Clinical outcome 10 years after attempted percutaneous transluminal coronary angioplasty in 856 patients.

Abstract OBJECTIVES: This study reports the 10-year outcome of 856 consecutive patients who underwent attempted coronary angioplasty at the Thoraxcenter during the years 1980 to 1985. BACKGROUND: Coronary balloon angioplasty was first performed in 1977, and this procedure was introduced into clinical practice at the Thoraxcenter in 1980. Although advances have been made, extending our knowledge of the long-term outcome in terms of survival and major cardiac events remains of interest and a valuable guide in the treatment of patients with coronary artery disease. METHODS: Details of survival, cardiac events, symptoms and medication were retrospectively obtained from the Dutch civil registry, medical records or by letter or telephone or from the patient's physician and entered into a dedicated data base. Patient survival curves were constructed, and factors influencing survival and cardiac events were identified. RESULTS: The procedural clinical success rate was 82%. Follow-up information was obtained in 837 patients (97.8%). Six hundred forty-one patients (77%) were alive, of whom 334 (53%) were symptom free, and 254 (40%) were taking no antianginal medication. The overall 5- and 10-year survival rates were 90% (95% confidence interval [CI] 87.6% to 92.4%) and 78% (95% CI 75.0% to 81.0%), respectively, and the respective freedom from significant cardiac events (death, myocardial infarction, coronary artery bypass surgery and repeat angioplasty) was 57% (95% CI 53.4% to 60.6%) and 36% (95% CI 32.4% to 39.6%). Factors that were found to adversely influence 10-year survival were age > or = 60 years (> or = 60 years [67%], 50 to 59 years [82%], or = 50% [80%]) and a history of previous myocardial infarction (previous myocardial infarction [72%], no previous infarction [83%]). These factors were also found to be independent predictors of death during the follow-up period by a multivariate stepwise logistic regression analysis. Other factors tested, with no influence on survival, were gender, procedural success and stability of angina at the time of intervention. CONCLUSIONS: The long-term prognosis of patients after coronary angioplasty is good, particularly in those <60 years old with single-vessel disease and normal left ventricular function. The majority of patients are likely to experience a further cardiac event in the 10 years after their first angioplasty procedure

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Acyclovir-Loaded Chitosan Nanospheres from Nano-Emulsion Templating for the Topical Treatment of Herpesviruses Infections

WOS: 000436507900010PubMed ID: 29642603Acyclovir is not a good candidate for passive permeation since its polarity and solubility limit is partitioning into the stratum corneum. This work aims to develop a new topical formulation for the acyclovir delivery. New chitosan nanospheres (NS) were prepared by a modified nano-emulsion template method. Chitosan NS were characterized by Dynamic Light Scattering (DLS), Transmission Electron Microscopy (TEM), and an in vitro release study. The in vitro skin permeation experiment was carried out using Franz cells and was equipped with porcine skin. Biological studies were performed on the Vero cell line infected by HSV-1 and HSV-2 strains. The acyclovir loaded chitosan NS appeared with a spherical shape, a size of about 200 nm, and a negative zeta potential of about 40.0 mV. The loading capacity of the drug was about 8.5%. In vitro release demonstrated that the percentage of acyclovir delivered from the nanospheres was approximately 30% after six hours. The in vitro skin permeation studies confirmed an improved amount of permeated acyclovir. The acyclovir-NS complex displayed a higher antiviral activity than that of free acyclovir against both the HSV-1 and the HSV-2 strain. The acyclovir-loaded NS showed no anti-proliferative activity and no signs of cytotoxicity induced by NS was detected. Confocal laser scanning microscopy confirmed that the NS are taken up by the cells.University of TurinThe authors would like to gratefully acknowledge the University of Turin for the funding research (RILO)

Linee guida sulla comunicazione on line in tema di tutela e promozione della salute

Questo documento vuole iscriversi in questo processo di rinnovamento del rapporto tra le istituzioni sanitarie e il cittadino con lo scopo di fornire indicazioni (in termini di contenuti informativi, servizi interattivi e strategie comunicative on line) per pianificare e realizzare un’attività di comunicazione in tema di tutela e promozione della salute (anche attraverso un Canale ‘Cittadini’ del portale del Ministero della Salute) che contribuisca a quell’empowerment del cittadino più volte richiamato dall’OMS (1978, 1986, 1998, 2005). L’obiettivo di questo documento è delineare le caratteristiche di un sito di un ente sanitario in grado di offrire una piattaforma telematica capace di incontrare in maniera efficace le esigenze informative, le aspettative e le priorità dei cittadini-pazienti e di favorire in loro lo sviluppo dell’apprendimento di comportamenti di promozione della salute e di prevenzione della malattia, contribuendo anche ad un uso più appropriato dei servizi sanitari. , infatti, la pratica clinica è tanto più efficace quanto più si costruisce su decisioni derivate dall’integrazione tra l’esperienza del medico e l’uso coscienzioso ed esplicito delle migliori evidenze scientifiche disponibili, mediate dalle preferenze del paziente. Partendo da un forte riferimento all’empowerment del cittadino e all’Evidence-based Medicine (EBM), l’epistemologia fondativa del SSN dalla metà degli anni Novanta, questo documento individua due concetti-chiave sui quali fondare la strategia comunicativa dei siti web degli enti e delle strutture sanitarie: la centralità del cittadino-paziente e l’importanza delle informazioni sulle prove di efficacia degli interventi sanitari. Nella prima parte del volume vengono presentati i risultati delle ricerche preparatorie all’individuazione di criteri di qualità per una sito di qualità in materia di tutela e promozione della salute: l’analisi epidemiologica per conoscere la diffusione delle malattie e dei fattori di rischio nella popolazione italiana; un revisione della letteratura relativa ai bisogni informativi di salute dei cittadini stessi, sia in termini di tipologia di informazioni che in termini di percorsi di ricerca preferiti; un’analisi della letteratura scientifica per determinare quale contributo, in termini di efficacia, possa offrire Internet, una rassegna normativa di settore e la ricognizione delle rilevazioni già condotte sul tema della qualità dei siti istituzionali. Vengono poi illustrati i risultati di un’indagine condotta a livello nazionale sull’opinione del cittadino riguardo i bisogni di salute percepiti; e quelli di un’analisi dei portali della salute delle Regioni e delle Aziende Sanitarie Locali che mettono in luce preziose indicazioni che riguardano la caratterizzazione istituzionale dei siti e la relazionalità attivata, il livello di trasparenza amministrativa, la disponibilità dei servizi on line e la qualità tecnologica. Nella seconda parte, invece, vengono presentati ed illustrati le raccomandazioni e i criteri fondamentali per una comunicazione on line di qualità in ambito sanitario, sia in riferimento ai contenuti informativi e alla tipologia degli interventi sanitari in Internet, che in relazione alle strategie di comunicazione e ai criteri redazionali

Phosphodiester Silybin Dimers Powerful Radical Scavengers: A Antiproliferative Activity on Different Cancer Cell Lines

Silibinin is the main biologically active component of silymarin extract and consists of a mixture 1:1 of two diastereoisomeric flavonolignans, namely silybin A (1a) and silybin B (1b), which we call here silybins. Despite the high interest in the activity of this flavonolignan, there are still few studies that give due attention to the role of its stereochemistry and, there is still today a strong need to investigate in this area. In this regard, here we report a study concerning the radical scavenger ability and the antiproliferative activity on different cell lines, both of silybins and phosphodiester-linked silybin dimers. An efficient synthetic strategy to obtain silybin dimers in an optical pure form (6aa, 6ab and 6bb) starting from a suitable building block of silybin A and silybin B, obtained by us from natural extract silibinin, was proposed. New dimers show strong antioxidant properties, determined through hydroxyl radical (HO&#9679;) scavenging ability, comparable to the value reported for known potent antioxidants such as quercetin. A preliminary screening was performed by treating cells with 10 and 50 &mu;M concentrations for 48 h to identify the most sensitive cell lines. The results show that silibinin compounds were active on Jurkat, A375, WM266, and HeLa, but at the tested concentrations, they did not interfere with the growth of PANC, MCF-7, HDF or U87. In particular, both monomers (1a and 1b) and dimers (6aa, 6ab and 6bb) present selective anti-proliferative activity towards leukemia cells in the mid-micromolar range and are poorly active on normal cells. They exhibit different mechanisms of action in fact all the cells treated with the 1a and 1b go completely into apoptosis, whereas only part of the cells treated with 6aa and 6ab were found to be in apoptosis

Un ingrediente fitoattivo da scarti di Castanea sativa

Nell’ottica di un’economia sostenibile e circolare, l’attenzione della ricerca scientifica negli ultimi anni si rivolge frequentemente allo studio degli scarti e dei sottoprodotti della filiera agricola come fonte di molecole bioattive da utilizzare in ambito farmaceutico, nutraceutico e cosmetico. I ricci delle castagne si rivelano un promettente ingrediente per la formulazione di cosmetici naturali ed efficaci

Lack of reactivation of tuberculosis in patients with psoriasis treated with secukinumab in a real-world setting of latent tuberculosis infection

Some biologics for psoriasis, especially anti-tumor necrosis factor (TNF)-α therapies, may re-activate latent tuberculosis (TBC) infection with consequent morbidity and mortality. However, there is a low reported incidence of conversion to positive TBC status among patients with psoriasis treated with second-generation biologic therapies, particularly anti-interleukin (IL)-17 therapies such as secukinumab

Lack of reactivation of tuberculosis in patients with psoriasis treated with secukinumab in a real-world setting of latent tuberculosis infection

Background Some biologics for psoriasis, especially anti-tumor necrosis factor (TNF)-alpha therapies, may re-activate latent tuberculosis (TBC) infection with consequent morbidity and mortality. However, there is a low reported incidence of conversion to positive TBC status among patients with psoriasis treated with second-generation biologic therapies, particularly anti-interleukin (IL)-17 therapies such as secukinumab. Objectives To evaluate the safety profile of secukinumab in psoriasis patients with latent TBC infection. Methods Real-life data were collected by retrospective chart review on patients with moderate-to-severe psoriasis who showed positivity for TBC screening at baseline and underwent secukinumab treatment for psoriasis at six Italian centers. Patients received secukinumab 300 mg at week 0/1/2/3/4, then every 4 weeks. Results Fifty-nine patients were enrolled; 30.5% also had psoriatic arthritis and other comorbidities were common. At baseline, the mean psoriasis duration was 14.5 years. Ten (17%) patients did not undergo prophylaxis before starting secukinumab. Conversely, isoniazid +/- rifampicin or rifampicin alone prophylaxis was administered in 49/59 (83.1%) patients. After a mean treatment duration of 84 weeks, there were no cases of TBC reactivation and no unexpected safety signals. Conclusions Secukinumab use over an extended period was safe in psoriasis patients with latent TBC, even in patients who did not receive chemoprophylaxis

Possible role of BMP-4 in the hyper-pigmentation of psoriatic plaques after anti-TNF-α treatment

Psoriasis over-expresses several inflammatory mediators, which impacts the activity of melanocytes. Tyrosinase (Tyr) and microphthalmia-associated transcription factor (MITF) are the primary regulators of melanogenesis. Furthermore, bone morphogenetic proteins (BMPs) modulate various pathobiologic processes including inflammation, melanogenesis and melanomagenesis. To determine the association between psoriasis and melanogenesis, psoriatic lesional skin was screened through gene expression, immunohistochemistry, immunogold staining and melanin content assays. The present study detected a decreased expression of Tyr, MITF and BMP-4 in psoriatic lesional skin compared with healthy skin. Tyr, BMP-4 and melanin content were also evaluated in the psoriatic lesional skin of patients receiving adalimumab therapy, before and after 16 weeks of treatment. TNF-α blockade modulated the Tyr, BMP-4 and melanin content of the patient skin lesions, which supported the hypothesis that hyper-pigmentation may occur in areas of psoriatic plaque after biological treatment. The present study confirmed the influence of the psoriatic pro-inflammatory network on melanogenesis, exerting an inhibitory effect mediated by TNF-α. Furthermore, the results regarding BMP-4 in the present study add another important element to the mechanism of psoriasis

User-centered design for citizens' empowerment through the portal of the italian ministry of health

In this paper we report on a study concerning the redesign of the Web portal of the Italian Ministry of Health, jointly conducted by the ministry and Sapienza Universit̀a di Roma. In this project, a multidisciplinary team consisting of computer scientists and engineers, sociologists and experts in communication, doctors and experts in public health was involved, in order to fully identify and understand citizens' needs in terms of health information, on the one hand, and to apply the most innovative methodologies and techniques for usercentered design and interfaces, on the other. Guidelines for on-line communication on protection and promotion of the health, and a mock-up for the futureWeb portal of the Italian Ministry of Health have been realized during the project. Copyright © 2011 for the individual papers by the papers' authors