The true cost of cardiovascular imaging: focusing on downstream, indirect, and environmental costs.

To develop a more realistic assessment of costs, herein named "true" costs, the extra-cancer from medical radiation, environmental damage from imaging paraphernalia and radioactive wastes must be included as long-term costs from imaging examinations. It is urgent to define the "true" costs across imaging modalities as it interferes on physicians' decision to request an exam and on research projects such as cost-effectiveness analysis. Cardiology is the specialty that most will benefit from the outcome as cardiovascular exams represent almost 30% of the total exams acquired annually worldwide.

A postural program to reduce dynamic knee valgus during single-limb squatting in young athletes: a preliminary study.

BACKGROUND: Dynamic knee valgus (DKV) is an undesirable multi-joint movement pattern associated with anterior cruciate ligament injury and patellofemoral pain syndrome, especially in sport activities. We assessed DKV in young athletes who followed a postural program to reduce a posterior rigidity mostly attributable to the tightness of hamstring muscles. METHODS: We considered 12- to 18-year-old athletes that followed a six-week program simply based on hamstring stretching and abdominal muscle activation/strengthening. DKV was assessed during a single-limb squat and the frontal plane projection angle (FPPA) between the femur and tibia was considered. RESULTS: Sixty-six athletes with a significant DKV (FPPA≥10°) were identified. Twenty-one subjects exhibited the considered rigidity profile and completed the intervention program. The mean reduction of the FPPA after the intervention was 8.1±7.9°, significantly asymmetric by about 3° (P<0.005) and skewed towards larger negative differences. The average change from the initial condition of -37±25% was statistically significant (P=1.7 x10-6). CONCLUSIONS: This preliminary result suggests that working on enhancing posterior muscle chain flexibility could be effective in reducing DKV in young athletes with a marked tightness of hamstring muscles. Moreover, this simple postural program can be a candidate for inclusion in sport training as a protective strategy against knee injuries.

Predictive Added Value of Selected Plasma Lipids to a Re-estimated Minimal Risk Tool.

Background: Lipidomics is emerging for biomarker discovery in cardiovascular disease, and circulating lipids are increasingly incorporated in risk models to predict cardiovascular events. Moreover, specific classes of lipids, such as sphingomyelins, ceramides, and triglycerides, have been related to coronary artery disease (CAD) severity and plaque characteristics. To avoid unnecessary testing, it is important to identify individuals at low CAD risk. The only pretest model available so far to rule out the presence of coronary atherosclerosis in patients with chest pain, but normal coronary arteries, is the minimal risk tool (MRT). Aim: Using state-of-the-art statistical methods, we aim to verify the additive predictive value of a set of lipids, derived from targeted plasma lipidomics of suspected CAD patients, to a re-estimated version of the MRT for ruling out the presence of coronary atherosclerosis assessed by coronary CT angiography (CCTA). Methods: Two hundred and fifty-six subjects with suspected stable CAD recruited from five European countries within H2020-SMARTool, undergoing CCTA and blood sampling for clinical biochemistry and lipidomics, were selected. The MRT was validated by regression methods and then re-estimated (reMRT). The reMRT was used as a baseline model in a likelihood ratio test approach to assess the added predictive value of each lipid from 13 among ceramides, triglycerides, and sphingomyelins. Except for one lipid, the analysis was carried out on more than 240 subjects for each lipid. A sensitivity analysis was carried out by considering two alternative models developed on the cohort as baseline models. Results: In 205 subjects, coronary atherosclerosis ranged from minimal lesions to overt obstructive CAD, while in 51 subjects (19.9%) the coronary arteries were intact. Four triglycerides and seven sphingomyelins were significantly (p < 0.05) and differentially expressed in the two groups and, at a lesser extent, one ceramide (p = 0.067). The probability of being at minimal risk was significantly better estimated by adding either Cer(d18:1/16:0) (p = 0.01), SM(40:2) (p = 0.04), or SM(41:1) at a lesser extent (p = 0.052) to reMRT than by applying the reMRT alone. The sensitivity analysis confirmed the relevance of these lipids. Furthermore, the addition of SM(34:1), SM(38:2), SM(41:2), and SM(42:4) improved the predictive performance of at least one of the other baseline models. None of the selected triglycerides was found to provide an added value. Conclusions: Plasma lipidomics can be a promising source of diagnostic and prognostic biomarkers in cardiovascular disease, exploitable not only to assess the risk of adverse events but also to identify subjects without coronary atherosclerosis, thus reducing unnecessary further testing in normal subjects.

The influence of lifestyle factors on miRNA expression and signal pathways: a review.

The term 'lifestyle' includes different factors that contribute to the maintenance of a good health status. Increasing evidences suggest that lifestyle factors may influence epigenetic mechanisms, such as miRNAs expression. The dysregulation of miRNAs can modify the expression of genes and molecular pathways that may lead to functional alterations. This review summarizes human studies highlighting that diet, physical activity, smoking and alcohol consumption may affect the miRNA machinery and several biological functions. Most miRNAs are involved in molecular pathways that influence inflammation, cell cycle regulation and carcinogenesis resulting in the onset or progression of pathological conditions. Investigating these interactions will be pivotal for understanding the etiology of pathologic processes, the potential new treatment strategies and for preventing diseases.