Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian a 40-69 year-old cohort in general practice

Scopo. La frazione lipoproteica denominata “colesterolo non-HDL” viene raccomandata come un indice di rischio coronarico (RC) associata alla dislipidemia combinata ed è stata trovata un utile fattore predittivo del rischio coronarico nei pazienti diabetici. Abbiamo studiato l’associazione tra i fattori di RC noti, incluso la colesterolo non-HDL ed una “condizione di RC elevato”, cioè un “RC a 5-anni >15%” in medicina generale. Metodi. Abbiamo studiato 4085 individui di età 40-69 anni, 489 diabetici e 3596 non-diabetici, appartenenti ad una coorte opportunistica. Sono state utilizzate le statistiche descrittive, e la regressione logistica multivariata aggiustata per età e sesso per i confronti tra i 2 gruppi. Risultati. Circa il 12% dei participanti era diabetico. I confronti aggiustati per età e sesso hanno mostrato che tutte le variabili erano significativamente peggiori nei diabetici rispetto ai non-diabetici (eccetto fumo, colesterolo totale e rapporto colesterolo totale/HDL). I diabetici avevano un “RC medio a 5-anni” più alto dei non-diabetici (18.8±11.9% vs 7.5±6.9%, P15%” (55.4% vs 11.1%, P<0.01). Nei diabetici, le variabili associate ad una “condizione di RC elevato” sono: fumo, pressione arteriosa sistolica (PAS) e colesterolemia non-HDL; nei non-diabetici: fumo, PAS, colesterolemia non-HDL e HDL (inversamente). Conclusioni. Il colesterolo non-HDL – oltre a fumo e PAS – è un forte predittore di una “condizione di RC elevato” sia negli individui diabetici che non-diabetici

Frontal GABA Levels Change during Working Memory

Functional neuroimaging metrics are thought to reflect changes in neurotransmitter flux, but changes in neurotransmitter levels have not been demonstrated in humans during a cognitive task, and the relationship between neurotransmitter dynamics and hemodynamic activity during cognition has not yet been established. We evaluate the concentration of the major inhibitory (GABA) and excitatory (glutamate + glutamine: Glx) neurotransmitters and the cerebral perfusion at rest and during a prolonged delayed match-to-sample working memory task. Resting GABA levels in the dorsolateral prefrontal cortex correlated positively with the resting perfusion and inversely with the change in perfusion during the task. Further, only GABA increased significantly during the first working memory run and then decreased continuously across subsequent task runs. The decrease of GABA over time was paralleled by a trend towards decreased reaction times and higher task accuracy. These results demonstrate a link between neurotransmitter dynamics and hemodynamic activity during working memory, indicating that functional neuroimaging metrics depend on the balance of excitation and inhibition required for cognitive processing

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Chirurgia plastica delle schisi del processo alveolare: La scuola di Bologna

Alveolar cleft repair is a debate topic in Cleft Lip and Palate treatment. Many surgical techniques have been described in the past, but there are different opinions on witch therapy is the best one for this malformation. There are different opinions also on with material is the best for grafting. The repair can be achieve by inserting different material in the cleft or without any grafting, as in the periostioplasty technique so said "boneless bone graft". The material can be autologous, allogenical or alloplastical. Also operative times are a debate topic and the discussion is not focus on of a few days or months of difference, but regard many years. In fact some authors treat alveolar cleft at neonatal age but some others prefer to operate at the age of 8-10 years. The article analyze the evolution in the treatment of this pathology in the last 50 years and to expose the methodology of the School of Bologna. During the period between 1981 and 2006, 460 patients with alveolar clefts have been treated in our unit with autologous bone grafting. Our protocol is to repair alveolar cleft with an autologous bone graft at an average age of 10. The operation is carried out after the growth of maxillary bone is completed for 80%, before the eruption of canine teeth. Autologous bone was taken in the 45% of patients from the skull, 35% from the iliac crest, and the 20% from the chin. The surgical technique of realizing a pocket to home the bone graft, key point to get a good result, and the surgical technique to get bone graft from the donor sites are described. We analyzed the experience of the School of Bologna, we describe the methodology and we evaluated the results and we can conclude that our method let us achieve satisfactory results