Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial

In hypoparathyroidism (HypoPT), calcium supplementation is virtually always required, although the disease is likely to be associated with an increased risk of nephrolithiasis. The use of calcium citrate (Ca-Cit) theoretically could have a positive impact on the nephrolithiasis risk because citrate salts are used to reduce this risk. Our objective was to evaluate the potential therapeutic advantage of Ca-Cit in comparison with calcium carbonate (CaCO3) in HypoPT, on nephrolithiasis risk factors, as well as to their ability to maintain desirable serum calcium levels. We also evaluated these preparations on quality of life (QOL). This randomized, double-blind, crossover trial recruited 24 adults with postsurgical chronic hypoparathyroidism at Campus Bio-Medico University of Rome. Participants were randomized 1:1 to Ca-Cit or CaCO3 for 1 month and then crossed over to the other treatment for another month. The primary outcomes were changes in albumin-adjusted serum calcium and in ion activity product of calcium oxalate levels (AP[CaOx] index). Secondary efficacy outcomes included changes in SF-36 survey score, fatigue score, constipation, and adverse events. No difference in terms of AP(CaOx) index was observed between the two groups. However, Ca-Cit was associated with a significant reduction in the oxalate/creatinine ratio compared with CaCO3 (-2.46 mmol/mol [SD 11.93] versus 7.42 mmol/mol [SD 17.63], p = 0.029). Serum calcium and phosphorus concentration was not different between the two calcium preparations. Ca-Cit was associated with less constipation (p = 0.047). No difference was found in QOL scores. Although Ca-Cit did not modify the AP(CaOx) index when compared with CaCO3, it was associated with a reduction in urinary oxalate excretion that could have a potential beneficial effect on nephrolithiasis risk. These results are likely to have clinical implications in HypoPT, particularly those who do not tolerate CaCO3 and those affected by nephrolithiasis. A longer-term experience is needed to confirm these findings. (c) 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)

Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) <= 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD

Legionella Infection Risk from Domestic Hot Water

We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of <20 μg/L and copper levels of >50 μg/L appeared to be protective against Legionella colonization. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches

Anti-Inflammatory Therapy for Acute Coronary Syndromes: Is It Time for a Shift in the Treatment Paradigm?

T he intense inflammatory response triggered by myocardial infarction (MI) is a part of the cardiac repair process: infiltrating leukocytes, by releasing proteases and reactive oxygen species, and clear the wound from dead cells and debris. Wound cleansing establishes, in turn, an environment which favors healing. Nevertheless, the close spatial relation between leukocytes and nearby viable cardiomyocytes in the border zone of ischemic damage has been deemed responsible for leukocyte-mediated cardiomyocyte injury. 1 During diapedesis, the white blood cells interact with the endothelium and transmigrate across the vascular wall to reach the infarct zone where they adhere to the viable cardiomyocytes; the result of this proximity and of leukocyte cytotoxic effects is the worsening of ischemic injury. Furthermore, the activation of inflammatory pathways is partly accountable for postinfarction dilative and fibrotic remodeling which impairs cardiac function through changes in geometry, mass, composition, and volume of the left ventricle. 1 As a consequence, targeting inflammatory signals has been considered for a long time a promising therapeutic approach to prevent heart failure and reduce mortality in patients with MI

The Meyer-Neldel rule in the conductivity of insulating germanium nitride and oxynitride films

Electrical conductivity, σ(T ), of a-Ge3Nx (3.7 < x < 4.6) and quasi-stoichiometric a-Ge2OyNx films has been investigated as a function of the temperature. Layers present a highly insulating behavior with conductivity and thermal activation energy rapidly rising, increasing T from room temperature to 600 K. Depending on the film composition, the conductivity can vary up to six orders of magnitude. Data analysis of σ(T) revealed a clear relation between the pre-exponential factor and the thermal activation energy, suggesting the validity of the Meyer- Neldel rule. For all investigated films, typical Meyer-Neldel parameters assume values in a narrow range: 10−8 < σ00 < 10−6 (Ωcm)−1 and 41 < EMN < 51 meV. To account for this behavior we have considered a model based on a sta- tistical shift of the Fermi level upon the temperature raise. Our study is the first experimental evidence of this kind of electrical behavior in this class of materials

Optimal process parameters for phosphorus spin-on-doping of germanium

The fabrication of homogeneously doped germanium layers characterized by total electrical activation is currently a hot topic in many fields, such as microelectronics, photovoltaics, optics and radiation detectors. Phosphorus spin-on-doping technique has been implemented on Ge wafers, by developing a protocol for the curing process and subsequent diffusion annealing for optimal doping. Parameters such as relative humidity and curing time turned out to affect the surface morphology, the degree of reticulation reached by the dopant source and the amount of dopant available for diffusion. After spike annealing in a conventional furnace, diffusion profiles and electrical properties have been measured. Ge loss from the surface during high-temperature annealing, due to diffusion into the source film, has been observed and quantified

Germanium nitride and oxynitride films for surface passivation of Ge radiation detectors

This work reports a detailed investigation of the properties of germanium nitride and oxynitride films to be applied as passivation layers to Ge radiation detectors. All the samples were deposited at room temperature by reactive RF magnetron sputtering. A strong correlation was found between the deposition parameters, such as deposition rate, substrate bias and atmosphere composition, and the oxygen and nitrogen content in the film matrix. We found that all the films were very poorly crystallized, consisting of very small Ge nitride and oxynitride nanocrystallites, and electrically insulating, with the resistivity changing from three to six orders of magnitude as a function of temperature. A preliminary test of these films as passivation layers was successfully performed by depositing a germanium nitride film on the intrinsic surface of a high-purity germanium (HPGe) diode and measuring the improved performance, in terms of leakage current, with respect to a reference passivated diode. All these interesting results allow us to envisage the application of this coating technology to the surface passivation of germanium-based radiation detectors

Evidence for oxidative activation of c-Myc–dependent nuclear signaling in human coronary smooth muscle cells and in early lesions of Watanabe heritable hyperlipidemic rabbits: protective effects of vitamin E

Background. Oxidized LDL (oxLDL) promotes atherogenesis, and antioxidants reduce lesions in experimental models. OxLDL-mediated effects on c-Myc are poorly characterized, and those on c-Myc nuclear pathways are completely unknown. c-Myc stimulates smooth muscle cell (SMC) proliferation and could be involved in atherosclerosis. We investigated the early effects of oxLDL and α-tocopherol on c-Myc, its binding partner Max, and the carboxy-terminal domain–binding factors activator protein-2 and elongation 2 factor in human coronary SMCs. We also investigated whether 9-week treatment of Watanabe heritable hyperlipidemic (WHHL) rabbits with diet-enriched α-tocopherol reduces c-Myc expression and oxLDL in the left coronary artery. Methods and Results. OxLDL enhanced c-Myc/Max expression and transcription by cotransfection assay and the nuclear activities of E2F and activator protein-2 by binding shift and supershift in coronary SMCs. a-Tocopherol significantly reduced these molecular events. Furthermore, a-tocopherol reduced early lesions, SMC density, and the immunohistochemical presence of c-Myc, which colocalized with oxLDL/foam cells in the coronaries of WHHL rabbits. Conclusions. We provide the first evidence that oxLDL and a-tocopherol may influence c-Myc activation and several c-Myc–dependent signaling pathways in human coronary SMCs. The observation that in vivo, an antioxidant reduces both c-Myc and oxLDL in early coronary lesions of rabbits is consistent with, but does not prove, the hypothesis that c-Myc–dependent factors activated by oxidative processes contribute to atherogenesis and coronary heart disease