Is increased uric acid a risk factor or a defensive response? The Campania Salute Network.

BACKGROUND AND AIMS: Circulating uric acid (UA) is positively associated with body mass index (BMI), blood glucose, blood pressure (BP), markers of inflammation, and altered lipid profile. UA has also anti-oxidative properties which might be beneficial for cardiovascular (CV) system. It is still debated whether or not UA is independently associated with increased CV morbidity and/or mortality. METHODS AND RESULTS: We studied prognostic impact of UA in 8833 hypertensive adults (mean age 53 ± 12 yrs, 3857 women) from the Campania Salute Network, without prevalent CV disease and more than stage 3 CKD. We calculated standardized UA Z-score, adjusted for age, sex, glomerular filtration rate, and BMI. Low and high UA and UA Z-score quartiles were compared to the 2 middle quartiles assumed to be "normal". Prevalence of obesity and diabetes was higher in low and high than in normal UA Z-score group (all p < 0.001). Systolic BP, left ventricular mass, carotid intima thickness were significantly higher and ejection fraction was reduced in the presence of high UA Z-score (all p < 0.001). Over 33-months average follow-up, incident major CV end-points (MACE) were not significantly different among low, normal and high UA or UA Z-score. In the latter analysis, however, incident MACE tended to be more frequent in the low than the high UA Z-score. Despite the results of multivariable analyses, the effect of less aggressive therapy in low UA Z-score cannot be excluded with certainty. CONCLUSION: In treated hypertensive patients, high levels of UA normalized for major biological determinants do not independently predict CV outcome. CLINICALTRIALS. GOV IDENTIFIER: NCT02211365.

Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study.

BACKGROUND: The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II-IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience. METHODS: This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated. RESULTS: Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915-0.954) when CA125 was included, and 0.925 (95% CI: 0.902-0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes. CONCLUSIONS: The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.

Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and systematic review.

BACKGROUND: In trichorionic pregnancies, fetal reduction from three to two lowers the risk of severe preterm delivery, but provides no advantage in survival. Similar data for dichorionic triamniotic (DCTA) triplets is not readily available. OBJECTIVES: To document the natural history of DCTA triplets and the effect of reduction on the risk of miscarriage and severe preterm delivery, compared with expectant management. SEARCH STRATEGY: Systematic search on MEDLINE, EMBASE, and the Cochrane Library. SELECTION CRITERIA: DCTA triplets with three live fetuses at 8-14 weeks of gestation, outcome data with expectant management and/or reduction, miscarriage before 24 weeks of gestation and/or severe preterm delivery before 32-33 weeks of gestation. DATA COLLECTION AND ANALYSIS: Five studies were included. Data from these were combined with data from three centres. MAIN RESULTS: There were 331 DCTA triplets. The miscarriage rate was 8.9% (95% CI 5.8-13.3%) and the severe preterm delivery rate was 33.3% (95% CI 27.5-39.7%), with expectant management. The miscarriage rate was 14.5% (95% CI 7.6-26.2%) with a reduction of the monochorionic pair, 8.8% (95% CI 3.0-23.0%) with a reduction of one fetus of the monochorionic pair, and 23.5% (9.6-47.3%) with a reduction of the fetus with a separate placenta. Severe preterm delivery rates were 5.5% (95% CI 1.9-14-9%), 11.8% (95% CI 4.7-26.6%), and 17.6% (95% CI 6.2-41.0%), respectively. CONCLUSIONS: In DCTA triplets, expectant management is a reasonable choice when the top priority is a liveborn infant. Where the priority is to minimise severe preterm delivery, the most advisable option is fetal reduction. Further studies are needed to clarify which particular technique is advisable to optimise the outcome.

Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses.

OBJECTIVES: To assess the diagnostic performance of subjective assessment by Level II ultrasound examiners in predicting the specific histology of adnexal masses. METHODS: The women included in this prospective multicenter cross-sectional study were older than 16 years of age and had at least one adnexal mass. They underwent transvaginal sonography (TVS) performed by Level II examiners, all of whom were familiar with the International Ovarian Tumor Analysis (IOTA) group definitions of ultrasound features of ovarian masses. The final outcome was histology. Specific diagnoses were categorized into 16 groups. Agreement between subjective assessment and final histology was measured using unweighted kappa coefficients. Sensitivities and specificities were obtained for subjective assessment. RESULTS: Of the 1279 women who underwent TVS, 313 were included in the final analysis. Overall agreement (16 × 16 table) between subjective assessment and histology was moderate, with a Cohen's kappa coefficient of 0.59 (95% CI, 0.53-0.65). The specificity of subjective assessment ranged between 91% and 100% for all histological subgroups. Highest sensitivities were achieved in the diagnosis of simple cysts (100% (95% CI, 61-100%)), hydrosalpinges (100% (95% CI, 34-100%)), mature teratomas (88% (95% CI, 74-96%)), endometriomas (75% (95% CI, 61-85%)), ovarian fibromas (88% (95% CI, 47-100%)), tubo-ovarian abscesses (88% (95% CI, 47-100%)) and serous cystadenocarcinomas (82% (95% CI, 66-93%)). Serous cystadenomas were misdiagnosed most commonly (40.5%). The sensitivity of subjective assessment in diagnosing adnexal torsion was 54% (95% CI, 25-81%); the 17 confirmed and/or suspected cases of adnexal torsion were not included in the 313 cases examined and analyzed for diagnostic performance. CONCLUSION: Overall, subjective assessment by Level II examiners was good for the detection of simple cysts, endometriomas, mature teratomas, hydrosalpinges, fibroma, tubo-ovarian abscess and serous cystadenocarcinomas.

Type of myocardial infarction presentation in patients with chronic kidney disease.

BACKGROUND AND AIM: Association of coronary and renal disease has been frequently found in epidemiological studies. Whether ECG-graphic presentation of myocardial infarction [S-T Elevated MI (STEMI) or Non S-T Elevated MI (NSTEMI)] is related to the degree of renal dysfunction is still unclear. METHODS AND RESULTS: We examined 146 patients with acute myocardial infarction, consecutively entering the Coronary Care Unit of our ward. At entry, patients underwent clinical, ECG-graphic and echocardiographic examination, and blood samples were withdrawn for cardiac markers and general biochemistry. GFR was calculated using the CKD-EPI equation. STEMI was found in 71 cases and NSTEMI in 75 cases. Renal function was normal in 61 patients (stage 1), mildly impaired (<90 mL/min/1.73 m(2) and ≥ 60 mL/min/1.73 m(2)) in 60 (stage 2) and moderately to severely impaired (GFR <60 mL/min/1.73 m(2)) in 25 cases (stages 3-4). Patients were, thereafter, clustered into two groups (stages 1-2 and stages 3-4). Compared to stage 1-2 subjects, stages 3-4 patients were older, were more likely to be diabetic and had more frequently previous cardiovascular diseases. The probability of presentation of NSTEMI for stage 3-4 patients was 4-fold greater than for stage 1-2 patients (p = 0.02). CONCLUSIONS: These data support the evidence that 1) NSTEMI is associated with more severe kidney dysfunction, likely due to more severe and/or longer lasting exposition to risk factors; 2) cardiac and renal impairment are strongly associated. ClinicalTrials.gov Identifier: NCT01636427.

Low-lipid diet reduces frequency and severity of acute migraine attacks.

BACKGROUND AND AIM: There is uncertainty regarding the prevention of migraine crises by changing the lifestyle of patients. The aim of this randomized, crossover intervention trial was to evaluate the effects of a low lipid intake on the incidence and severity of migraine crises, in comparison to a diet with moderate lipid intake. METHODS AND RESULTS: After a 2-month run-in when patients received preventive medication but were left on their habitual diet, a low-lipid or a normal-lipid diet was randomly prescribed for 3 months and thereafter diets were crossed over for the following 3 months. Headache was diagnosed based on the International Classification of Headache Disorders (IHCD) III criteria. The number and severity of attacks were assessed using a self-reported calendar. Adherence to the diet was assessed by a food frequency questionnaire. An analysis was performed on the 83 episodic or chronic migraineurs (63 female and 20 male), in the age range of 18-57 years, who completed both intervention periods. Obese subjects had a significantly higher number of attacks than those overweight or with normal body weight (24.7 ± 8, 16.3 ± 12, and 15.6 ± 11, respectively, p < 0.03) with a significant relationship between the body mass index (BMI) and the number of monthly attacks (r = 0.238, p < 0.03). The number (2.9 ± 3.7 vs. 6.8 ± 7.5, p < 0.001) and severity (1.2 + 0.9 vs. 1.7 ± 0.9, p < 0.01) of attacks significantly decreased during both intervention periods, with a significant difference in favour of the low-lipid diet. CONCLUSIONS: In this group of patients, the low-lipid diet significantly affected the number and severity of migraine attacks in comparison to a normal-lipid diet. ClinicalTrials.gov Identifier: NCT 01917474.

A case of acute myocarditis associated with Chlamydia trachomatis infection: role of cardiac MRI in the clinical management.

We report the case of a 32-year-old male with Chlamydia trachomatis infection and admitted with chest pain, signs of myocardial damage and coronary arteries free from significant atherosclerotic disease. Cardiac magnetic resonance imaging (MRI) documented imaging patterns of myocardial involvement suggestive of acute myocarditis, and repeated cardiac MRI examinations were used to define appropriate clinical management of the patient. In particular, the decision to submit the patient to an additional antibiotic course was based on evidence of persisting myocardial edema, while no further treatments were prescribed once these imaging findings disappeared. The case emphasizes the potential value of cardiac MRI as the only non-invasive modality currently available for evaluating the temporal evolution of myocardial involvement after acute myocarditis.

Cardiometabolic risk in overweight subjects with or without relative fat-free mass deficiency: the Strong Heart Study.

BACKGROUND AND AIM: Sarcopenia is a condition mainly due to loss of fat-free mass (FFM) in elderly individuals. RFFMD, however, is also frequent in obese subjects due to abnormal body composition. Objective of this study was to evaluate the impact of relative fat-free mass deficiency (RFFMD) on cardiometabolic (CM) risk in obese normoglycemic individuals. METHODS AND RESULTS: Overweight/obese American Indians from the Strong Heart Study population, without diabetes and with FBG ≤ 110 mg/dL and with GFR >60 mg/mL/1.73 m(2) were selected for this analysis (n = 742). RFFMD was defined on the basis of a multivariable equation previously reported. Fasting glucose and 2 h-OGTT were measured together with urine albumin/creatinine excretion, laboratory and anthropometric parameters. In addition to lower FFM and greater adipose mass, participants with RFFMD had higher body mass index, waist circumference, C-reactive protein, fibrinogen, insulin resistance and urinary albumin/creatinine than participants with normal FFM (all p < 0.001); they also had a greater prevalence of hypertension, impaired glucose tolerance (IGT) or OGTT-diabetes than participants with normal FFM (all p < 0.003) and a near 2-fold greater probability of significant proteinuria (p < 0.01). RFFMD was more frequent in women than in men: significant sex-RFFMD interactions were found for BMI and waist circumference (both p < 0.0001). CONCLUSIONS: RFFMD in overweight/obese normoglycemic individuals is associated with greater probability of hypertension, abnormalities of glucose tolerance and proteinuria. Assessment of RFFRMD might, therefore, help stratifying cardiometabolic risk among normoglycemic individuals with overweight/obesity.

Serum uric acid does not predict incident metabolic syndrome in a population with high prevalence of obesity.

AIM: To evaluate whether uric acid (UA) predicts 4-yr incidence of metabolic syndrome (MetS) in non-diabetic participants of the Strong Heart Study (SHS) cohort. METHODS AND RESULTS: In this population-based prospective study we analyzed 1499 American Indians (890 women), without diabetes or MetS, controlled during the 4th SHS exam and re-examined 4 years later during the 5th SHS exam. Participants were divided into sex-specific tertiles of UA and the first two tertiles (group N) were compared with the third tertile (group H). Body mass index (BMI = 28.3 ± 7 vs. 31.1 ± 7 kg/m(2)), fat-free mass (FFM = 52.0 ± 14 vs. 54.9 ± 11 kg), waist-to-hip ratio, HOMA-IR (3.66 vs. 4.26), BP and indices of inflammation were significantly higher in group H than in group N (all p < 0.001). Incident MetS at the time of the 5th exam was more frequent in group H than group N (35 vs. 28%, OR 1.44 (95% CI = 1.10-1.91; p < 0.01). This association was still significant (OR = 1.13, p = 0.04) independently of family relatedness, sex, history of hypertension, HOMA-IR, central adiposity and renal function, but disappeared when fat-free mass was included in the model. CONCLUSIONS: In the SHS, UA levels are associated to parameters of insulin resistance and to indices of inflammation. UA levels, however, do not predict incident MetS independently of the initial obesity-related increased FFM.

Transcranial Magnetic Stimulation and Deep Brain Stimulation in the treatment of alcohol dependence.

Alcohol dependence is a major social, economic, and public health problem. Alcoholism can lead to damage of the gastrointestinal, nervous, cardiovascular, and respiratory systems and it can be lethal, costing hundreds of billions to the health care system. Despite the existence of cognitive-behavioral therapy, psychosocial interventions, and spiritually integrated treatment to treat it, alcohol dependence has a high relapse rate and poor prognosis, albeit with high interindividual variability. In this review, we discuss the use of two neuromodulation techniques, namely repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), and their advantages and disadvantages compared to first-line pharmacological treatment for alcohol dependence. We also discuss rTMS and DBS targets for alcohol dependence treatment, considering experimental animal and human evidence, with careful consideration of methodological issues preventing the identification of feasible targets for neuromodulation treatments, as well as inter-individual variability factors influencing alcoholism prognosis. Lastly, we anticipate future research aiming to tailor the treatment to each individual patient by combining neurofunctional, neuroanatomical and neurodisruptive techniques optimizing the outcome.

An assessment of contamination of the Fusaro Lagoon (Campania Province, southern Italy) by trace metals.

The Fusaro Lagoon is a shallow lagoon, located in SW Italy, largely influenced in the last decades by several anthropic impacts. The study examined the pollution status of the lagoon, during year 2011-2012 at nine sampling stations with the aim to find out proper measurements of water lagoon restoration. Concentrations of heavy metals (HMs) (aluminium [Al], barium [Ba], cadmium [Cd], copper [Cu], iron [Fe], manganese [Mn], vanadium [V] and zinc [Zn]) were examined in water, sediments and specimens of the ascidian Ciona intestinalis sp. A. Low levels of dissolved oxygen concentration were detected at many stations, with mean values of 5.2-6.4 mg L(-1). The redox potential of surface waters was also low, -2.7 to 50.7 mV. Sediments possessed high organic matter content, 17.7-29.4%. In sediments, the mean Zn level, 251.4 mg kg(-1), was about sixfold higher than that recorded in year 2000 (38.5 mg kg(-1)) and considerably higher than that recorded in 2007 (191 mg kg(-1)). The mean levels of Cd were outstandingly high, with a mean value of 70.5 mg kg(-1), about 30- and 50-fold higher than those determined in 2000 and 2007, respectively. Cadmium (Cd), Cu and nickel (Ni) appeared in excess with respect to most current guidelines, reaching significant pollution levels. C. intestinalis sp. A was detected only at few stations, with metals accumulated preferentially in the body in respect to the tunic, from 1.2 times for Zn (178 mg kg(-1)) to 4.0 times for V (304 mg kg(-1)). Data suggests the necessity of an immediate action of eco-compatible interventions for environmental restoration.

Focusing and imaging with increased numerical apertures through multimode fibers with micro-fabricated optics.

The use of individual multimode optical fibers in endoscopy applications has the potential to provide highly miniaturized and noninvasive probes for microscopy and optical micromanipulation. A few different strategies have been proposed recently, but they all suffer from intrinsically low resolution related to the low numerical aperture of multimode fibers. Here, we show that two-photon polymerization allows for direct fabrication of micro-optics components on the fiber end, resulting in an increase of the numerical aperture to a value that is close to 1. Coupling light into the fiber through a spatial light modulator, we were able to optically scan a submicrometer spot (300 nm FWHM) over an extended region, facing the opposite fiber end. Fluorescence imaging with improved resolution is also demonstrated.

Evaluation of sediment contamination by heavy metals, organochlorinated pesticides, and polycyclic aromatic hydrocarbons in the Berre coastal lagoon (southeast France).

During the last decades, the Berre lagoon, located in southeastern France, has been deeply affected by strong contaminant inputs. Surveys of surface sediment contamination have been sparsely performed since 1964 with data often disconnected with regard to time and space. To contribute to filling this gap, this study examined the pollution status of the lagoon during a 2012 sampling. Concentrations of heavy metals (HMs) (cadmium [Cd], chromium [Cr], copper [Cu], lead [Pb], and zinc [Zn]), organochlorine pesticides (OCPs), and polycyclic aromatic hydrocarbons were examined. The available seawater metal fraction was also investigated. Water from the Vaine basin (VB; stations 1 through 6) exhibited the lowest oxygen concentration (mean O2% saturation 38.9%). HM loads were in the order of Zn > Cr > Pb > Cu > Cd with overall concentration ranges of 0.20-1.40 mg kg(-1) for Cd, 17.1-119 mg kg(-1) for Cr, 7.0-60.7 g(-1) for Cu, 12.0-104 mg kg(-1) for Pb, and 56.5-215 mg kg(-1) for Zn. Although HMs accumulated at levels largely exceeding their relative natural background level of 11-fold for Pb and 80-fold for Zn, their mean concentrations decreased largely to below the acceptable legal limits. HM loads were 20 to threefold the relative corresponding value of the threshold effect level benchmark of potential biological risk. Metals were only scantly released by sediments with mean percentage release of 0.99% for Cd and 40.2% for Cr with a peak for this latter element of 99% in the VB sector. In the case of OCPs, sediments appeared to be significantly polluted, especially in the VB area, with a mean lindane concentration of 0.05 mg kg(-1), which is ≤ fivefold the legal threshold. Among PAHs, benzo[a]pyrene exceeded the permitted limit of 0.1 mg kg(-1) mainly in the VB sector.

Geochemical survey of an illegal waste disposal site under a waste emergency scenario (Northwest Naples, Italy).

Since the mid 1980s, Naples and the Campania region have suffered from the dumping of wastes into overfilled landfills. The aim was to characterise a former cave located in Roccarainola (Naples, Italy) for its eventual destination to a controlled landfill site. A detailed hydro-geochemical survey of the area was carried out through drilling of 14 boreholes and four monitoring wells. Samples of water, sediment and soil were analysed for heavy metals and organic contaminants from a dew pond placed in the middle of the cave. The underneath aquifer was also surveyed. The nature of gases emitted from the site was investigated. Results of the geognostic survey revealed the presence of huge volumes of composite wastes, approximately half a million of cubic metre, which accumulated up to a thickness of 25.6 m. In some points, wastes lie below the free surface level of the aquifer. The sampled material from the boreholes revealed levels of As, Cd, Cr, Cu, Hg, Pb, Sn, Tl and Zn exceeding the intervention legal limits. Outstanding loads of Cd, Pb and Zn were found, with levels exceeding of about 50, 100 and 1,870 times the limit. In several points, polycyclic aromatic hydrocarbon load was extremely high, 35 vs 1 mg kg(-1) of the threshold. The aquifer was also very heavily polluted by Cd, Cr-tot, Cu, Fe, Mn, Ni, Pb and Zn, with impressive high load of Cr and Mn, up to 250-370 times the limits. Hot gases up to 62 °C with presence of xylene and ethylbenzene were found. Results indicated that the site needs an urgent intervention of recovery to avoid compromising the surrounding areas and aquifers of the Campania plain.

Genomic characterization and chromosomal mapping of 5 river buffalo skeletal muscle differentiation master genes.

River buffalo (Bubalus bubalis, 2n = 50, BBU) is a species of economic relevance in a number of countries. This species shows a very peculiar biology and a great capacity for environmental adaptation. There has been an increasing economic interest as well as a growing demand for a more detailed knowledge of molecular features in this species. From this perspective we report a genomic, transcriptional and cytogenetic analysis of 5 master genes involved in skeletal muscle development. Of these 5 genes, MYOD1, MYF5, MYF6 and MYOG belong to the basic helix-loop helix protein family while MSTN belongs to the TNF-B protein family. In mammals, these genes are involved in the early stages of skeletal muscle differentiation, development and regeneration. These pivotal biological functions are finely regulated in a tissue- and temporal-specific manner. We used a comparative genomic approach to obtain the buffalo specific sequences of MYOD1 and MYF6. The nucleotide sequence similarity and the protein domain conservation of the newly obtained sequences are analysed with respect to bovine and other mammalian species showing sequence similarity. The presence of a polymorphism in MYOD1 coding sequence is described and its possible effect discussed. Using a quantitative PCR approach, we compared the level of the 5 transcripts in adult and fetal muscle. These genes were physically localised on river buffalo R-banded chromosomes by FISH using bovine genomic BAC-clones. Here, we present a genomic and cytogenetic analysis which could offer a background to better characterise the buffalo genes involved in muscle function and which may be responsible for buffalo-specific meat features.

Femtosecond laser fabricated monolithic chip for optical trapping and stretching of single cells.

We report on the fabrication by a femtosecond laser of an optofluidic device for optical trapping and stretching of single cells. Versatility and three-dimensional capabilities of this fabrication technology provide straightforward and extremely accurate alignment between the optical and fluidic components. Optical trapping and stretching of single red blood cells are demonstrated, thus proving the effectiveness of the proposed device as a monolithic optical stretcher. Our results pave the way for a new class of optofluidic devices for single cell analysis, in which, taking advantage of the flexibility of femtosecond laser micromachining, it is possible to further integrate sensing and sorting functions.

Superhydrophobic lab-on-chip measures secretome protonation state and provides a personalized risk assessment of sporadic tumour.

Secretome of primary cultures is an accessible source of biological markers compared to more complex and less decipherable mixtures such as serum or plasma. The protonation state (PS) of secretome reflects the metabolism of cells and can be used for cancer early detection. Here, we demonstrate a superhydrophobic organic electrochemical device that measures PS in a drop of secretome derived from liquid biopsies. Using data from the sensor and principal component analysis (PCA), we developed algorithms able to efficiently discriminate tumour patients from non-tumour patients. We then validated the results using mass spectrometry and biochemical analysis of samples. For the 36 patients across three independent cohorts, the method identified tumour patients with high sensitivity and identification as high as 100% (no false positives) with declared subjects at-risk, for sporadic cancer onset, by intermediate values of PS. This assay could impact on cancer risk management, individual's diagnosis and/or help clarify risk in healthy populations.

Dietary pattern and blood pressure control in a hypertension outpatient clinic.

Although it is well known that some dietary measures are able to beneficially affect blood pressure (BP) levels, hypertensive patients find it very difficult to definitively change their nutritional habits. The aim of this study was to evaluate the effects on BP of a return to the habitual diet following a dietary intervention period. Three hundred and seven hypertensive patients (149 females, 158 males) with a mean age of 52+/-12 years were included in the study. All enrolled patients had reported having reverted to their habitual diet after a period of at least 6 months on a prescribed low-energy and/or low-sodium diet. Nutritional habits were investigated by a simple semiquantitative 24-item food-frequency questionnaire. Patients were divided into tertiles according to their systolic BP. The groups differed in regard to their body mass index (27.6+/-4, 28.7+/-4, and 30.4+/-6 kg/m(2), respectively, for the low- to high-systolic BP groups, but were similar in regard to the number of antihypertensive pills taken (2.1+/-0.9, 2.2+/-1.2, 2.2+/-1.3) and metabolic parameters. Patients in the lowest tertile consumed a diet significantly lower in the percentage of energy from saturated fats and sodium content and significantly higher in the percentage of energy from carbohydrate, and the fiber and potassium content in comparison to the highest tertile. The number of servings of legumes, fish and cooked vegetables was higher and that of salami and cheese lower in the 1st tertile. Definitively changing a habitual diet to a healthier one is a difficult task for hypertensive patients. However, those who return to a diet richer in vegetables, legumes and fish and poorer in saturated fat and salt achieve better control of their BP, without increasing the number of antihypertensive pills.

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study.

Aims of this study were to investigate the prevalence of metabolic syndrome (MS), diagnosed according to the International Diabetes Federation (IDF) criteria and its relationship with echocardiographic parameters of cardiac structure and function. The study was performed in 707 subjects, age 45-54 years, of the Gubbio Population Study who underwent a comprehensive examination including measurement of body size, blood pressure (BP) and heart rate, 12-lead electrocardiogram, Doppler echocardiography, standardized blood and urine laboratory tests. One hundred and fifty-three subjects were found to have MS, which was more frequent among hypertensive patients than normotensive controls (36.2 vs 13.7%, P<0.001). Apart from visceral obesity present in all subjects by definition according to the IDF criteria, high levels of BP (>130/85 mm Hg) and triglycerides (>or=150 mg/dl) were the most frequently observed components of the syndrome, since their prevalence averaged 75% of those with the syndrome. Left ventricular mass (95.6+/-22 vs 86.4+/-22 g/m(2); P<0.001) and prevalence of left ventricular hypertrophy were increased in the subgroup with MS. Waist circumference, BP and blood glucose were the components of the syndrome with stronger impact on cardiac mass. An early impairment of the diastolic function was detected in this subgroup with a reduction of the early-to-late diastolic filling (0.91+/-0.17 vs 0.99+/-0.23, P<0.001). The results of the present study indicate that MS is frequent in middle-aged general population, particularly in subjects with arterial hypertension. The syndrome is associated to the increase in ventricular mass and the early impairment of diastolic function.

Improvement of cardiovascular risk profile in an elderly population of low social level: the ICON (Improving Cardiovascular risk profile in Older Neapolitans) study.

Older age and low socio-economic conditions are associated with poor control of cardiovascular risk factors (RFs). We assessed the prevalence and awareness of cardiovascular RFs in 503 elderly outpatients of low social status attending two public Internal Medicine clinics in Naples, and studied the interaction of education and employment level with risk profile. The therapeutic intervention was oriented to improve patients' motivation through a positive patient-physician relationship, in keeping with the current guidelines for hypertension. The effect of treatment was evaluated by comparing retrospectively the level of cardiovascular RFs at baseline and at the last follow-up examination performed within 31 October 2005. Only 33.3% of patients (age=68+/-6 years) had attended primary school. Overall (current or previous) employment level was also low. Obesity, hypertension and dyslipidaemia were present in most patients, diabetes in 17.3% of them. In all 8.0% of hypertensives, 16.1% of diabetics and 24.7% of dyslipidaemiacs were unaware of their diseases. Cardiovascular risk profile was worse at lower educational and employment levels. Odds ratios for the metabolic syndrome were 0.28 (95% confidence interval (CI)=0.15-0.52) and 0.35 (0.20-0.62) in the most qualified of three education and employment groups, respectively, compared to the lowest ones. The level of all cardiovascular RFs was effectively reduced during treatment. Control rate of most RFs improved significantly (for hypertension, from 12.8 to 36.5%, P<0.001). These patients had a high prevalence of cardiovascular RFs, which correlated with their educational and work activity levels. Awareness of their health status was unsatisfactory. Treatment, specifically addressing patient-physician relationship, favourably affected cardiovascular risk profile.