Acute effects of coffee on QT interval in healthy subjects

The coronary endothelial function is recognized to have an important role in the physiology of the diastolic ventricular relaxation, a phase of the heart cycle that influences the electrocardiographic QT interval. Endothelial function is investigated in vivo by flow mediated dilation (FMD) in the brachial artery and has proven to be a strong predictor of both coronary endothelial function and cardiovascular events. It has been reported that coffee acutely induces FMD changes. In particular, the brachial artery FMD seems to decrease after caffeinated coffee (CC) and to increase after decaffeinated coffee (DC) ingestion. Since the cardiovascular effects of coffee are still a debated matter, this study aimed at investigating with a randomized, double-blind crossover design, if the QT interval of adult healthy subjects (19 males and 21 females) changes in the hour following CC or DC ingestion. Both systolic and diastolic blood pressure were higher in the hour following the ingestion of CC; the heart rate significantly increased 30 minutes after CC ingestion. A significant increase of the QT duration was observed one hour after DC ingestion (398.9 ± 3.8 vs 405.3 ± 3.7 msec; P < 0.05), not after CC. The QT interval corrected for heart rate did not significantly change following CC or DC ingestion. In conclusion, despite CC and DC previously demonstrated to influence the FMD they do not seem to induce a significant unfavourable acute change of the left ventricular repolarization. Further investigations are required to elucidate the effects of coffee in subjects with cardiovascular diseases

Coffee and endothelial function: a battle between caffeine and antioxidants ?

Although coffee is largely consumed by adults in Western countries, controversy exists about its impact on the cardiovascular system. We recently demonstrated that caffeinated and decaffeinated espresso coffee have different acute effects on endothelial function in healthy subjects, measured using flow-mediated dilation (FMD) of the brachial artery. In this study, we measured the anti-oxidant capacity of two coffee substances in terms of free stable radical 2,2-diphenyl-1-picryl-hydrazyl 50% inhibition (I50 DPPH). The caffeinated coffee had a slightly higher anti-oxidant capacity than decaffeinated espresso coffee (I50 DPPH: 1.13±0.02 vs 1.30±0.03 ml; Po0.001). We suggest that the unfavourable effects observed after caffeinated coffee ingestion are due to caffeine and that the antioxidant activity is responsible for the increased FMD observed after decaffeinated coffee ingestion. Further clinical and epidemiological studies are needed to understand the chronic effects of coffee consumption on health

A low resting metabolic rate is associated with metabolic syndrome

Background & aims: The metabolic syndrome is associated with central accumulation of fat. Previous studies showed that some obese subjects are characterized by a sparing energy metabolism. The aim of this study was to investigate whether obese subjects with metabolic syndrome have a lower resting metabolic rate than obese subjects without metabolic syndrome. Methods: Forty obese subjects were divided into three groups according to the presence of metabolic syndrome and type 2 diabetes; 15 non-obese healthy control subjects were also enrolled. Body composition (bio-impedance analysis) and resting metabolic rate (indirect calorimetry) were performed. Results: The group with metabolic syndrome exhibited a significantly lower resting metabolic rate adjusted for fat-free mass with respect to the control group and the obese group without metabolic syndrome (respectively: 10873 vs. 11873, po0.01 and 12373kJ/kg fat-free mass 24h, po0.01; mean7sem). The obese group with metabolic syndrome and type 2 diabetes (T2D) had a not different adjusted resting metabolic rate (11476 kJ/kg fat-free mass 24 h) with respect to other groups. Conclusions: An energy sparing condition seems to characterize non-diabetic obese subjects with metabolic syndrome

Localization of sentinel lymph node in breast cancer. A prospective study

Introduction: Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically nodenegative patients. Patients and methods: A cohort of 898 female patients with breast carcinoma was considered, from 2001 to 2008. Once SLN was localized, by means of radio-colloid or blue dye staining, and isolated, a biopsy was performed. Only those positive for metastases were submitted to axillary dissection. Results: Only in nine cases a SLN was not isolated. We had 819 cases of first level SLN (group A) and 69 cases of second level SLN (group B). Considering all of 889 cases, SLN was localized in the second level in 69 patients (7.8%); but if we consider metastatic SLN alone (340 cases), it was in the second level in 23 subjects (6.8%). In total, we had a positive second level SLN in 2.3% of cases (23/889). Conclusion: Second level SLN could be considered only an anomalous lymphatic axillary drainage and it does not linked to particular histological variants of the primitive tumour. In our study, skip metastases were recognized in only 2.6% of cases, therefore, whenever a SLN is not isolated for any reason, the first level sampling represent a viable operative choice

A bizarre foreign body in the appendix: A case report

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management optio

"Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature

Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, discomfort, jaundice, weight loss. The majority of patients are identified incidentally at the time of cholecystectomy for cholelithiasis. It is not possible to differentiate preoperatively between gallbladder adenocarcinoma and gallbladder neuroendocrine carcinoma (NEC) with imaging techniques. The only curative therapeutic modality for LCNECs is a complete en bloc surgical resection, including regional lymph node clearances and hepatic lobectomy, but only in patients without multiple metastasis. LCNECs benefit from an aggressive surgical resection in combination with chemotherapy, if resectability is possible. If the tumour is non-resectable, the primary management is therefore medical and not surgical. All patients with LCNEC presented a poor prognosis with a median survival of 10 months after the initial diagnosis. Only in five patients (62.5%) a wide surgical excision was performed, while in the other cases the tumour was non-resectable or multiple liver metastases were present at diagnosis

Flavouring extra-virgin olive oil with aromatic and medicinal plants essential oils stabilizes oleic acid composition during photo-oxidative stress

Essential oils (EOs) from medicinal and aromatic plants (MAPs) are well-known as natural antioxidants. Their addition to extra-virgin olive oil (EVOO) can contribute to reducing fat oxidation. The main aim of this study was to improve both food shelf-life and aromatic flavour of EVOO, adding different EOs of Sicilian accessions of common sage, oregano, rosemary and thyme. The morphological and production characteristics of 40 accessions of MAPs were preliminarily assessed. EOs from the most promising accessions of MAPs were analysed by gas-chromatography and mass spectrometry. Photo-oxidative studies of the EOs were carried out and the determination of the EVOO fatty acids obtained from 4 Italian olive varieties was also made. EO content was on average 1.45% (v/w) for common sage, 3.97% for oregano, 1.42% for rosemary and 5.90% for thyme accessions. The highest average EO yield was found in thyme (172.70 kg ha1) whilst the lowest (9.30 kg ha1) in rosemary accessions. The chemical composition of EOs was very different in the four MAPs in the study. No significant change of oleic acid percentage was detected in the mixture of EVOO with EO samples. The results seem to highlight the presence of an antioxidant effect of EOs on EVOO

Intrarenal hemodynamics and carotid intima-media thickness in the metabolic syndrome

Aims: Metabolic syndrome (MetS) is associated with increased cardiovascular risk. We hypothesize that early vascular changes are already present at the time of diagnosis of MetS. The relationship of different measures of early vascular impairment with body fat distribution and the natural progression of MetS was examined in newly diagnosed subjects non-pharmacologically treated. Methods: 246 consecutively enrolled subjects were categorized according to the presence of MetS and type 2 diabetes (T2D). Intra-renal Doppler flow was used to ascertain resistive (RI) and pulsatility (PI) indices as markers of vascular resistance. Carotid intima-media thick- ness (IMT), cutis-rectis (CR) and rectis-aorta (RA) thicknesses were measured by ultrasono- graphy; RA/CR ratio was used as measure of body fat distribution. Pro-inflammatory cytokines, C-reactive protein, oxidative markers insulin and adiponectin blood concentra- tions were also measured. Results: Baseline characteristics demonstrated increasing trends in biochemical, inflam- matory, and oxidative parameters from MetS??, MetS+, to MetS+/T2D (p&lt;0.001). After adjusting for age, the same increasing trends across the groups were observed in both sexes in IMT (p &lt; 0.001), RI (p &lt; 0.001) and PI (p &lt; 0.001). IMT correlated with RI (r = 0.25; p &lt; 0.001), PI (r = 0.26; p &lt; 0.001), and RA/CR ratio (r = 0.43; p &lt; 0.001). Conclusions: Carotid IMT and intra-renal resistances are elevated at an early stage in MetS and are associated with a dysregulated production of fat-derived hormones and cytokines

Fitting the Stocking Rate with Pastoral Resources to Manage and Preserve Mediterranean Forestlands: a Case Study

Pasture practices have affected Mediterranean forest ecosystems for millennia, and they are still quite widespread in mountainous areas. Nevertheless, in the last decades, the stability of forest ecosystems has been jeopardized due to the abandonment of traditional agro-pastoral practices, so that the gradual reduction of open areas due to progressive succession processes has caused a high increase of grazing pressure by livestock and wild ungulates feeding on forest areas. This paper aims at showing a methodological approach for evaluating the effect of applying measures in order to improve the grazing value of grasslands and ecotonal patches and lower the grazing impact on native woodlands. A protected area in Sicily (Italy) is considered as a representative case study. The analysis of remotely sensed imagery and several field surveys enabled to identify and map six different land use units subject to grazing, i.e., (1) forests; (2) grasslands (pastures dominated by palatable herbs and grasses); (3) overgrazed grasslands (dominatedby poisonous and/or thorny herbs and forbs, not palatable); (4) encroached pastures; (5) roadside firebreaks (dominated by palatable herbs) with no shrubs; and (6) wooded/ encroached roadside firebreaks. Several data were collected through sample plots selected within each land use unit, in order to assess their pastoral value. These data have been used to define current and optimal animal stock rates aiming at addressing pasture management planning towards a sustainable use of forestland and shrubland