Hearing and Vision Screening Program for newborns in Italy.

Materials and Methods: Data were collected through a nationwide survey conducted in 2018. All maternity wards active in Italy in 2017 were included. Background: The aims of this paper were to present data on the implementation and coverage of simultane-ous Universal Neonatal Hearing and Vision Screening programmes and to evaluate the organization and management of these healthcare procedures in Italy. Conclusions: Our results show that implementation of simultaneous hearing and vision screening increased the coverage of both screening tests and is a new multi-disciplinary approach to sensorineural disability. The use of both ABR and TEOAE tests in the hearing screening decreases the number of newborns sent for audiological evaluation, with a notable reduction of costs. The consideration that ocular problems are two to three times more common in deaf and hearing impaired children than their in hearing peers, confirms the importance of establishing guidelines for simultaneous hearing and vision screening, that favors the formation of a multi-disciplinary team (pediatrician, audio-logist, ophthalmologist). Results: HEARING SCREENING. Overall 427,365 newborns out of 448,386 (95.3%) received the hearing screening test (first level) in 391 out of the 409 maternity hospitals (95.5%), with a national mean referral rate of 3.63% (SD ± 4.58). A statistically significant increase (p<0.034) of newborns sent to audiological examination was found in maternity hospitals with Neonatal Intensive Care Unit (NICU) with "TEOAE only" protocol (9.32% SD ± 7.57), compared to those with "TEOAE/AABR" (3.0% SD ± 3.29). VISION SCREENING. Overall 335,262 newborns out of 448,386 (74.7%) received vision screening (Red Reflex test) for vision impairment in 302 out of 409 maternity hospitals (73.8%), before nursery discharge. The mean referral rate, recorded in only 22 maternity hospitals out of 302 (7.2%), was 0.48% with a rate of lost to follow up of 0.75 %.

Comfort rules for face masks among healthcare workers during COVID-19 spread.

BACKGROUND: The outbreak of Coronavirus disease 2019 (COVID-19) made imperative the use of protective devices as a source control tool. As there is no definite antiviral treatment and effective vaccine, the only efficient means of protecting and mitigating infectious contagion has been the use of personal protective equipment, especially by healthcare workers. However, masks affect the humidification process of inhaled air, possibly leading to a basal inflammatory state of the upper airways. STUDY DESIGN: This is a single-center observational study conducted at the University Hospital of Catania from April 1, 2020, to June 31, 2020. METHODS: We analyzed the role of protective masks on the elimination of upper airways complaints in healthcare workers of the University Hospital of Catania. We evaluated 277 subjects through a self-administered 17 item questionnaire based on respiratory, work performance and health-related quality of life domains. RESULTS: A higher prevalence of nasal and ocular symptoms, perceived reduced work performance, difficulty in concentrating, and sleep disorders were found. After two weeks adhering to a list of good practices that we recommended, significant reversibility of the symptoms investigated and work performance enhancement were observed. CONCLUSIONS: Despite clinical complaints related to personal protective equipment, effective amelioration through usage rules is easily obtained. Given the essential use of protective masks, healthcare workers have to adhere to appropriate work and safety prevention rules.

Bisphosponates and dental implants: a case report and a brief review of literature.

This paper reports a brief review of literature about dental implant in patients taking bisphosphonates (BPs) and a case of a patient taking zoledronate, submitted to postextractive implant surgery. A 54-years-old woman was referred to our observation, at the First Section of Dentistry of Department of Medical-Surgical Specialties, University of Catania. The patient, affected by multiple myeloma, reported being subjected to implant surgery, during the administration of zoledronate. Clinical and radiographic evaluations showed an area of BPs-related osteonecrosis in the only postextraction site where no implant was positioned. From this brief review of literature, we can conclude that the risk of bisphosphonates-related osteonecrosis and of implant failure in patients taking oral bisphosphonates may be low. This is a unique case of implant surgery in patient taking intravenous bisphosphonates. For that, we cannot conclude that implant surgery is safe in patients taking intravenous bisphosphonates or that the immediate implant placement following extraction may prevent the osteonecrosis. According to guidelines of AAOMS, to date any kind of surgical procedure involving alveolar bone in patients treated with itravenous BPs is contraindicated. More studies would be needed to optimize the clinical guidelines for the treatment of patients taking BPs.

Impact of exclusive e-cigarettes and heated tobacco products use on muco-ciliary clearance.

BACKGROUND: Tobacco smoking impairs mucociliary clearance (MCC) efficiency as shown by prolonged saccharin test transit time (STTT). Avoiding exposure to tobacco smoke from combustible cigarettes may restore MCC function and former smokers have been shown to exhibit similar STTT as never smokers. The impact on STTT of switching from smoking to combustion-free tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) is not known. METHODS: We report STTT of exclusive EC and HTP users. Test results were compared with those obtained in current, former, and never smokers. RESULTS: STTT were obtained from 39 current, 40 former, 40 never smokers, and from 20 EC and 20 HTP users. Comparison of STTT values showed significant difference among the five study groups (p < 0.00001) with current smokers having a median [interquartile range (IQR)] STTT of 13.15 min, which was significantly longer compared with that of all other study groups. In particular, compared with former (7.26 min) and never smokers (7.24 min), exclusive EC users and exclusive HTP users had similar STTT at 7.00 and 8.00 min, respectively. CONCLUSION: Former smokers who have switched to exclusive regular use of combustion-free nicotine delivery systems (i.e., ECs and HTPs) exhibit similar saccharin transit time as never and former smokers. This suggests that combustion-free nicotine delivery technologies are unlikely to have detrimental effects on MCC function.

Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series.

AIM: The exact pathogenesis of bisphosphonates-related osteonecrosis of jaws (BRONJ) is still not clear. Two broad theories have been articulated to explain the pathogenesis of BRONJ. One centres on the bisphosphonate induced osteoclast inhibition and the other explains the process in terms of antiangiogenic mechanisms. Both try to address the predilection for this occurrence in the jaws. In most cases the development of osteonecrosis in those taking bisphosphonates (BPs) has been associated with trauma, predominantly dental extraction. This study reports a case series of patients, treated with Zoledronate, submitted to a preventive protocol of dental extraction, in order to minimize the risk of occurrence of bisphosphonates-related osteonecrosis. METHODS: A total of 34 patients treated with Zoledronate and requiring single or multiple dental extractions were treated, at our Center for research, prevention and care of BRONJ, I Section of Dentistry, Department of Medical Surgical Specialties, University of Catania. The protocol provides an antibiotic prophylaxis and the surgical extraction of interested teeth, accompanied by the removal of the adjacent alveolar bone. RESULTS: A total of 71 extractions in 34 patients were performed with this approach. The follow-up was 12 months. No signs of inflamed tissue or necrotic exposed bone in any patients. CONCLUSION: With limits of present study, the results of our case series are very promising because BRONJ did not develop in any of the patients. In all patients taking Zoledronate and showing untreatable inflammatory dental conditions, the present protocol might be advisable.

The use of mineral trioxide aggregate in endodontics.

UNLABELLED: Mineral trioxide aggregate (MTA), composed mainly of tricalcic silicate, tricalcic alluminate, bismuth oxide, is a particular endodontic cement. It is made of hydrophilic fine particles that harden in the presence of dampness or blood. It is biocompatible, radiopaque and it is harder to infiltrate, compared to classic materials for root filling such as amalgam, cements, Super-EBA, and IRM. and SEM studies of sections and copies in resin of root neoapices filled with amalgam, IRM, Super-EBA and MTA, as well as tests of microinfiltration have shown that MTA has excellent sealing capacities. It requires a working time of about 5 min and a hardening time that varies from 2 h and 45 min to 4 h according to the density of the air entrapped during mixing and the dampness of the receiving site. The long hardening time reduces internal tensions and the incidence of marginal infiltration, but it forces to definitively fill the tooth in the following sitting, with an interval of at least 3 days from the MTA application. Clinical experience shows how MTA is a material of choice in cases not only of endodontic surgery, apicectomy and retrograde filling but also in the sealing filling of perforations of the pulp chamber and of the root, stripping, internal reabsorptions, readaptations, lacerations, and apical transports. It has been used with success also in direct cappings and in apexifications instead of calcium hydroxide, leading to quicker therapies and more predictable RESULTS: The authors outline the operative phases of the different treatments proposed, make a survey of the most important studies published so far and hope that a new sealing cement with more reduced hardening times will soon be available.

The adrenergic regulation of the lipid metabolism.

The author summarized the literature data regarding the adrenergic regulation of the lipid metabolism, subdividing them according to the following scheme; anatomical findings, experimental findings, physiopathological findings, short-term pharmacological findings, long-term pharmacological findings, conclusive considerations of therapeutical interest.

Nitrite plasma levels in type 1 and 2 diabetics with and without complications.

BACKGROUND: The authors thought it interesting to examine the interrelationship between nitric oxide and diabetes mellitus by the determination of the nitrite plasma levels, stable end-products of nitric oxide, in various clinical patterns of diabetes mellitus. METHODS: Our series consisted of 161 female subjects (mean age 54 +/- 7 years, disease duration 5 +/- 3 months) subdivided into: a) 13 patients suffering from insulin-dependent diabetes (IDDM) without clinical and instrumental signs of micro- and macro-angiopathy; b) 148 suffering from non insulin-dependent diabetes mellitus (NIDDM) of whom: 1) 52 without vascular complications (28 normal weight, BMI < 25, and 24 obese, BMI > 30); 2) 40 with clinical and instrumental signs of non hypertensive coronary heart disease (CHD); 3) 25 with CHD and hypertension (arterial blood pressure over 160/95 mmHg); 4) 31 with hypercholesterolemia (values over 250 mg/dl). All patients were examined in good glycometabolic conditions reached by oral hypoglycemiant (12 cases) or insulin (149 cases) treatment. As normal control 37 female subjects (mean age 48 +/- 7) without internistic diseases were considered. For each sample we determined the plasma levels of nitrites by the Gutman and Hollywood method. RESULTS: Almost similar nitrite plasma levels in IDDM (17 +/- 0.5 mumol/L) and normal controls (17 +/- 0.2 mumol/L) were found; in non complicated non obese NIDDM a not significantly elevated value (21 +/- 0.8 mumol/L) as compared with the IDDM and control group was found; the obese NIDDM patients showed a value (18 +/- 0.4 mumol/L) not significantly different in comparison with the non obese NIDDM group. In the NIDDM group with non hypertensive CHD) the nitrite values was almost similar (20 +/- 0.5 mumol/L) to the corresponding group without vascular complications. In the patients with CHD and hypertension the nitrite level was superimposable (20 +/- 0.7 mumol/L) on the one recorded in NIDDM patients without vascular complications and in those with CHD without hypertension. In NIDDM patients with hypercholesterolemia the mean nitrite value was sharply elevated (24 +/- 0.8 mumol/L); the difference between this group and those of non hypercholesterolemic, non obese, obese and CHD (with or without hypertension) patients was significant (p < 0.05). CONCLUSIONS: It is conceivable that diabetes mellitus per se causes a tendential not significant increase of NO production in comparison with normal controls; some factors such as blood pressure, overweight, disease duration, therapeutic treatment and coronary complications appear not to influence NO production. In hypercholesterolemic diabetic patients the nitrite enhanced level in plasma might mean a compensatory response to a continuous inactivation of NO involved in a protective competition towards damaging factors and chiefly against oxidised LDL.

Nitrite plasma levels in chronic lung disease patients.

BACKGROUND: The authors carried out a study in a group of lung disease patients, about the behaviour of the plasmatic levels of nitrites (stable, specific and irreversible end-products of nitric oxide). METHODS: The series consisted of 13 male patients (mean age 65 +/- 7 years) with chronic obstructive pulmonary disease with type 1 respiratory failure; 33 male subjects (mean age 58 +/- 5 years) without internistic disease were considered as controls. For each subject the determination of nitrite plasma levels by the Gutman and Hollywood method based on the Griess colorimetric reaction was performed. RESULTS: The mean value of the plasmatic nitrites was significantly reduced (p < 0.05) as compared to the controls (11 +/- 0.48 mumol/l vs 21 +/- 0.92 mumol/l). CONCLUSIONS: The authors hypothesized that in chronic lung disease patients there would be a condition of initial pulmonary hypertension; in this condition long-term endothelium-dependent nitric oxide production, aimed at the vasodilating effects with secondary excessive exhaled amount of NO, might cause a reduction in nitrite plasma levels. These levels may represent an early marker of pulmonary hypertension and suggest interesting therapeutic treatments through inhalation of exogenous NO.

Nitrite plasma levels after an oral fat meal in normolipemic subjects.

BACKGROUND: The authors, investigating the effects of an oral triglyceride-rich fatty load upon the endothelial function as regards the production of nitric oxide, performed the determination of plasma nitrites, which are stable, specific and irreversible end-products of nitric oxide. METHODS: The series consists of 13 metabolically normal female subjects (mean age 55 +/- 7 years); after an overnight fasting each subject undertook an oral fat load (butter 1 g/kg); a venous blood withdrawal was carried out before oral fat meal and after two and four hours. For each plasma sample total cholesterol, HDL-cholesterol and triglyceride plasma levels were determined by enzymatic methods; LDL-cholesterol was calculated by Friedwald's formula; the nitrite plasma levels were obtained by the Gutman and Hollywood colorimetric method. RESULTS: Total cholesterol, HDL-cholesterol, LDL-cholesterol did not show significant changes after the oral fat load; triglycerides rose significantly (p < 0.05) after 4 hours as compared to the basal value (226 +/- 12 vs 175 +/- 12 mg/dl, +30%). The nitrite plasma levels were almost unchanged before oral fat load and after 2 and 4 hours. CONCLUSIONS: The results suggest that the acute biochemical stress consisting of increased triglyceride-rich very low density lipoproteins was not able to stimulate the endothelial production of nitric oxide.

Haemostatic balance in patients with acute focal cerebral vasculopathy.

The authors investigated the behaviour of some markers of the haemostatic balance in a group of patients with acute focal cerebral vasculopathy. The series consists of 70 female patients (mean age: 61 +/- 5), 25 of whom suffering from TIA and 45 from thrombotic stroke; 40 normal controls (mean age 43 +/- 5) were also considered. For each patient after an overnight fasting a withdrawal of venous blood was done within 24-36 hours after the admission. For each sample the determination of seven prothrombotic markers [(fibrinogen (F), factor VII (F VII), antithrombin III (AT III), protein C (PC), protein S (PS) (coagulometric method IL), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) (ELISA method Boehringer)] and of three prethrombotic markers [(fibrinopeptide A (FPA), beta-thromboglobulin (BTG) and D-dimer (D-D) (ELISA method, Boehringer)] was performed. The results obtained in the group of the cerebrovasculopathic patients compared to the controls showed a significant increase of F (p < 0.001), F VII (p < 0.005), BTG (p < 0.05) and D-D (p < 0.01), whereas significant differences regarding AT III, PC, PS, t-PA, PAI and FPA were not observed. The authors hypothesized that the increased levels of fibrinogen and factor VII in the cerebrovascular subjects, globally considered, may depend on a marked prothrombotic state, linked in a pathogenetic sense to the vascular disease; the existence of a prethrombotic state is also documented by the increase of betathromboglobulin and D-dimer.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of an oral fat load on some prothrombotic markers in coronary heart patients.

The Authors studied the effects of an oral fat load with saturated fats on some recently identified molecular markers in order to assess a change in clotting balance in a prothrombotic sense. The series consists of 30 female subjects (mean age 46 +/- 4 yrs) suffering from coronary heart disease in the chronic phase (previous myocardial infarction, angor). Each subjects was kept on a standard diet and without drugs influencing the lipid and clotting balance. A venous blood withdrawal was done after an overnight fasting and three hours after an oral fat load (butter g 1/kg). For each sample the plasma levels of triglycerides, total cholesterol (enzymatic method), beta-thromboglobulin, d-dimer and tissue plasminogen activator (immunoenzymatic ELISA Methods, Boehringer Mannheim) were determined. The oral fat load caused a significant increase in triglycerides (p less than 0.05), whereas total cholesterol values remained almost unchanged. The values of beta-thromboglobulin showed a significant (p less than 0.05) reduction, whereas the ones of D-dimer (D-D) and tissue plasminogen activator showed a slight but not significant increase. The results demonstrated that the oral fat load did not cause any hemostatic change in prothrombotic sense; moreover, a reduction of the platelet activation is notable, probably dependent on the consumption of endogenous heparin involved in the lipoproteinlipase release.

Thrombotic markers during myocardial infarction.

The authors carried out a study on the behavior of some thrombotic molecular "markers" in a group of patients suffering from myocardial infarction, just after the first symptoms and after two weeks from the event. The series consists of 12 subjects (6 males, 6 females, mean age 52 +/- 7), suffering from acute myocardial infarction; just after the first symptoms and instrumental signs (before the thrombolysis) and after two weeks a venous blood withdrawal was done; on the plasma of each sample the determination of fibrinogen (F) (coagulative method), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), D-dimer (D-D), fibrinopeptide A (FPA) and betathromboglobulin (BTG) (ELISA methods) was performed. The values of t-PA, FPA and BTG did not show remarkable variations; after two weeks from the myocardial infarction compared to the basal values a significant reduction of PAI-1 (4.6 +/- 0.28 UI/ml vs 5.4 +/- 0.33 UI/ml, p < 0.01), D-D (215 +/- 10 ng/ml, vs 253 +/- 12 ng/ml, p < 0.05) and a significant increase of F (294 +/- 28, vs 218 +/- 16 mg%, p < 0.05) were observed. The authors suggest that a basal reduction of the fibrinolytic activity documented by the enhanced PAI-1, may play a major role, influencing pathogenetically the thrombotic event; the other markers seem to be of lower importance, being only secondarily altered in the first phase and gradually returning to a normal pattern after an adequate elapsed time; a preinfarctual hypofibrinolytic condition, probably enhanced by some triggering factor, actually appears the sole prothrombotic system to be counteracted with adequate diet and drug treatments.

Nitric oxide plasma levels in patients with chronic and acute cerebrovascular disorders.

BACKGROUND: The authors carried out a study on plasma level of nitrites, stable end-products of nitric oxide, aimed at investigating some features of the cerebral microvascular function in chronic and acute cerebrovascular disorders, METHODS: The series consists of 16 patients with chronic cerebral vascular disease, 11 patients with TIA, 28 patients with thrombotic stroke and 27 normal controls; the diagnosis was done on the basis of clinical, ultrasonographic and tomodensitometric findings. For each subject the determination of nitrate plasma levels by a method based on the colorimetric reaction (developed by nitrites dissolved in an acid solution containing sulfanilamide) was performed; this reaction yields quantitative results exactly corresponding to the amount of nitric oxide. RESULTS: In chronic cerebrovascular patients NO2-values tendentially higher (16.4 +/- 0.52 mumol/l) but not statistically different from those of controls (13.2 +/- 0.52) were obtained; also the values found in the group with TIA, even if slightly reduced (8.0 +/- 1.4 mumol/l), did not differ from controls; in the stroke group a significant (p < 0.05) reduction (6.4 +/- 0.52 mumol/l), as compared to controls, was found. CONCLUSIONS: On the basis of these results and of the literature data on the physiopathological profile of NO, the authors suggest a compensatory increase of the basal tone of NO in chronic cerebrovascular diseases, while an impaired endothelial synthesis of the marker could play a critical role in TIA patients and more evidently in stroke patients, presenting a wide microvascular area completely and irreversibly excluded.

Nitrite plasma levels in normolipemic and hypercholesterolemic arteriopathics after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasmatic levels of nitrites, stable end-products of nitric oxide in arteriopathic patients before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 63 subjects (mean age 64 +/- 9) suffering from peripheral arterial occlusive disease; 21 subjects with total cholesterol (TC) lower than 200 mg/dl were considered as normolipemic (group A); 24 subjects with TC ranging between 200 and 240 mg/dl were considered as mild hypercholesterolemic (group B); 18 subjects with TC higher than 240 mg/dl were consider as severe hypercholesterolemic (group C). All the patients were examined before and after 15 and 30 days of a vasoactive treatment (calciparine, aspirin, buflomedil and pentoxiphylline); group B after vasoactive and diet (NCEP phase 1) treatment and group C after vasoactive, diet and drug (simvastatin) treatment. Nitrite plasma levels were determined by the Gutman and Hollywood colorimetric method. RESULTS: In group A the basal value of nitrites was sharply (p < 0.05) lower than controls; after vasoactive treatment a significant increase (p < 0.05), was observed after 15 and 30 days; in group B the basal value was higher than controls; after 15 days a significant increase (p < 0.5) was noted, but a regression was found after 30 days. Also in group C the basal value of nitrites was higher (p < 0.05) than controls; after treatment significant changes were not found. CONCLUSIONS: The increase of nitrites in group A may be due to an improved endothelial function; this phenomenon, less appreciable in group B and no longer evident in group C may depend on the lipid-lowering treatment.

Plasma prothrombotic markers after a short- and middle term treatment with iloprost in arteriopathic patients with critical limb ischemia.

The authors carried out an investigation on the "short" and "middle-term" effect of the prostanoid derivate iloprost on some molecular haemostatic markers in a group of peripheral vasculopathic patients with critical limb ischemia. The series consists of 10 patients (6 males, 4 females, age 52 +/- 5) suffering from peripheral obstructive vasculopathy at the III-IV stage by Fontaine. After overnight fasting, each patient was given an intravenous infusion of iloprost lasting six hours at the rate of 2 ng/kg/min and reaching approximately the global dosage of 50 gamma; before and after the infusion a venous blood sample was withdrawn; the experiment was repeated under the same conditions after a four week treatment with the drug administered daily at the same dosage. For each sample the plasma levels of betathromboglobulin (BTG) fibrinopeptide A (FPA), tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-I) and D-dimer (D-D) (ELISA, methods, kits Boehringer) were measured. The basal values of BTG, FPA, tPA, PAI-I and D-D were significantly increased compared to those of a control group; after the iloprost infusion (acute effect) significant changes of the BTG, FPA, tPA and PAI-I were not found; D-D only showed a marked reduction (p < 0.05); after the four week treatment with infusion the basal values of BTG, FPA, tPA and PAI-I resulted almost unchanged; D-D only showed a marked reduction (p < 0.05) both as regards the basal value and those after the infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipidemic effects of a mild-term treatment with calcium heparin in vasculopathic subjects.

The Authors study the lipidemic effects of a "middle-term" treatment with heparin calcium in vasculopathic subjects undergoing the drug for antithrombotic purposes. The series consists of 35 subjects (21 m, 14 f, mean age 57 +/- 8) suffering from peripheral arteriopathy (24 cases) and instable angina (11 cases) of arteriosclerotic nature, and free from endocrinometabolic and hepatorenal diseases; all the subjects were normolipemic, except for 4 cases having hyperlipoproteinemia of type II B. After a week of standard diet and drug wash-out, each patient underwent antithrombotic treatment with calcium heparin (10.000 Units subcutaneously) for three weeks during the hospitalization; for each sample, the plasma levels of triglycerides (TG), total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), HDL-3-cholesterol (HDL-3-C) and HDL-2-cholesterol (HDL-2-C) were determined enzymatically (kits Boerhinger Mannheim). The Authors observe a significant (P less than 0.05) increase of TC and LDL-C after one and after two weeks of treatment with a return to the baseline after three weeks; levels of TG, HDL-C, HDL-3-C, HDL-2-C and the HDL-C/TC and HDL-2-C/HDL-C ratios showed an ascending profile until the third week without significant changes, compared to the baseline values. Subdividing the series arbitrarily into into two groups (A and B) respectively having rather low ("normolipemic") and high ("hyperlipemic") values of TC and TG respectively below (group A) and above (group B) 230 mg/dl (TC) and 165 mg/dl (TG).(ABSTRACT TRUNCATED AT 250 WORDS)

Nitrite plasma levels in normolipemic and hypercholesterolemic patients with peripheral occlusive arteriopathy.

BACKGROUND: The authors studied the nitrite plasma levels in a group of patients with peripheral obstructive arteriopathy. METHODS: The series consisted of 63 subjects (43 males, 20 females, mean age 64 +/- 9 years) suffering from peripheral arterial occlusive disease of the lower limbs, at II (55 cases) and III (8 cases) Fontaine stage; 21 subjects with total cholesterol (TC) lower than 200 mg/dl were considered as normolipemics, 24 subjects with TC values between 200 and 240 as mild hypercholesterolemics, 18 subjects with TC above 240 mg/dl as severe hypercholesterolemics. For each subject the determination of nitrite plasma levels was carried out, by the Gutman and Hollywood colorimetric method. RESULTS: In the normolipemic arteriopathics the basal value of nitrites was sharply reduced (p < 0.05) compared to the controls; in the mild hypercholesterolemics the mean basal value of nitrites was markedly higher compared to the controls; in the severe hypercholesterolemics the mean basal value of nitrites was statistically (p < 0.05) higher than that of the controls. In the arteriopathic patients, globally considered, the mean basal value of nitrites was superimposable on that of the normal control subjects. CONCLUSIONS: This study, carried out on the nitrite plasma levels in a group of arteriopathic patients allowed us to show the enhanced levels of nitric oxide due to the increase of LDL; this effect, previously observed in hypercholesterolemic diabetic and coronaropathic patients, leads us to the hypothesis of a stimulating effect of LDL upon NO endothelial synthesis; this would be a compensatory response to the damaging and vasoconstricting action of LDL.

Nitrite, endothelin and E-selectin plasma levels after arginine infusion in normal, obese and type 2 diabetic subjects.

BACKGROUND: The authors studied the behaviour of nitrites (specific end-products of nitric oxide), endothelin and E-selectin after arginine infusion (biosynthetic precursor of nitric oxide). METHODS: The series consisted of 28 female subjects (mean age 59 +/- 8) of whom: 12 normal controls; 12 suffering from essential obesity (BMI 31.4 +/- 0.7); 14 suffering from uncomplicated type 2 diabetes mellitus. Each subject received intravenous arginine (20 g in two hours); before the infusion and after 1 hour and 2 hours venous blood withdrawal was performed. For each plasma sample the levels of nitrites (colorimetric reaction), endothelin (ELISA method) and E-selectin (ELISA method) were determined. RESULTS: In the controls plasma nitrites decreased significantly (p < 0.05), more evidently at the second hour. In the obese subjects a sharp significant (p < 0.05) fall of nitrites was observed, more evidently at the second hour. In the diabetics nitrite values were reduced (p < 0.05) compared to the baseline. Endothelin levels after arginine were almost unchanged in normal and obese subjects, while in diabetics a significant (p < 0.05) reduction was observed. In the three groups of subjects E-selectin values were not modified by arginine. CONCLUSIONS: This study demonstrates that arginine infusion increase NO biosynthesis in normal, obese and diabetic subjects, inducing a significant reduction of nitrites for an early process of organic reconversion; endothelin showed a reductive trend, mainly in diabetics, probably due to an antagonistic balanced response towards an overproduction of nitric oxide. E-selectin did not change, without correlation with the nitrite and endothelin values, because of an independence from the production of the two "hemodynamic markers".