Efficacy and safety of glucagon-like peptide-1 agonists on macrovascular and microvascular events in type 2 diabetes mellitus: A meta-analysis.

AIMS: Glucagon-like peptide-1 (GLP-1) agonists improve glycaemic control in type 2 diabetes mellitus (DM). Outcome trials investigating macro and microvascular effects of GLP-1 agonists reported conflicting results. The aim of this study was to assess, in a meta-analysis, the effects of GLP-1 agonists on mortality, major nonfatal cardiovascular (CV) events, renal and retinal events. DATA SYNTHESIS: MEDLINE, Cochrane, ISI Web of Science, SCOPUS and ClinicalTrial.gov databases were searched for articles published until June 2017. Randomized trials enrolling more than 200 patients, comparing GLP-1 versus placebo or active treatments in patients with DM, and assessing outcomes among all-cause death, CV death, MI, stroke, HF, diabetic retinopathy and nephropathy were included. 77 randomized trials enrolling 60,434 patients were included. Compared to control, treatment with GLP-1 significantly reduced the risk of all-cause death (RR: 0.888; CI: 0.804-0.979; p = 0.018) and the risk of CV death (RR: 0.858; CI: 0.757-0.973; p = 0.017). GLP-1 agonists did not affect the risk of MI (RR: 0.917; CI: 0.830-1.014; p = 0.092) as well as the risk of stroke (RR: 0.882; CI: 0.759-1.023; p = 0.097), HF (RR: 0.967; CI: 0.803-1.165; p = 0.725), retinopathy (RR: 1.000; CI: 0.807-1.238; p = 0.997) and nephropathy (RR: 0.866; CI: 0.625-1.199; p = 0.385). CONCLUSIONS: Treatment with GLP-1 agonists in DM patients is associated with a significant reduction of all cause and CV mortality.

Vitamin D deficiency and clinical outcome in patients with chronic heart failure: A review.

AIM: The aim of this review was to summarize evidence on the role of Vitamin D deficiency in heart failure (HF), from pathophysiological mechanisms to clinical effects of Vitamin D supplementation. DATA SYNTHESIS: Chronic HF secondary to left ventricular (LV) systolic dysfunction is a growing health problem, still associated with poor clinical outcome. In recent years, experimental and epidemiological evidence focused on the role of Vitamin D in HF. Cross sectional studies demonstrated that prevalence of HF is increased in patients with Vitamin D deficiency or parathyroid hormone (PTH) plasma level increase, whereas longitudinal studies showed enhanced risk of developing new HF in patients with Vitamin D deficiency. In addition, in patients with established HF, low plasma levels of Vitamin D are associated with worsening clinical outcome. Yet, clinical studies did not definitively demonstrate a benefit of Vitamin D supplementation for preventing HF or ameliorating clinical outcome in patients with established HF. CONCLUSIONS: Despite convincing experimental and epidemiological data, treatment with Vitamin D supplementation did not show clear evidence of benefit for preventing HF or influencing its clinical course. Ongoing clinical studies will hopefully shed lights on the effects of Vitamin D supplementation on clinical endpoints along the spectrum of HF.

[VAP and oral hygiene.A systematic review].

Ventilator associated pneumonia (VAP) is a common nosocomial infection in intensive care units. International literature showed how the use of professional oral hygiene protocols provide an essential support in VAP prevention. The aim of this study is to provide a systematic and narrative updated review, to further demonstrate that a proper protocol of oral hygiene, in special needs patients, can reduce risk of developing VAP. In this study were analyzed 10 narrative and 3 systematic reviews. Systematic reviews were evaluated with AMSTAR checklist, INSA tool was used to analyze narrative reviews. The findings of this study suggest that the use of antimicrobials combined with tooth brushing can actively contribute to reducing the incidence of VAP.

Interoperable atlases of the human brain.

The last two decades have seen an unprecedented development of human brain mapping approaches at various spatial and temporal scales. Together, these have provided a large fundus of information on many different aspects of the human brain including micro- and macrostructural segregation, regional specialization of function, connectivity, and temporal dynamics. Atlases are central in order to integrate such diverse information in a topographically meaningful way. It is noteworthy, that the brain mapping field has been developed along several major lines such as structure vs. function, postmortem vs. in vivo, individual features of the brain vs. population-based aspects, or slow vs. fast dynamics. In order to understand human brain organization, however, it seems inevitable that these different lines are integrated and combined into a multimodal human brain model. To this aim, we held a workshop to determine the constraints of a multi-modal human brain model that are needed to enable (i) an integration of different spatial and temporal scales and data modalities into a common reference system, and (ii) efficient data exchange and analysis. As detailed in this report, to arrive at fully interoperable atlases of the human brain will still require much work at the frontiers of data acquisition, analysis, and representation. Among them, the latter may provide the most challenging task, in particular when it comes to representing features of vastly different scales of space, time and abstraction. The potential benefits of such endeavor, however, clearly outweigh the problems, as only such kind of multi-modal human brain atlas may provide a starting point from which the complex relationships between structure, function, and connectivity may be explored.

Imaging haemodynamic changes related to seizures: comparison of EEG-based general linear model, independent component analysis of fMRI and intracranial EEG.

BACKGROUND: Simultaneous EEG-fMRI can reveal haemodynamic changes associated with epileptic activity which may contribute to understanding seizure onset and propagation. METHODS: Nine of 83 patients with focal epilepsy undergoing pre-surgical evaluation had seizures during EEG-fMRI and analysed using three approaches, two based on the general linear model (GLM) and one using independent component analysis (ICA): The results were compared with intracranial EEG. RESULTS: The canonical GLM analysis revealed significant BOLD signal changes associated with seizures on EEG in 7/9 patients, concordant with the seizure onset zone in 4/7. The Fourier GLM analysis revealed changes in BOLD signal corresponding with the results of the canonical analysis in two patients. ICA revealed components spatially concordant with the seizure onset zone in all patients (8/9 confirmed by intracranial EEG). CONCLUSION: Ictal EEG-fMRI visualises plausible seizure related haemodynamic changes. The GLM approach to analysing EEG-fMRI data reveals localised BOLD changes concordant with the ictal onset zone when scalp EEG reflects seizure onset. ICA provides additional information when scalp EEG does not accurately reflect seizures and may give insight into ictal haemodynamics.

Independent component analysis of interictal fMRI in focal epilepsy: comparison with general linear model-based EEG-correlated fMRI.

The general linear model (GLM) has been used to analyze simultaneous EEG-fMRI to reveal BOLD changes linked to interictal epileptic discharges (IED) identified on scalp EEG. This approach is ineffective when IED are not evident in the EEG. Data-driven fMRI analysis techniques that do not require an EEG derived model may offer a solution in these circumstances. We compared the findings of independent components analysis (ICA) and EEG-based GLM analyses of fMRI data from eight patients with focal epilepsy. Spatial ICA was used to extract independent components (IC) which were automatically classified as either BOLD-related, motion artefacts, EPI-susceptibility artefacts, large blood vessels, noise at high spatial or temporal frequency. The classifier reduced the number of candidate IC by 78%, with an average of 16 BOLD-related IC. Concordance between the ICA and GLM-derived results was assessed based on spatio-temporal criteria. In each patient, one of the IC satisfied the criteria to correspond to IED-based GLM result. The remaining IC were consistent with BOLD patterns of spontaneous brain activity and may include epileptic activity that was not evident on the scalp EEG. In conclusion, ICA of fMRI is capable of revealing areas of epileptic activity in patients with focal epilepsy and may be useful for the analysis of EEG-fMRI data in which abnormalities are not apparent on scalp EEG.

[Biliary scintigraphy vs. ultrasonography in the etiological diagnosis of acute pancreatitis]. / Biliscintigraphie contre échographie dans le diagnostic étiologique de la pancréatite aiguë.

Etiology of acute pancreatitis has important implications in the treatment of the disease as gallstones pancreatitis requires the correction of the underlying biliary disease. The usefulness of ultrasonography in the detection of stones in emergency has been questioned, and HIDA biliscintigraphy has been reported to be a possible indicator of biliary pancreatitis. This study compares the value of HIDA colesscintigraphy and ultrasonography in the etiologic diagnosis of 35 patients admitted and treated for acute pancreatitis in our Institution. All patients underwent ERCP for the confirmation of the findings. Cholescintigraphy showed no visualisation of the gallbladder, suggesting biliary tract stones, in 25 patients. In all of them ERCP confirmed the presence of gallbladder and/or common bile duct stones, and endoscopic sphincterotomy and later elective cholescystectomy was performed. Ultrasonography failed to demonstrate biliary stones in 11 of those patients. HIDA cholescintigraphy showed a sensitivity and a negative predictive value of 1 vs 0.56 and 0.45 for ultrasonography. From the results of our study it can be concluded that HIDA biliscintigraphy is more reliable than ultrasonography in the discrimination of biliary vs non-biliary acute pancreatitis in emergency.

Coordination and spin state equilibria as a function of pH, ionic strength, and protein concentration in oxidized dimeric Scapharca inaequivalvis hemoglobin.

The oxidized homodimeric Scapharca inaequivalvis hemoglobin undergoes changes in coordination and spin state as a function of pH, ionic strength, and protein concentration which have been monitored by optical absorption spectroscopy. Three species contribute to the spectra between pH 5.8 and 8.7: (i) a hexacoordinate high spin aquomet derivative, whose concentration is essentially constant over the whole pH range analyzed; (ii) a pentacoordinate high spin component which prevails at alkaline pH values, and (iii) a hexacoordinate low spin hemichrome, which is formed at acid pH. The contribution of each of the components to the observed spectra was calculated with the singular value decomposition procedure and has been described quantitatively in terms of a linkage scheme which accounts for the change in heme coordination and for the observation that the high spin to low spin transition entails dissociation into monomers. An important feature of the linkage scheme is the cooperative binding of protons to aquomet dimers. Stopped flow experiments to study the kinetics indicate that dissociation into monomers is the rate-limiting process. The unusually strong tendency of oxidized HbI to loose the heme-bound water molecule is discussed in terms of strain in the iron-proximal histidine bond.

[L-T4 malabsorption determined by intolerance to cow's milk proteins and celiac disease in a patient with congenital hypothyroidism. A clinical case]. / Malassorbimento di L-t4 determinato da intolleranza alle proteine del latte vaccino e malattia celiaca in paziente affetto da ipotiroidismo congenito. Caso clinico.

An infant with congenital hypothyroidism (CH) is described who in the course of thyroxin replacement therapy developed cow's milk protein intolerance (CMPI) and subsequently coeliac disease (CD). The presence of these two pathologies interfered with the intestinal absorption of L-thyroxin (L-T4) and made the appropriate management of CH difficult. A male patient, formula fed from birth, was screened for CH at 5 days of age. CH was confirmed and L-T4 treatment (6.8 micrograms/kg/day per os) begun at 35 days of age. Seen after 3 weeks because of feeding problems and impaired growth and with a serum T4 concentration of 4.7 micrograms/dl and a TSH of 56 mU/ml, his replacement dose was increased to 12 micrograms/kg/day. One week later, the child was hospitalized because of vomiting, acidosis and shock. CMPI was diagnosed and the child began a diet with a hydrolyzed milk protein food. After 7 weeks the serum T4 improved to 11 micrograms/dl, the TSH decreased to 10 mU/ml, while maintaining the 12 micrograms/kg dose. After 2 months an oral challenge with cow's milk confirmed the diagnosis of CMPI with a concomitant decrease in serum T4 to 6.4 micrograms/dl, while TSH rose to 64 mU/ml. Weight and T4 levels normalised with CMPI diet. At 12 months of age the patient presented anorexia and impaired growth.(ABSTRACT TRUNCATED AT 250 WORDS)

[Erythrocyte deformability in subjects with microangiopathy caused by vibrating tools]. / La deformabilità eritrocitaria in soggetti affetti da microangiopatia da strumenti vibranti.

A research on hemorheological and microvascular behavior with regard to the red blood cell filterability determined by the Teitel-Reid-Dormandy technique has been performed on 15 subjects with microangiopathy due to vibrating tools, who were hospitalized at the Work Medicine Institute of the 2nd Medical Faculty of Naples University. The results pointed out an increase of filtration times and a consequent decrease of blood flow, as opposed to the control group. As a conclusion of the research, the authors were in the opinion that in the vibrating tool syndrome, in addition to the hemodynamic elements, the hemorheological components of the microcirculation should also be primarily evaluated alongside red blood cell filterability.

[Combined instrumental evaluation of microangiopathy caused by vibrating tools]. / Valutazione strumentale combinata nella microangiopatia da strumenti vibranti.

A clinico-instrumental study has been carried out on 15 subjects who had been hospitalized for microangiopathy due to vibrating tools at the Work Medicine Institute of the 2nd Medical Faculty of Naples University. Various instrumental methods (in vivo nailbed microscopy, conjunctival biomicroscopy, finger photoplethysmography, hand-contact thermography) were employed. As a conclusion of the research and from the obtained results it is assumed that the evaluation of the various methods, as far as the microangiopathy due to vibrating tools is concerned, should be performed in a critical and exhaustive way. However, the in vivo nailbed microscopy integrated by conjunctival biomicroscopy seems to represent the most sensitive indicator of microcirculatory disorders in differentiating conditions of general microvascular pathology and for a more precise diagnosis and appropriate therapy.

[Effects of pentobarbital on serum levels of LH and FSH, in normal conditions and after GnRH stimulation: preliminary report]. / Effetti del pentobarbital sui livelli sierici di LH ed FSH, nell'uomo, in condizioni basali e dopo stimolo con GnRH: nota preliminare.

The authors have tested serum levels of LH and FSH in healthy males anaesthetized with 20 mg/Kg body weight of pentobarbital, and stimulation test with GnRH. LH has reached levels higher than the stimulation test has been practised in the anaesthetized volunteers than in subjects awakes. The AA. have also showed that there is no effect on psychic stress and of atropine, used as preanaesthetic drug, on serum levels of the pituitary hormones. At the end, PB has no effect on serum levels of FSH.

[Inhibitory effects of atropine on serum prolactin levels after TRH stimulation]. / Effetto inibente dell'atropina sui livelli sierici di prolattina dopo stimolo con TRH.

The authors have tested serum levels of PRL after administration of atropine 10' and 60' before stimulation test with TRH, in 12 male and 12 female. The administration of the drug 10' before TRH has inhibited the PRL release, in all the groups. No effect presented atropine if administered 60' before TRH test.