. The groundwater at JR supplies all needs of the local population, while the water at IxS-T is mainly used for recreational and health spa purposes. Increasing trends of As and F− in the sedimentary aquifer of IxS-T are related with the increase in TDS, Cl−, HCO3 – and SiO2, while silicate alteration releasing Na and HCO3 – are related with As and F− presence in the volcanic aquifer of JR. Reservoir temperature was adequately estimated with K2 /Mg and Na-K-Ca (Mg corrected) geothermometers at IxS-T, and with chalcedony and quartz geothermometers at JRUAEM 3716/201

Electronic medical record in cardiology: a 10-year Italian experience

SummaryObjectives:the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based.Methods:an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined.Results:the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology.Conclusion:the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization

Electronic Medical Records Optimize Clinical Data Management in the Outpatient Cardiological Clinic

A system based on a relational database with administrative and clinical information and integrated with an Information System, where the system covers the role of a Functional Island, is routinely used in our Institution. To analyze how Electronic Medical Records (EMR) may help physicians in organizing and reducing time waste in a busy outpatient clinic, a sample of 1000 reports were evaluated for system performance. The time needed for building new clinical histories or modifying the already acquired ones, to create physical examination and biochemical and instrumental exams reports, was assessed. Cardio-pulmonary tests, basal, dynamic and effort EKG, chest X-ray, Echo Doppler studies, nuclear medicine procedures, invasive techniques, were collected. Clinical management was integrated with the administrative system (ADT), to correctly identify each patient. This system provided not only easy retrieving of stored data such as clinical history, physical examination, instrumental exams reports but also the results of new exams performed in the same day of patient visit with a time lapse of 1 to 20\u27. Graphical interface structure contained preformatted fields which allowed selection or modifications of data/text models without additional waste of time. EMR represents an important tool for organization and synergy of different Laboratories in a outpatient clinic, optimizing the time needed for data entry and leading to an overall better quality of care

Identification of responders to CRT by stress echo: no contractile reserve, no party

Background: Cardiac resynchronization therapy (CRT) is increasingly used, but the identification of "responders" remains challenging. Aim: to assess the value of inotropic reserve during pharmacological echo stress to identify responders. Materials and methods: We enrolled 32 patients (age 69?9 years; 9 females) referred to CRT, all with LV ejection fraction (LVEF) ≤35n %, NYHA ≥IIb and QRS duration ≥130 milliseconds. Twenty-two patients showed echocardiographic criteria for dyssynchrony (at least one of M-mode, Tissue Doppler, or live 3D echo criteria). All patients underwent pharmacological stress echo (dobutamine, up to 40 mcg/Kg/min in 29, dipyridamole 0.84 mg/kg 10 min, in 3). Patients were considered with contractile response if variation of WMSI (from 1=normal, to 4=dyskinetic, 17 segment model of left ventricle) stress-rest (delta WMSI) was ≥0.20. "Responders" to CRT were defined at 6 months follow-up as survivors with NYHA class improvement ≥1 grade and without new hospital admission for acute heart failure. Results: In the follow-up (median=20 months), 16 patients were responders to CRT (Group I) and 16 non-responders (Group II). Responders showed a wider QRS (I=162?25 vs. II=142 ?27 msec; p .044) and a greater delta WMSI (I=0.34?0.25 vs. II= 0.15?0.18; p=.021). At individual patient analysis, inotropic reserve was more often associated with a favourable clinical outcome (see figure) whereas dyssynchrony criteria by echocardiography were equally present in the two groups (I=12/16 vs. II=10/16, p=ns). In the follow-up there were 5 deaths, all in group II. Conclusion: Patients with contractile reserve during stress echo show a favourable clinical response to CRT. This parameter shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response: no muscle, no party

Adrenomedullin plasma levels as predictors of left ventricular reverse remodelling in patients treated with cardiac resynchronization therapy

Purpose: Adrenomedullin (ADM), a potent natriuretic and vasorelaxing peptide, has been isolated from human pheochromocytoma cells and from cardiovascular tissue. Increase in ADM plasma levels in congestive heart failure (CHF) patients (pts) is due to many cardiac and systemic factors and in particular to the greater plasma volume and to the activation of sympathetic nervous system. Aim of this study was to assess the role of plasma ADM levels in CHF pts treated by cardiac resynchronization therapy (CRT). Methods: 42 pts, mean age 70 years, 27 males, NYHA Class III-IV CHF underwent CRT. Cause of CHF were idiopathic dilated cardiomyopathy in 27 pts, post ischemic in 15; all pts were in sinus rhythm and with complete left bundle branch block (QRS duration 138?8 msec). A complete echoDoppler exam, blood samples for brain natriuretic peptide (BNP) and ADM were obtained within 2 days before implantation. Results: At 18?6 months follow-up, >1 NYHA Class improvement was observed in 31/42 pts. However, a >10% reduction in end-systolic dimensions (ESD): -18.2?2.3% was reported in 16 pts (Group I); in the remaining 26 pts ESD change was almost negligible: -1.5?3.2% (Group II). The two groups were comparable for age, sex, cause of LV dysfunction, ongoing therapy, QRS duration at baseline, pre implantation ESD (60.6?1.8 vs 59.9?1.9 mm - Group I vs II), LVEF% (24.3?1.2 vs 25.4?1.3%) and BNP (545?80 vs 494?89 pg/ml). Significantly higher pre implantation ADM levels were present in Group I than in Group II (25.8?2.4 pmol/l vs. 17.1?1.6, p = 0.005). Conclusions: Significantly higher ADM levels indicate a subgroup of pts in whom significant reverse remodelling can be observed after CRT. Since AM is also produced in cardiac myocytes, lower ADM values before CRT could suggest the presence of more severe myocardial damage which may impair LV reverse remodelling even in the setting of clinically successful resynchronization

Pacing-induced regional differences in adenosine receptors mRNA expression in a swine model of dilated cardiomyopathy

The adenosinergic system is essential in the mediation of intrinsic protection and myocardial resistance to insult; it may be considered a cardioprotective molecule and adenosine receptors (ARs) represent potential therapeutic targets in the setting of heart failure (HF). Aim of the study was to test whether differences exist between mRNA expression of ARs in the anterior left ventricle (LV) wall (pacing site: PS) compared to the infero septal wall (opposite region: OS) in an experimental model of dilated cardiomyopathy. Cardiac tissue was collected from LV PS and OS of adult male minipigs with pacing-induced HF (n=10) and from a control group (C, n=4). ARs and TNF– mRNA expression was measured by Real Time-PCR and the results were normalized with the three most stably expressed genes (GAPDH, HPRT1, TBP). Immunohistochemistry analysis was also performed. After 3 weeks of pacing higher levels of expression for each analyzed AR were observed in PS except for A1R (A1R: C=0.6±0.2, PS=0.1±0.04, OS=0.04±0.01, p<0.0001 C vs. PS and OS respectively; A2AR: C=1.04±0.59, PS=2.62±0.79, OS=2.99±0.79; A2BR: C=1.2±0.1, PS=5.59±2.3, OS=1.59±0.46; A3R: C=0.76±0.18, PS=8.40±3.38, OS=4.40±0.83). Significant contractile impairment and myocardial hypoperfusion were observed at PS after three weeks of pacing as compared to OS. TNF- mRNA expression resulted similar in PS (6.3±2.4) and in OS (5.9±2.7) although higher than in control group (3.4±1.5). ARs expression was mainly detected in cardiomyocytes. This study provided new information on ARs local changes in the setting of LV dysfunction and on the role of these receptors in relation to pacing-induced abnormalities of myocardial perfusion and contraction. These results suggest a possible therapeutic role of adenosine in patients with HF and dyssynchronous LV contraction

Adenosine receptor expression in an experimental animal model of myocardial infarction with preserved left ventricular ejection fraction.

Adenosine, a purine nucleoside and a "retaliatory metabolite" in ischemia, is ubiquitous in the body and increases 100-fold during ischemia. Its biological actions are mediated by four adenosine receptors (ARs): A(1), A(2A), A(2B) and A(3). The aim of this study was to determine possible myocardial alterations in AR expression in an experimental animal model of myocardial infarction (MI) with a preserved left ventricular (LV) ejection fraction. LV tissue was collected from sexually mature male farm pigs with MI (n = 6) induced by permanent surgical ligation of the left anterior descending coronary artery and from five healthy pigs (C). mRNA expression of A(1)R, A(2A)R, A(2B)R, A(3)R and TNF-? was determined by real-time PCR in tissue collected from border (BZ) and remote zones (RZ) of the infarcted area and from LV of C. BZ, RZ and samples of C were stained immunohistochemically to investigate A(3)R immunoreaction. After 4 weeks a different regulation of ARs was observed. A(1)R mRNA expression was significantly lower in the infarct regions than in controls (C = 0.75 ? 0.2, BZ = 0.05 ? 0.2, RZ = 0.07 ? 0.02 p = 0.0025, p = 0.0016, C vs. BZ and RZ, respectively). Conversely A(3)R was higher in infarct areas (C = 0.94 ? 0.2, BZ = 2.85 ? 0.5, RZ = 3.48 ? 1.0, p = 0.048 C vs. RZ). No significant differences were observed for A(2A)R (C = 1.58 ? 0.6, BZ = 0.42 ? 0.1, RZ = 1.37 ? 0.6) and A(2B)R (C = 1.66 ? 0.2, BZ = 1.54 ? 0.5, RZ = 1.25 ? 0.4). A(3)R expression was confirmed by immunohistochemical analysis and was principally localized in cardiomyocytes. TNF-? mRNA results were: C 0.41 ? 0.25; BZ 1.60 ? 0.19; RZ 0.17 ? 0.04. The balance between A(1)R and A(3)R as well as between A(2A)R and A(2B)R was consistent with adaptative retaliatory anti-ischemic adenosinergic changes in the infarcted heart with preserved LV function