Biophysical integrated approach for the management of early stages of CKD in elderly patients: a 12-month controlled study.

BACKGROUND: Chronic Kidney Disease (CKD) and its clinical evolution are an emerging issue, due to an increasingly aging population. Consequently, the evaluation of integrative strategies to manage the decline in renal function is warranted. The previous evidence indicates that a biophysical integrated approach can significantly improve renal function. Nevertheless, controlled trials assessing the clinical efficacy of this strategy are still needed. METHODS: A 12-month controlled study was designed to assess the clinical outcome of a group of elderly patients affected by stage II/IIIa CKD randomly assigned to either control or biophysical treatment. In addition to the standard treatment with renin-angiotensin-aldosterone system inhibitors, the biophysical group underwent electromagnetic information transfer through aqueous system procedure every 3 months. Estimated glomerular filtration rate (eGFR), according to CKD-epidemiology collaboration formula, was calculated at baseline and every 3 months. RESULTS: A total of 238 patients were included in the study, 118 (73.9 ± 3.8 years) in the biophysical therapy group and 120 (74.6 ± 4.2 years) in the control group. At baseline, mean eGFR was 69 ± 11.8 ml/min in the biophysical group and 70.7 ± 11.5 ml/min in the control group. After 1 year, eGFR was 74.1 ± 12.3 ml/min in the biophysical group, compared to 66.3 ± 11.9 ml/min in the control group, with a statistically significant difference between groups (p < 0.0001). The observed improvement in eGFR in the biophysical group was independent of age, gender, and antihypertensive treatment. CONCLUSION: This study shows a potential contribution of a biophysical integrated strategy to support renal function against its natural decline in the elderly, warranting further clinical evaluation.

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study.

BACKGROUND: Lung ultrasonography (LUS) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a standard workup in differentiating ADHF from noncardiogenic dyspnea in the ED. METHODS: We conducted a multicenter, prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after (1) the initial clinical assessment and (2) after performing LUS ("LUS-implemented" diagnosis). All patients also underwent chest radiography. After discharge, the cause of each patient's dyspnea was determined by independent review of the entire medical record. The diagnostic accuracy of the different approaches was then compared. RESULTS: The study enrolled 1,005 patients. The LUS-implemented approach had a significantly higher accuracy (sensitivity, 97% [95% CI, 95%-98.3%]; specificity, 97.4% [95% CI, 95.7%-98.6%]) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup (sensitivity, 85.3% [95% CI, 81.8%-88.4%]; specificity, 90% [95% CI, 87.2%-92.4%]), chest radiography alone (sensitivity, 69.5% [95% CI, 65.1%-73.7%]; specificity, 82.1% [95% CI, 78.6%-85.2%]), and natriuretic peptides (sensitivity, 85% [95% CI, 80.3%-89%]; specificity, 61.7% [95% CI, 54.6%-68.3%]; n = 486). Net reclassification index of the LUS-implemented approach compared with standard workup was 19.1%. CONCLUSIONS: The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED. TRIAL REGISTRY: Clinicaltrials.gov; No.: NCT01287429; URL: www.clinicaltrials.gov.

Intra-plaque production of platelet-activating factor correlates with neoangiogenesis in human carotid atherosclerotic lesions.

Platelet-activating factor (PAF) is a phospholipid mediator synthesized by activated inflammatory and endothelial cells. Recently PAF has been shown to contribute to neoangiogenesis in several experimental models. Here we evaluated the presence of PAF and its potential role in neovascularization within human atherosclerotic plaques. The amount of PAF extracted from 18 carotid plaques (266.65+/-40.07 pg/100 mg dry tissue; mean +/- SE) was significantly higher than that extracted from 18 normal arterial specimens (6 from carotid artery and 12 from aorta) (4.72+/-2.31 pg/100 mg dry tissue; mean +/- SE). The levels of PAF significantly correlated with the infiltration of CD68-positive monocytes and the extent of neovascularization, detected as von Willebrand Factor-positive cells. The amount of PAF also correlated with the area occupied by TNF-alpha-expressing cells. The absence of enhanced level of PAF in the circulation of atherosclerotic patients suggests a local production of this mediator within the plaque. The lipid extracts of atherosclerotic plaques containing high levels of PAF-bioactivity, but not those of control arteries, were angiogenic in a murine Matrigel model. WEB 2170, a specific PAF receptor antagonist, significantly prevented angiogenesis induced by the lipid extracts of atherosclerotic plaques. Our results indicate a local production of PAF within the atherosclerotic plaques and suggest that it may contribute to intra-plaque neoangiogenesis.