How common is isolated nocturnal hypertension?

The growing use of methods to measure blood pressure (BP) under everyday life conditions in ‘out-of-office’ settings, through either 24-h ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM), for defining BP status has led to identification of four specific hypertension phenotypes, characterized by variable agreement or disagreement between office BP (OBP) and out-of-office BP: true normotension (normal office and out-of-office BP), sustained hypertension (both elevated office and out-of-office BP), masked hypertension (normal office BP and out-of-office BP), and white-coat hypertension (WCH), when OBP is elevated, but out-of-office BP levels are within normal limits. The term ‘white-coat hypertension’ is probably a misnomer and a misconception, because it does not necessarily reflect, or at most partially, an alerting reaction or white-coat effect. However, the suggestion to use the term ‘isolated office hypertension’ instead of the more appealing ‘white coat hypertension’ has not gained popularity in clinical practice

Increase of fumonisin b2 and ochratoxin a production by black Aspergillus species and oxidative stress in grape berries damaged by powdery mildew.

Powdery mildew (PM), caused by the fungus Erysiphe necator, is one of the most widespread fungal disease of grape and may cause extensive openings on the berry surface during the infection. We evaluated the effect of damage caused by PM in grape berries on the growth of and mycotoxin production by Aspergillus and on the oxidative stress in infected berries. Berries of Vitis vinifera L. cv. Negroamaro with sound skin (SS) and those naturally infected by PM were surface sterilized and inoculated with either fumonisin B2 (FB2)-producing strains of Aspergillus niger or ochratoxin A (OTA)-producing strains of Aspergillus carbonarius and incubated at 20 and 30uC. The PM berries were significantly more susceptible to both Aspergillus colonization (5 to 15 times more susceptible) and OTA and FB2 contamination (2 to 9 times more susceptible) than were SS berries. The highest toxin concentration was detected in inoculated PM berries both for OTA (9 ng/g) at 20uC and for FB2 (687 ng/g) at 30uC. In inoculated SS and PM berries, although malondialdehyde and hydrogen peroxide concentrations did not increase, the two black Aspergillus species caused a significant decrease in ascorbate content, thus inducing a pro-oxidant effect. These results indicate that grape berries affected by PM are more susceptible to black Aspergillus growth and to production and/or accumulation of FB2 and OTA. Thus, preventive control of E. necator on grape berries could reduce the mycotoxicological risk from black Aspergillus infection

Fumonisin B2 by Aspergillus niger in the grape–wine chain: an additional potential mycotoxicological risk

Fumonisins are mycotoxins with cancer-promoting activity and are associated with a number of animal and human diseases. The potential risk of contamination by fumonisin B2 (FB2), although at low levels, has been demonstrated in must and wine. Black aspergilli in general and Aspergillus niger in particular are considered to be the major responsible agents of FB2 contamination in grape and its by-products. Contamination by FB2 therefore is yet another safety concern of grape and wine producers, as ochratoxin A, produced mainly by A. carbonarius, may prove to be a major mycotoxicological problem in the grape–wine chain

In-hospital percentage BNP reduction is highly predictive for adverse events in patients admitted for acute heart failure: the Italian RED Study

Introduction: Our aim was to evaluate the role of B-type natriuretic peptide (BNP) percentage variations at 24 hours and at discharge compared to its value at admission in order to demonstrate its predictive value for outcomes in patients with acute decompensated heart failure (ADHF). Methods: This was a multicenter Italian (8 centers) observational study (Italian Research Emergency Department: RED). 287 patients with ADHF were studied through physical exams, lab tests, chest X Ray, electrocardiograms (ECGs) and BNP measurements, performed at admission, at 24 hours, and at discharge. Follow up was performed 180 days after hospital discharge. Logistic regression analysis was used to estimate odds ratios (OR) for the various subgroups created. For all comparisons, a P value 46% at discharge had an area under curve (AUC) of 0.70 (P 300 pg/mL. A BNP reduction of 25.9% after 24 hours had an AUC at ROC curve of 0.64 for predicting adverse events (P 46% was 4.775 (95% confidence interval (CI) 1.76 - 12.83, P 300 pg/mL and whose percentage decrease at discharge was 46% was 9.614 (CI 4.51 - 20.47, P 46% at hospital discharge compared to the admission levels coupled with a BNP absolute value < 300 pg/mL seems to be a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalized with ADHF

Complexity and dynamics of the winemaking bacterial communities in berries, musts, and wines from apulian grape cultivars through time and space

Currently, there is very little information available regarding the microbiome associated with the wine production chain. Here, we used an amplicon sequencing approach based on high-throughput sequencing (HTS) to obtain a comprehensive assessment of the bacterial community associated with the production of three Apulian red wines, from grape to final product. The relationships among grape variety, the microbial community, and fermentation was investigated. Moreover, the winery microbiota was evaluated compared to the autochthonous species in vineyards that persist until the end of the winemaking process. The analysis highlighted the remarkable dynamics within the microbial communities during fermentation. A common microbial core shared among the examined wine varieties was observed, and the unique taxonomic signature of each wine appellation was revealed. New species belonging to the genus Halomonas were also reported. This study demonstrates the potential of this metagenomic approach, supported by optimized protocols, for identifying the biodiversity of the wine supply chain. The developed experimental pipeline offers new prospects for other research fields in which a comprehensive view of microbial community complexity and dynamics is desirable.Peer ReviewedPostprint (published version

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

I nutraceutici nell'ipertensione

L’impiego di nutraceutici dotati di azione antipertensiva può essere considerato, unitamente ad una dieta equilibrata ed all’adozione di uno stile di vita sano, parte integrante di una strategia di prevenzione degli eventi cardiovascolari in soggetti con valori pressori nel range normale-alto, purché non concomitino altri determinanti del rischio cardiovascolare globale tali da configurare una condizione di rischio CV elevato o molto elevato, che rende mandatorio l’inizio di una terapia farmacologica. Il loro utilizzo può essere suggerito anche come utile adiuvante al trattamento farmacologico nei pazienti ipertesi, specie in presenza di effetti collaterali non tollerati nei confronti delle varie classi di farmaci antipertensivi. Il cioccolato fondente (con almeno l’80% di cacao) e il succo di barbabietola sembrano in atto essere i due nutraceutici con le più convincenti prove di efficacia. Necessitano, tuttavia, ulteriori studi finalizzati a stabilire la sicurezza a lungo termine dei nutraceutici descritti ed a valutare quali tra questi presentino il più favorevole rapporto costo-efficacia, in modo da non considerarli presidi di élite e da consentirne un più ampio uso nella popolazione