[Giant tricuspid annular calcification and kyphoscoliosis: is there a link?] / Calcificazione gigante dell'anulus tricuspidale e cifoscoliosi: esiste un collegamento?

Although mitral annular calcification is a common degenerative condition of the fibrous mitral annulus, tricuspid annular calcification, especially isolated, is rare. We report the case of a 73-year-old male, with a history of hypertension and severe kyphoscoliosis, referred to the emergency department for progressive dyspnea and leg swelling. Echocardiography revealed a dilated right heart with a homogeneous, hyperechoic, crescent shaped mass along the tricuspid annulus. Computed tomography confirmed the calcific nature of the lesion. Right heart catheterization revealed mild pre-capillary pulmonary hypertension and a mild spirometrically-defined restrictive ventilatory defect. Kyphoscoliosis has recently been associated with alterations in cardiac deformation and with an increased risk of restrictive lung disease. In our patient, we hypothesized that both these anomalies could have led to premature tricuspid annular degeneration resulting in a giant tricuspid calcification.

Rationale and design of the Biventricular Evaluation of Gliflozins effects In chroNic Heart Failure: BEGIN-HF study.

AIMS: Sodium-glucose cotransporter type 2 inhibitors (SGLT-2i) represent a unique class of anti-hyperglycaemic agents for type 2 diabetes mellitus that selectively inhibit renal glucose reabsorption, thereby increasing urinary excretion of glucose. Several studies have demonstrated the cardioprotective effects of SGLT-2i in patients with heart failure (HF), unrelated to its glucosuric effect. It is unclear whether the benefits of SGLT-2i therapy also rely on the improvement of left ventricular (LV) and/or right ventricular (RV) function in patients with HF. This study aimed to evaluate the effect of SGLT-2i on LV and RV function through conventional and advanced echocardiographic parameters with a special focus on RV function in patients with HF. METHODS AND RESULTS: The Biventricular Evaluation of Gliflozins effects In chroNic Heart Failure (BEGIN-HF) study is an international multicentre, prospective study that will evaluate the effect of SGLT-2i on echocardiographic parameters of myocardial function in patients with chronic stable HF across the left ventricular ejection fraction (LVEF) spectrum. Patients with New York Heart Association Class II/III symptoms, estimated glomerular filtration rate > 25 mL/min/1.73 m2 , age > 18 years, and those who were not previously treated with SGLT-2i will be included. All patients will undergo conventional, tissue-derived imaging (TDI), and strain echocardiography in an ambulatory setting, at time of enrolment and after 6 months of SGLT-2i therapy. The primary endpoint is the change in LV function as assessed by conventional, TDI, and myocardial deformation speckle tracking parameters. Secondary outcomes include changes in RV and left atrial function as assessed by conventional and deformation speckle tracking echocardiography. Univariate and multivariate analyses will be performed to identify predictors associated with primary and secondary endpoints. CONCLUSIONS: The BEGIN-HF will determine whether SGLT-2i therapy improves LV and/or RV function by conventional and advanced echocardiography in patients with HF irrespective of LVEF.

Pharmacological Anti-Remodelling Effects of Disease-Modifying Drugs in Heart Failure with Reduced Ejection Fraction.

Cardiac remodelling is an adverse phenomenon linked to heart failure progression and an important contributor to heart failure severity. Cardiac remodelling could represent the real therapeutic goal in the treatment of patients with heart failure with reduced ejection fraction, being potentially reversed through different pharmacotherapies. Currently, there are well-established drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and ß-blockers with anti-remodelling effects; recently, angiotensin receptor neprilysin inhibitor effects on inhibiting cardiac remodelling (improving N-terminal pro-B-type natriuretic peptide levels, echocardiographic parameters of reverse cardiac remodelling and right ventricular function in patients with heart failure with reduced ejection fraction) were demonstrated. More recently, hemodynamic consequences of gliflozins, reduced cardiac hydrostatic pressure as a possible cause of ventricular remodelling and hypertrophy were proposed to explain potential anti-remodelling effects of gliflozins. Gliflozins exert their cardioprotective effects by attenuating myofibroblast activity and collagen-mediated remodelling. Another postulated mechanism is represented by the reduction in sympathetic activity, through the reduction in renal afferent nervous activity and the suppression of central reflex mechanisms. Benefits of gliflozins on left ventricular hypertrophy, dilation, and systolic and diastolic function were also described. In this review, we aimed to provide a wide overview on cardiac remodelling with a particular focus on possible anti-remodelling effects of angiotensin receptor neprilysin inhibitors and gliflozins.

Liver disease and heart failure.

INTRODUCTION: Several systemic conditions, inflammatory disease, infections and alcoholism, may affect both the heart and the liver. Common conditions, such as the non-alcoholic fatty liver disease (NAFLD), may increase the risk of cardiac dysfunction. Patients with acute decompensated HF (ADHF) may develop acute ischemic hepatitis and, chronic HF patients may develop congestive hepatopathy (CH). EVIDENCE ACQUISITION: Laboratory anomalies of hepatic function may predict the outcome of patients with advanced HF and the evaluation of both cardiac and hepatic function is very important in the management of these patients. In clinically apparent ischemic hepatitis more than 90% of patients have some right-sided HF. There are systemic disorders characterized by the accumulation of metals or by metabolism defects that may affect primarily the liver but also the heart leading to symptomatic hypertrophic cardiomyopathy (HCM). EVIDENCE SYNTHESIS: Abnormal LFTs indicate the mechanism of liver injury: liver congestion or liver ischemia. In AHF, it's important an adequate evaluation of heart and liver function in order to choose the treatment in order to ensure stable hemodynamic as well as optimal liver function. CONCLUSIONS: Measurements of LFTs should be recommended in the early phase of ADHF management. Physicians with interest in HF should be trained in the evaluation of LFTs. It's very important for cardiologists to know the systemic diseases affecting both heart and liver and the first imaging or laboratory findings useful for a diagnosis. it is very important for internists, nephrologists, cardiologists, primary physicians and any physicians with interest in treating HF to recognize such signs and symptoms belong to rare diseases and liver diseases that could be mistaken for HF.

Targeted metabolomics in the expanded newborn screening for inborn errors of metabolism.

Inborn errors of metabolism are genetic disorders due to impaired activity of enzymes, transporters, or cofactors resulting in accumulation of abnormal metabolites proximal to the metabolic block, lack of essential products or accumulation of by-products. Many of these disorders have serious clinical consequences for affected neonates, and an early diagnosis allows presymptomatic treatment which can prevent severe permanent sequelae and in some cases death. Expanded newborn screening for these diseases is a promising field of targeted metabolomics. Here we report the application, between 2007 and 2014, of this approach to the identification of newborns in southern Italy at risk of developing a potentially fatal disease. The analysis of amino acids and acylcarnitines in dried blood spots by tandem mass spectrometry revealed 24 affected newborns among 45,466 infants evaluated between 48 and 72 hours of life (overall incidence: 1 : 1894). Diagnoses of newborns with elevated metabolites were confirmed by gas chromatography-mass spectrometry, biochemical studies, and genetic analysis. Five infants were diagnosed with medium-chain acyl CoA dehydrogenase deficiency, 1 with methylmalonic acidemia with homocystinuria type CblC, 2 with isolated methylmalonic acidemia, 1 with propionic acidemia, 1 with isovaleric academia, 1 with isobutyryl-CoA dehydrogenase deficiency, 1 with beta ketothiolase deficiency, 1 with short branched chain amino acid deficiency, 1 with 3-methlycrotonyl-CoA carboxylase deficiency, 1 with formimino-transferase cyclodeaminase deficiency, and 1 with cystathionine-beta-synthase deficiency. Seven cases of maternal vitamin B12 deficiency and 1 case of maternal carnitine uptake deficiency were detected. This study supports the widespread application of metabolomic-based newborn screening for these genetic diseases.

Artificial neural network modelling of retention of pesticides in various octadecylsiloxane-bonded reversed-phase columns and water-acetonitrile mobile phase.

Previously, retention of 26 pesticides in the reversed-phase column Gemini (Phenomenex) and water-acetonitrile mobile phase was modelled using a feed-forward artificial neural network (ANN) learned by error back-propagation, accounting for both the effect of solute structure and mobile phase composition. To this end, logK(ow) of solutes and four quantum chemical molecular descriptors (the dipole moment, the mean polarizability, the anisotropy of the polarizability and an hydrogen-bonding descriptor based on the atomic charges located on the acid and basic functional groups) and acetonitrile % (v/v) in the eluent (%ACN) were used as ANN inputs. The above ANN-based approach is here tested on further five similar octadecylsiloxane-bonded columns in water-acetonitrile mobile phase within the %ACN range 30-70%. A quite good predictive performance evaluated on three external solutes in the whole %ACN range is observed, prediction errors being lower than +/-0.1 log k units or slightly higher although still within +/-0.15 log k units. On the other hand, multilinear regression used in place of ANN provides a more diffuse and non-uniform residual distribution for all the investigated columns. ANN multiple-column retention prediction is attempted by adding to the above variables a column descriptor defined as the average retention of calibration solutes extrapolated to 100% water. This more general model is built using 16 solutes and five 5-microm columns in calibration, while its predictive performance is tested on the remaining 10 compounds. Under these conditions, prediction errors are generally within +/-0.2 log k units regardless of the kind of column. The possibility of cross-column prediction is evaluated by column leave-one-out cross-validation within the five 5-microm stationary phases and on a 4-microm external column. This analysis reveals that accuracy of retention prediction for unknown solutes in unknown columns is acceptable provided that the external column is not very dissimilar to those used in calibration.

Quantitative structure-retention relationships of pesticides in reversed-phase high-performance liquid chromatography based on WHIM and GETAWAY molecular descriptors.

The ability of the Weighted Holistic Invariant Molecular (WHIM) and GEometry, Topology, and Atom-Weights AssemblY (GETAWAY) descriptors to represent the effect of molecular structure on the retention of pesticides in reversed-phase high-performance liquid chromatography (RP-HPLC) is investigated. To this end, two retention data sets previously collected in water-acetonitrile mobile phase are re-examined. The first data set (data-set-1) consists of retention data of 26 neutral compounds belonging to widely used pesticide classes, collected within the mobile phase composition range 40-65% (v/v) acetonitrile. The second data set (data-set-2) describes retention of phenoxy acid herbicides and structurally related compounds (benzoic acid and phenylacetic acid derivatives), as a whole covering the pK(a) range 2.3-4.3, as a function of mobile phase composition, ranging between 30 and 70% (v/v) acetonitrile, and pH, ranging between 2 and 5. For each data set, the mobile phase attributes are combined with WHIM or GETAWAY descriptors into "mixed" predictive models in order to attempt retention modelling within the whole mobile phase composition range of analytical interest. Six- or seven-dimensional multilinear models, preliminarily selected using a genetic algorithm, were improved using a multi-layer artificial neural network (ANN) learned by back propagation. ANN performance was tested on three molecules not used in the learning stage and by leave-more-out cross validation. The results reveal that while WHIM descriptors seem not adequate to model retention of solutes of data-set-1, GETAWAY descriptors provide a satisfactory retention model. On the other hand WHIM and GETAWAY descriptors applied to data-set-2 provide a similar performance, even if slightly worse as compared with the above case. Accuracy of retention modelling in these cases is comparable or slightly poorer as compared with the results previously obtained by combining quantum chemical descriptors or usual physico-chemical solute properties (log k(ow) and pK(a)) and mobile phase attributes.

A multi-lysimeter investigation on the mobility and persistence of pesticides in the loam soil of the Fucino Plain (Italy).

In order to evaluate the impact of intensive horticulture on the water resources of the Fucino Plain, one of the most important agricultural settlements of Central Italy, the mobility and persistence in the soil of five commonly used pesticides was investigated by means of multi-lysimeter experiments. The fate of simazine, carbaryl, dicloran, linuron and procymidone was evaluated in the laboratory under experimental conditions simulating as closely as possible both pesticide application and irrigation practices required by the local crops. An efficient extraction procedure followed by chromatographic analysis, allowing the simultaneous determination of the applied chemicals, was used to monitor the pesticide residues in the soil columns as a function of time from application and depth. The experiment, carried out for about 60 days, revealed that soil contamination apparently involves only the surface layer since none of the investigated pesticides was detected at depths greater than 20-30 cm. However, the five pollutants exhibit a quite different behaviour that can be related to their physico-chemical properties.

Modelling of retention of pesticides in reversed-phase high-performance liquid chromatography: quantitative structure-retention relationships based on solute quantum-chemical descriptors and experimental (solvatochromic and spin-probe) mobile phase descriptors.

A quantitative structure-retention relationship (QSRR) analysis based on multilinear regression (MLR) and artificial neural networks (ANNs) is carried out to model the combined effect of solute structure and eluent composition on the retention behaviour of pesticides in isocratic reversed-phase high-performance liquid chromatography (RP-HPLC). The octanol-water partition coefficient and four quantum chemical descriptors (the total dipole moment, the mean polarizability, the anisotropy of the polarizability and a descriptor of hydrogen-bonding based on the atomic charges on acidic and basic chemical functionalities) are considered as solute descriptors. In order to identify suitable mobile phase descriptors, encoding composition-dependent properties of both methanol- and acetonitrile-containing mobile phases, the Kamlet-Taft solvatochromic parameters (polarity-dipolarity, hydrogen-bond acidity and hydrogen-bond basicity, pi*, alpha and beta, respectively) and the 14N hyperfine-splitting constant (aN) of a spin-probe dissolved in the eluent are examined. A satisfactory description of mobile phase properties influencing the solute retention is provided by aN and beta or alternatively pi* and beta. The two seven-parameter models resulting from combination of aN and beta, or pi* and beta, with the solute descriptors were tested on a set of 26 pesticides representative of 10 different chemical classes in a wide range of mobile phase composition (30-60% (v/v) water-methanol and 30-70% (v/v) water-acetonitrile). Within the explored experimental range, the acidity of the eluent, as quantified by alpha, is almost constant, and this parameter is in fact irrelevant. The results reveal that aN and pi*, that can be considered as interchangeable mobile phase descriptors, are the most influent variables in the respective models. The predictive ability of the proposed models, as tested on an external data set, is quite good (Q2 close to 0.94) when a MLR approach is used, but the modelling capability can be further improved using an artificial neural network.

Quantitative structure-retention relationships of pesticides in reversed-phase high-performance liquid chromatography.

In this paper, a quantitative structure-retention relationships (QSRR) method is employed to predict the retention behaviour of pesticides in reversed-phase high-performance liquid chromatography (HPLC). A six-parameter nonlinear model is developed by means of a feed-forward artificial neural network (ANN) with back-propagation learning rule. Accurate description of the retention factors of 26 compounds including commonly used insecticides, herbicides and fungicides and some metabolites is successfully achieved. In addition to the acetonitrile content, included to describe composition of the water-acetonitrile mobile phase, the octanol-water partition coefficient (from literature) and four quantum chemical descriptors are considered to account for the effect of solute structure on the retention. These are: the total dipole moment, the mean polarizability, the anisotropy of polarizability and a descriptor of hydrogen bonding ability based on the atomic charges on hydrogen bond donor and acceptor chemical functionalities. The proposed nonlinear QSRR model exhibits a high degree of correlation between observed and computed retention factors and a good predictive performance in wide range of mobile phase composition (40-65%, v/v acetonitrile) that supports its application for the prediction of the chromatographic behaviour of unknown pesticides. A multilinear regression model based on the same six descriptors shows a significantly worse predictive capability.

Comparison of different sorbents for multiresidue solid-phase extraction of 16 pesticides from groundwater coupled with high-performance liquid chromatography.

A procedure based on solid-phase extraction (SPE) followed by high-performance liquid chromatography (HPLC) with diode array detection has been developed for the simultaneous analysis of 16 widely used pesticides in groundwater samples. The compounds analysed were: aldicarb, atrazine, desethylatrazine, desysopropylatrazine, carbofuran, 2,4-D, dicloran, fenitrothion, iprodione, linuron, metalaxyl, metazachlor, phenmedipham, procymidone, simazine and vinclozolin. Five different SPE sorbents, C(18) bonded silica (Isolute SPE C18 (EC)), graphitised carbon black (Superclean Envi-Carb), highly cross-linked polystyrene-divinylbenzene (Lichrolut EN), divinylbenzene-N-vinylpyrrolidone (Oasis HLB) and surface modified styrene-divinylbenzene (Strata X), were compared. HPLC separation and quantification of the selected pesticides was carried out under isocratic conditions by means of a new reversed-phase column (Gemini from Phenomenex) based on C(18) bonded to organic-silica particles. Oasis HLB and Strata X provided the best results in the preconcentration of 1-l samples, yielding average recoveries higher than 70%, except for phenmedipham that rapidly degrades in groundwater. Detection limits of the target pesticides provided by the proposed SPE-HPLC procedure were between 0.003 and 0.04microg l(-1).

Low serum concentrations of di-(2-ethylhexyl)phthalate in women with uterine fibromatosis.

Di-(2-ethylhexyl)phthalate (DEHP) is the most commonly used plasticizer in flexible polyvinylchloride formulations, and is a widespread ubiquitous environmental contaminant. A potential role of exposure to DEHP and its primary metabolite, monoethylhexylphthalate (MEHP), on women's reproductive function is suggested in the current study. The aim of the study was to test serum concentrations of DEHP and/or MEHP in women with uterine fibromatosis. Two groups of women were enrolled in the study: (i) women with uterine fibromatosis undergoing surgical menopause (n = 15) and (ii) healthy women (n = 20). Serum DEHP and MEHP concentrations were measured by high-performance liquid chromatography. Serum MEHP distribution was found to be non-Gaussian (p = 0.001) while serum DEHP distribution was compatible with a normal curve (p = 0.141). Patients with uterine fibromatosis showed significantly lower serum MEHP concentrations (median [interquartile range]: 0 [0-0] microg/ml, range: 0-0.57 microg/ml) than controls (0.42 [0-0.51] microg/ml, range: 0-1.20 microg/ml, z = -2.93, p = 0.0034). Likewise, serum DEHP concentrations in women with fibromatosis were found to be significantly lower than in controls (patients: 0.27 +/- 0.096 microg/ml (mean +/- standard deviation (SD)), range: 0.14-0.59 microg/ml vs. controls: 0.30 +/- 0.14 microg/ml (mean +/- SD), range: 0-0.63 microg/ml; t = 3.212, df = 33, difference: -0.325 (95% confidence interval: -0.5309, -0.1191), p = 0.0029). In conclusion, the present findings indicate for the first time that serum DEHP and MEHP concentration are lower in women with uterine fibromatosis, suggesting a possible correlation between phthalate esters and fibromatosis pathology.