Prospective evaluation of the effect of statins on blood pressure control in hypertensive patients in clinical practice.

BACKGROUND AND AIM: Some clinical evidence supports a statin antihypertensive effect. Our aim is to evaluate the statin effect on blood pressure control in hypertensive patients in the setting of clinical practice, and the role of some predetermined individual patient characteristics (age, gender, baseline BP levels, pre-treatment LDL-C levels) on the supposed statin BP lowering effect. METHODS AND RESULTS: Two hundred and fifty-four hypertensive patients with hypercholesterolemia were enrolled in the Ambulatory service of the Hypertension Research Unit of Bologna University Hospital. After 2-4 weeks of a run-in period patients were allocated to statin treatment and followed-up for 24 weeks. The blood pressure response to statins was compared in several subgroups of patients according to age, gender, baseline BP and pre-treatment cholesterolemia. In the overall study population, the use of statins was associated with a significant reduction in systolic (-7.6+/-4 mmHg, p<0.05) and diastolic blood pressures (-5.2+/-3 mmHg, p<0.05) in comparison to baseline. The blood pressure decrease was more pronounced in patients younger than 65 years (p<0.05), with higher baseline systolic blood pressure (p<0.005), and in those with higher cholesterolemia before statins (p<0.05). CONCLUSIONS: Our study suggests a BP-lowering effect of statins, consistent with some other literature. Some parameters like age, baseline systolic blood pressure and cholesterolemia influence the antihypertensive effect of statins. The lack of consideration for these confounding factors may be one of the reasons for the conflicting results about the BP lowering effects of statins.

Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions.

OBJECTIVE: To investigate the relationship between lesion severity and other clinical factors and bladder function recovery. PATIENTS AND METHODS: The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Logistic approach with univariate and multivariate analysis. RESULTS: Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p < 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p < 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. DISCUSSION AND CONCLUSION: Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. Patients with bladder function recovery show a higher frequency of central cord and Brown-Sequard syndromes (with better prognosis) and a lower frequency of detrusor-sphincter dyssynergia.

[Silica risk in construction industry: an investigation on raw materials]. / Il rischio silice nel settore edilizia: esperienza di un'indagine sulle materie prime.

Typical construction activities like demolition, excavation and sanding can expose workers to silica, but there are few investigations carried out with the aim of evaluating the silica content in raw materials used for these activities (mortars, plasters, cement...). Our intervention has been directed in looking for free crystalline silica in samples of raw materials. We have measured the silica content in these materials comparing declared and real composition found in the products. Our intent was to obtain more information about the working activities which expose workers to free crystalline silica in construction industry and to highlight the silica presence in raw materials also when the companies don't declare it, against labeling rules based on Italian law D.lgs 65/03.

[Metabolic syndrome and hypertension: prevention and treatment]. / Sindrome metabolica e ipertensione: prevenzione e trattamento.

Since the 1950s the definition of the aggregate of metabolic disorders possibly presenting with adult obesity has evolved without reaching a unifying agreement on what metabolic syndrome is. After years of consensus on and research into identifying the extent to which certain criteria of metabolic syndrome may be predisposing factors for cardiovascular events, a reverse shift can be noticed in recent studies raising numerous points of contention about various elements that may be diagnostic for the syndrome. Of these, one of the most tenuous is probably arterial hypertension. Uncertainties have emerged regarding the arbitrariness of cut-off values, which differ according to the classification system the study applied, the methods of measurement, and the dilemma of hyperinsulinemia/insulin resistance which is present in only 50-60% of individuals with hypertension. Currently available data fail to solve these conundrums; however, some studies have correlated hypertension and dislipidemia with an increased risk of cardiovascular events. International epidemiologic data indicate that the prevalence of the syndrome varies between populations and between the sexes within the same populations, suggesting that diagnostic criteria need to take better account of ethnic group origin. Prevention of metabolic syndrome is still based on lifestyle changes; the huge risk of an imminent pandemic has called the attention of the American Heart Association to the importance of prevention and early treatment of the pediatric population--a new segment at risk of early cardiovascular events. Pharmacological therapy is directed at controlling various risk factors, particularly hypertension and metabolic disturbances. ACE inhibitors, sartans and statins are currently the drugs of first choice in treating metabolic syndrome.

The VO(2)-on kinetics in constant load exercise sub-anaerobic threshold reflects endothelial function and dysfunction in muscle microcirculation.

To propose a test to evaluate endothelial function, based on VO(2) on-transition kinetics in sub-anaerobic threshold (AT) constant load exercise, we tested healthy subjects and patients with ischemic-hypertensive cardiopathy by two cardiopulmonary tests on a cycle ergometer endowed with an electric motor to overcome initial inertia: a pre-test and, after at least 24 h, one 6 min constant load exercise at 90 % AT. We measured net phase 3 VO(2)-on kinetics and, by phase 2 time constant (tau), valued endothelial dysfunction. We found shorter tau in repeated tests, shorter time between first and second test, by persisting endothelium-dependent arteriolar vasodilatation and/or several other mechanisms. Reducing load to 80 % and 90 % AT did not produce significant changes in tau of healthy volunteers, while in heart patients an AT load of 70 %, compared to 80 % AT, shortened tau (delta=4.38+/-1.65 s, p=0.013). In heart patients, no correlation was found between NYHA class, ejection fraction (EF), and the two variables derived from incremental cycle cardio-pulmonary exercise, as well as between EF and tau; while NYHA class groups were well correlated with tau duration (r=0.92, p=0.0001). Doxazosin and tadalafil also significantly reduced tau. In conclusion, the O(2) consumption kinetics during the on-transition of constant load exercise below the anaerobic threshold are highly sensitive to endothelial function in muscular microcirculation, and constitute a marker for the evaluation of endothelial dysfunction.

Effects of TRH-T on spinal motoneurones in man.

The effect of thyrotropin-releasing hormone tartrate (TRH-T) on the decrease in H Max/M Max ratio, an index of the spinal motoneurone pool, induced by haloperidol, was studied in 15 healthy volunteers. In all subjects, the H response was examined by an electromyographic apparatus. The values were expressed as H Max/M Max ratio, that gives an index of excitability of the spinal motoneurone pool. It was found that the mean H Max/M Max ratio value significantly decreased after haloperidol administration, but this effect was completely reversed by the injection of TRH-T. This finding suggests that the peptide may modulate motoneurone functions.

Changes in cerebrospinal fluid levels of malondialdehyde and glutathione reductase activity in multiple sclerosis.

The chemical composition of human cerebrospinal fluid (CSF) is considered to reflect brain metabolism. In this study we measured malondialdehyde (MDA) levels and the activity of enzymes involved in antioxidative processes, glutathione reductase and glutathione peroxidase, in human cerebrospinal fluid of multiple-sclerosis (MS) patients and normal healthy volunteers. Our results indicated that the cerebrospinal fluid in MS showed significantly higher endogenous levels of MDA than the control, as well as a much greater resistance to in-vitro stimulation test. In addition, we found the activity of GSH reductase significantly increased, about twice the control values, whereas the activity of glutathione peroxidase was markedly decreased as compared to control values. Our findings suggest that in MS the activity of antioxidant enzymes is modified, and indicates the conceivable possibility of a pathogenic role of oxidative stress in the determinism of the disease.

The effect of transport on some metabolic parameters and meat quality in pigs.

Two groups of 40 castrated male pigs were selected at random in an abattoir from pigs arriving from two farms, situated 650 km (group A) and 180 km (group B) from the plant, respectively. The animals were kept in lairage overnight and slaughtered the following morning. At slaughter, samples of blood were collected to determine serum levels of some enzymes [lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT) and glutamic phosphatase transaminase (GPT)]. Measurements of pH were then taken on the Longissimus thoracis at the level of the last rib 45 min, 3 h and 24 h post mortem. After overnight chilling of the sides at +2°C, a portion of the Longissimus thoracis was removed for colour and drip measurements. Results show that distance travelled affects pH values at 45 min and 24 h, group A presenting higher values than group B (P < 0·001). Drip loss did not differ significantly between the two groups, while group A showed lower values of L (∗) and higher a (∗) values than group B (P < 0·05 and P < 0·01, respectively), with no differences in the mean values of b (∗). In group A, a higher value of LDH was observed (P < 0·001) than in group B. GOT and GPT showed no significant difference between the two groups. It is concluded that, although some significant effects of treatment were recorded on some quality traits, the magnitude of the differences are not considered of much practical significance.

Comparison of chemical composition of meat determined at eight laboratories.

Sixteen minced samples of lean beef M. semimembranosus and M. gracilis were analysed for nitrogen, fat, moisture, collagen, ash and pH using recommended procedures in eight European Communitie' (EC) meat research laboratories. Differences between replicate determinations within laboratories were often larger than suggested in reference methods although they were smaller than the differences between laboratories. Moisture and pH were determined most consistently, collagen least consistently.

Beef quality assessed at European research centres.

Loin steaks and cubes of M. semimembranosus from eight (12 month old) Galloway steers and eight (16-18 month old) Charolais cross steers raised in England and from which the meat was conditioned for 2 or 10 days, were assessed in research centres in Belgium, Denmark, England, France, the Federal Republic of Germany, Ireland, Italy and the Netherlands. Laboratory panels assessed meat by grilling the steaks and cooking the cubes in casseroles according to local custom using scales developed locally and by scales used frequently at other research centres. The meat was mostly of good quality but with sufficient variation to obtain meaningful comparisons. Tenderness and juiciness were assessed most, and flavour least, consistently. Over the 32 meats, acceptability of steaks and casseroles was in general compounded from tenderness, juiciness and flavour. However, when the meat was tough, it dominated the overall judgement; but when tender, flavour played an important rôle. Irish and English panels tended to weight more on flavour and Italian panels on tenderness and juiciness. Juciness and tenderness were well correlated among all panels except in Italy and Germany. With flavour, however, Belgian, Irish, German and Dutch panels ranked the meats similarly and formed a group distinct from the others which did not. The panels showed a similar grouping for judgements of acceptability. French and Belgian panels judged the steaks from the older Charolais cross steers to have more flavour and be more juicy than average and tended to prefer them. Casseroles from younger steers were invariably preferred although the French and Belgian panels judged aged meat from older animals equally acceptable. These regional biases were thought to be derived mainly from differences in cooking, but variations in experience and perception of assessors also contributed.

Eating quality of European beef assessed at five research institutes.

Loin steaks from 10 animals (five of each of two types) from each of eight European countries were assessed for eating quality at five institutes in Denmark, Ireland, England, France and the Federal Republic of Germany. All panels found wide variation in eating quality and many of the steaks were unacceptably tough. Although attempts to relate quality to production factors were often confounded, differences in post-slaughter handling, particularly between producing countries, dominated eating quality. Breed, sex, age or fatness had relatively little influence on eating quality in this trial. A common eight-category scale of tenderness/toughness was used in addition to each institute's usual descriptive scales for tenderness, flavour, juiciness and overall acceptability, employing four to eleven categories. Within panels, attribute scores were not independent and tenderness and flavour in combination were the best predictors of overall acceptability. Between panels, tenderness was highly interrelated, flavour and juiciness poorly interrelated. These findings, together with estimates of each panel's discrimination and the variation between individual assessors, are discussed in relation to standardisation and equivalence of sensory methodology.

Autoplastic grafting from the iliac wing: surgical technique, indications and complications.

The authors describe the surgical technique used to obtain (by anterior and posterior access) autoplastic bone from the ilium in 186 oncological cases. Indications, the results obtained and the principal causes of complications are discussed.

VO2 kinetics in supra-anaerobic threshold constant tests allow the visualization and quantification of the O2 saving after cytochrome c oxidase inhibition by aerobic training or nitrate administration.

We tested whether the known cytochrome c oxidase (COX) inhibition by nitric oxide (NO) could be quantified by VO(2) kinetics during constant load supra-Anaerobic Threshold (AT) exercises in healthy trained or untrained subjects following aerobic training or nitrate administration. In cycle ergometer constant load exercises supra-AT, identified in previous incremental tests, VO(2) kinetics describe a double exponential curve, one rapid and one appreciably slower, allowing the area between them to be calculate in O(2) l. After training, with increased NO availability, this area decreases in inverse ratio to treatment efficacy. In fact, in 11 healthy subjects after aerobic training for 6-7 weeks, area was decreased on average by 51 %. In 11 untrained subjects, following the assumption of an NO donor, 20 mg isosorbide 5 mononitrate, area was decreased on average by 53 %. In conclusion, supra-AT VO(2) kinetics in constant load exercises permit the quantification of the inhibitory effect NO-dependent on COX after either physical training or nitrate assumption.

Utility of delayed spinal cord injury rehabilitation: an Italian study.

The objective was to examine the utility of delayed spinal cord injury rehabilitation. The design was a retrospective study in the spinal unit of a large rehabilitation hospital. The participants were 117 patients at their first rehabilitation admission with an event to admission time of 90 days or more. The main outcome measures were the Barthel Index, Rivermead Mobility Index, Walking Index for Spinal Cord Injury and motor scores at admission and discharge; relative changes were examined. Patients showed a significant increase in all the outcome measures and achieved independence or assisted independence; significant neurological improvement and improvement in walking were recorded too; most of the patients were discharged home. The present data demonstrate the utility of delayed rehabilitation and highlight the importance of having rehabilitation in a specialised setting.

[Correlations of heart rate and arterial pressure in the orthoclinostatic test. Study of 3500 subjects]. / Correlazioni tra frequenza cardiaca e pressione arteriosa nel test ortoclinostatico. Studio su 3500 soggetti.

The study deals with the data resulting from the analysis of 3497 passive orthoclinostatic tests performed in the neurological Clinic of Pisa during the last 10 years. Blood pressure and heart rate values both in supine and upright positions have been analyzed, particularly focusing the orthostatic hypotension, which were 184 over 3497 tests. The results show that in young subjects only hypersympatheticotonic hypotension are present, due to a dysfunction of the regulating hypothalamic centres, while at more advanced age there is a prevalence of orthostatic hypotension with low differential values of heart rate. Differential values of heart rate as a function of age have been the calculated.

Cerebral ischemia and livedo reticularis in a patient with impairment of coagulation factor VII and free protein S.

The association of ischemic cerebrovascular lesions with livedo reticularis is known as Sneddon syndrome. It affects young subjects, primarily women, and its neurological manifestations are TIAs, ischemic stroke, progressive dementia and epileptic seizures. Its etiopathogenesis has still to be clarified. Some authors have associated it with an antiphospholipid antibody syndrome. Recently it has been assumed that a defect in blood coagulation may be involved in its pathogenesis. Here we report a case in which both an increase in coagulation factor VII activity and a deficiency in free protein S were documented.

Pressure sores and blood and serum dysmetabolism in spinal cord injury patients.

STUDY DESIGN: Spinal cord injury (SCI) patients with pressure sores were studied before and after surgical intervention for ulcer healing and compared with matched SCI patients without sores and with patients with pressure sores and other diseases. OBJECTIVE: To analyse the relationship between pressure sores and anaemia and serum protein alteration in SCI patients. To study the pathogenesis of these alterations and suggest appropriate therapy. SETTING: Spinal cord unit in Rome, Italy. SUBJECTS: A total of 13 SCI patients with pressure sores, 13 comparable patients without pressure sores and four patients with other diseases and pressure sores. MAIN MEASURES: Haematochemical parameters. RESULTS: Patients with pressure sore showed significant decreased red cells, decreased haemoglobin and haematocrit, increased white cells and ferritin and decreased transferrin and transferrin saturation; total hypoproteinemia and hypoalbuminemia with increased Alfa-1 and gamma globulins increased erythrocyte sedimentation rate and C-reactive protein were also present. The alterations returned to normal after surgical intervention for pressure sore healing. CONCLUSIONS: Patients with pressure sores suffer from anaemia and serum protein alteration that fells within the range of metabolic alteration of chronic disorders and neoplastic diseases. The alterations depend on a decreased utilisation of iron stores in the reticuloendothelial system and on inhibition of the hepatic synthesis of albumin. With regard to treatment, iron treatment should be avoided because of the risk of haemochromatosis.

[Modification of the blink reflex in hemidystonia]. / Modificazioni del blink reflex nell'emidistonia.

With the aim of evaluating the excitability of the brain stem reflex centers, we studied the side-to-side differences in the EMG activity of the early and late components of the blink reflex, in subjects with unilateral dystonia without demonstrable brain lesions. We observed that both early and late responses of direct blink reflex were significantly higher in the affected side than in the contralateral one.