High disease relapse after bDMARD spacing in psoriatic arthritis compared to rheumatoid arthritis and axial spondyloarthritis patients: real-life data from BIOPURE registry.

The objective is to evaluate the effectiveness of a spacing strategy of bDMARDs in a cohort of selected patients in disease remission or low-disease activity (LDA) without glucocorticoids affected with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). This was a single-centre study carried out on patients prospectively enrolled in the biologic Apulian registry. Patients whose disease was in remission or LDA without taking glucocorticoids during the previous 6 months and who had agreed to increase the time interval between bDMARD doses were included in this study. Demographic and clinical characteristics were recorded at baseline and at 3, 6 and 12 months of follow-up. Endpoint of the study was the survival of spacing doses in the time lag of the study. Failure of spacing was defined as the first flare of disease. Thirty-seven RA, 28 PsA and 20 axSpA patients underwent bDMARD spacing according to a local strategy. During the follow-up, 5 RA, 6 PsA and 4 axSpA patients had a joint flare, but further 5 PsA patients manifested a skin relapse. Global persistence was 86.5% for RA (MST = 41 (95% CI: 37-45) months) and 80% for axSpA patients (MST = 36 (95% CI: 31-42) months). PsA patients showed a lower persistence, being of 60.7% (MST = 30 (95% CI: 23-36) months) (log-rank test, p = 0.03). Dose reduction by spacing bDMARD doses may be a feasible approach in patients with persistent remission/LDA activity. However, PsA patients might have greater odds of spacing failure because of skin psoriasis relapse. Key Points • Spacing of bDMARDs may be a feasible strategy for some patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis who achieve the target and withdrawn glucocorticoids. • Psoriatic arthritis patients showed lower persistence because of both articular and skin relapses.

[Limits of cardiac functional adaptation in "top level" resistance athletes]. / Limiti dell'adattamento funzionale cardiaco in atleti "top level" di resistenza.

BACKGROUND: Sports activity, particularly when performed at high level, provokes cardiovascular adjustments depending on the type of sport and on the level of the load. METHODS: We evaluated 15 athletes from the Italian national team during a non-agonistic period of cross country skiing, with non-invasive tests including exercise test, color Doppler echocardiography, Holter monitoring, physical examination and standard rest electrocardiogram. RESULTS: Physical examination, rest electrocardiogram, exercise testing and echocardiography were all within the range of the expected values for this type of subjects. Holter monitoring recorded during the periods of agonistic activity revealed significant hypokinetic arrhythmias such as severe bradycardia, pauses, I and II degree atrioventricular blocks, and complete atrioventricular block in 2 cases; these features were not observed on Holter monitoring recorded during the non-agonistic period. CONCLUSIONS: The perfect health status of subjects and their racing results may bring about physiological functional adjustments, but these observations suggest the need for a follow-up to evaluate possible pathologic outcomes.

[Hormone replacement therapy and the wellbeing of menopausal women]. / Terapia ormonale sostitutiva e benessere della donna in menopausa.

BACKGROUND AND AIMS: The authors performed a retrospective analysis of 682 patients attending the Menopause Centre from 1994 to today. These patients were referred for a wide variety of symptoms occurring in premenopause and menopause. METHODS: All patients initially underwent general screening which was followed by appropriate therapy on the basis of objective examination, blood chemical and instrumental tests, and the subjective clinical situation. RESULTS AND CONCLUSIONS: It was found that the most frequently used treatment was sequential or combined oestroprogestin replacement treatment (63%), with tibolone in 9% of cases and veralipride in 5%. The best results from the point of view of the improved wellbeing of the woman were obtained using HRT and tibolone.

Plasma apolipoproteins A-I and B in survivors of myocardial infarction and in a control group.

The values of apolipoproteins (apo) A-I and B were determined in a population sample of hospital outpatients with a standardized method to verify if the cutpoints calculated in a cross-sectional study in the US are usable with other populations. We also tested the apolipoproteins' ability to discriminate between healthy people and survivors of myocardial infarction. In the studied population the apo A-I value corresponding to the HDL-cholesterol decisional centile is 1.12 g/L for males and 1.17 g/L for females; the apo B value corresponding to the LDL-cholesterol decisional centile is 1.23 g/L for males and 1.14 g/L for females. These values are quite close to the cutpoints proposed for the American population (1.20 g/L for both apolipoproteins). In comparison with the LDL- and HDL-cholesterol decisional concentrations, the cutpoints for apolipoproteins allow a correct classification of a greater percentage of postmyocardial infarction patients (16% higher for apo B and 5% for apo A-I). Standardized assays coupled with a reference database allow a better clinical use of apolipoprotein measurements.

Multicenter evaluation of the Paragon CZE 2000 capillary zone electrophoresis system for serum protein electrophoresis and monoclonal component typing.

Serum protein electrophoresis and typing of monoclonal components (MCs) are routine but time-consuming and technically demanding assays. We evaluated capillary electrophoresis (Paragon CZE 2000) for automation of the two assays. CZE and cellulose acetate electrophoresis gave similar data on 794 samples. Within-run and between-run CVs were < 2% for albumin and gamma-globulins and 4-7% for alpha 1-, alpha 2-, and beta-globulins. Bilirubin, hemoglobin, triglycerides, and fibrinogen were found not to interfere. No carryover by capillaries was detected. The detection limit for MC was < 0.5 g/L. MC assessment by immunosubtraction on 403 samples identified the monoclonal type in all samples with peak concentrations > 10 g/L; only 50% of MCs that could not be quantified by densitometric scan were typed.

Accuracy of cholesterol measurements in Italian clinical laboratories. Joint project GISSI prevention--Italian Society of Clinical Biochemistry. SIBioC GISSI Prevenzione Group.

We report the results of an external quality assessment scheme for serum total cholesterol measurement involving about 100 Italian laboratories participating in an epidemiological study of post myocardial infarction. Two frozen human serum pools with Abell-Kendall assigned values are distributed quarterly at the laboratories (up to now seven events occurred); the obtained results are evaluated and discussed. In one exercise (# 5) duplicated measurements were repeated on three different days. Eighty-five to 98% of the laboratories obtained results within the total error limits (+/- 8.9%). But, while precision (calculated on the six replicates of exercise # 5) is good (90% of the laboratories obtained CV < 3%), inaccuracy problems are evident in every event. Indeed the mean bias from the reference method value ranged from 1.54 and 3.49% in the various events.

Distribution of CII and CIII peptides in lipoprotein classes: methods and clinical significance.

We describe a method for measuring apolipoprotein (apo) C distribution between apo B-containing lipoprotein (apo B-LP) and non-apo B-LP. The procedure requires the precipitation of apo B-LP, the redissolution of the pellet, and the quantification of C peptides in the redissolved pellet. The ratio of apo C in non-apo B-LP to apo C in apo B-LP has been calculated for both CII and CII (R-CII and R-CIII, respectively). R-CII (0.49 +/- 0.25) and R-CIII (0.84 +/- 0.54) in patients on maintenance dialysis are significantly lower than in the control group (1.14 +/- 0.57 and 1.45 +/- 0.92, respectively), indicating that hypertriglyceridemia in these patients results from a reduced catabolism of triglyceride-rich LP (TGRLP). Patients with coronary artery disease (CAD) show a distribution of C peptides no different from the control group. Analysis of covariance reveals that the patterns of R-CII and R-CIII are not entirely predictable from the serum concentration of triglycerides. This result seems to support the hypothesis that the underlying metabolic defects involving TGRLP in dialysis patients are not the same as those in patients with CAD.

Lipoprotein(a) concentrations are increased in patients with myocardial infarction and angiographically normal coronary arteries.

It is generally accepted that Lp(a) is an independent risk factor of cardiovascular diseases. Since the apolipoprotein component of Lp(a) shows some homologies to plasminogen, it is, however, unclear as to whether the pathological effect is due to the role played by the lipoprotein in lipid metabolism or in the fibrinolytic system. We compared two groups of patients with myocardial infarction, with and without angiographically documented coronary artery disease. In the latter group, imbalances in the clotting system are very likely, while members of the former group may also display disturbances of lipid metabolism. The results show that the two groups display differences in lipid metabolism, whereas they have similar patterns of thrombogenicity indices and Lp(a) values. This study seems to support the hypothesis that Lp(a) does play a role in the fibrinolytic system, since even those myocardial infarctions without obstructive coronary artery disease have a high frequency of Lp(a) concentrations above 300 mg/l, i.e. similar to the situation found in the myocardial infarctions with angiographically documented coronary artery disease. Whether the high Lp(a) concentrations in the two groups are related to an impaired fibrinolysis will be the subject of further investigation.

Air in the main pancreatic duct: demonstration with US.

Air in the pancreas--nearly always related to an abscess or a pancreatic fistula--is rarely demonstrated. Over a 3-year period, the authors detected air in the main pancreatic duct with ultrasonography (US) in 11 patients. The ductal caliber was normal in five patients and dilated in six. At US, air in the main pancreatic duct is characterized by strongly echogenic foci or echogenic lines in the duct, casting acoustic shadows or producing reverberation artifacts. It is likely that in patients who have biliary-enteric anastomoses or have undergone sphincterotomy, air in the duct of Wirsung is the result of biliary-pancreatic reflux. In patients who have not undergone such operations, the likely cause of pancreatic gas is duodenal-pancreatic duct reflux. Pancreatic gas may be related to causes other than a pancreatic abscess or fistula; it is therefore important for clinicians to realize that pancreatic ductal gas seen on US images may be secondary to prior surgery or due to sphincter of Oddi dysfunction.

Serum selenium and precursors of cardiovascular risk factors in adolescents.

The aim of this study was to determine, in a population of Italian adolescents, the association of serum selenium levels with precursors of biochemical and anthropometric variables known as being among the major risk factors for cardiovascular diseases in the adult population. The following measurements were taken in a school sample of 627 adolescents (aged 12-13 years); serum selenium, total cholesterol, high density lipoprotein cholesterol, non-HDL cholesterol, height, weight, body mass index, systolic blood pressure and diastolic blood pressure. The serum selenium levels were slightly higher in males (83.1 +/- 10.1 micrograms/l) than in females (81.7 +/- 11.0 micrograms/l), but the difference was not statistically significant. Serum selenium was positively correlated with total cholesterol, diastolic blood pressure and HDL cholesterol in both sexes; moreover it was positively correlated with non-HDL cholesterol and negatively correlated with height in males only.

[L-carnitine for the treatment of acute myocardial infarct]. / La L-carnitina nella terapia dell'infarto miocardico acuto.

The treatment with L-carnitine in acute myocardial infarction was tested in 146 patients admitted in a coronary care unit. The administration of L-carnitine was based upon the drug availability and did not occur at random. Altogether 49 patients received the drug and 97 served as controls. By comparing the clinical characteristics at hospital admission a worse prognosis could be expected in those who did not receive the drug. Within 28 days from admission no deaths were observed in the treated group whereas 18 deaths (18.6 percent) were recorded among the controls. The prediction of fatal events was estimated by multiple logistic function taking the 28-days mortality as end point (either including or excluding the 72 hours early deaths) and using 2 different sets of factors as possible predictors, including the use of the drug. In particular there were 18 factors usually claimed as determinants of short term prognosis and 9 factors which were shown statistically different between the 2 groups. In all the 4 solutions the coefficient of L-carnitine was negative and in 3 of them also statistically significant, suggesting the protective role of the drug against early fatalities. Only the coefficient of the clinical impression of severity showed a greater statistical significance. The reported observations can be defined as the results of a pilot study which justify a more systematic study of the drug in the acute phase of myocardial infarction.

[Surveillance of coronary and cerebrovascular events. Experience and teachings of the Latin Area of the Monitoring of Cardiovascular Diseases project]. / Sorveglianza degli eventi coronarici e cerebrovascolari. L'esperienza e gli insegnamenti dell'Area Latina del Progetto MONICA.

The paper reports data collected during the first three years (1983-1985) of the MONICA Project--Monitoring of Cardiovascular Diseases--in the Area Latina. The age adjusted attack rates for coronary heart disease, averaged over a three year period, were 328 per 100,000 per year in males and 101 in females. The correspondent rates for cerebrovascular diseases were 247 and 161 per 100,000 respectively. The fatality rates for coronary events were 8.3% for males and 8.6% for females within the first hour. They rose to around 30% for both sexes within 24 hours and to 56% in males and 73% in females within 28 days. The fatality rates for cerebrovascular diseases during the first day were 25.3% in males and 27.8% in females, while within 28 days they reached 44.2% and 51.0% respectively. A large proportion of fatal events (about 50% for coronary cases and almost one third for cerebrovascular cases) occurred at home without any health care assistance.

Register for cerebrovascular events in the Area Latina, Italy. Clinical and epidemiological data during three years of surveillance.

Data are presented on the cerebrovascular events collected by a surveillance system during 1983-1985 in the MONICA Project-Area Latina, on a target population of about 400,000 subjects aged 25-74. The cerebrovascular events observed in 3 years were 2245: the fatalities (within 28 days from the onset of symptoms) numbered 1016 (562 males and 454 females), and the non fatal cases 1229 (742 males and 482 females). The attack rates per 10,000 per year were 21.96 for males and 15.20 for females. By definition, all the non fatal cases received some kind of treatment in hospital or nursing home. Among the fatal cases 68% received a treatment in a hospital or nursing home, while 32% died without medical attention. The fatality rate within 28 days was 43% for males and 48% for females.

High density lipoprotein cholesterol distribution and predictive power in some Italian populations studies.

Nine Italian population samples, for a total of 12,365 males and 8,043 females aged 11 to 84, were examined. The age and sex distribution of HDL-cholesterol levels were calculated for studying its relationship with major cardiovascular risk factors, and for estimating its predictive power on coronary events and on all causes of mortality. Mean values of HDL-cholesterol in the pool of the samples ranged, according to different age groups, from 46.4 to 56.8 mg/dl in males and from 53.7 to 55.8 mg/dl in females. The linear correlation coefficients between HDL-cholesterol and 10 risk factors did not show high levels except those with triglycerides in men aged 20-34 (-0.33) and 35-64 (-0.34). Using the multiple linear regression model the levels of HDL-cholesterol were estimated as a function of the 10 risk factors solving 4 equations (for males, females and for two age groups, 20-34 and 35-64). The factors showing significant coefficients were body mass index (negative), triglycerides (negative), cigarette smoking (negative), alcohol consumption (positive), physical activity (positive), and non-HDL-cholesterol (negative). The Cox model was used for the prediction of coronary death and all causes of death and the logistic function for the prediction of coronary incidence in two of the studies on men aged 46-65 (6 year follow-up) and aged 60-79 (5 year follow-up), and including 5 other factors as possible confounders. Only the univariate prediction of coronary deaths in one study (men aged 46-65) provided a significant coefficient for HDL-cholesterol (t = -2.7624).

Mortality and coronary events in two Italian MONICA areas: area Latina and area Brianza.

In Italy three areas have been enrolled in the MONICA Project, two being located in Northern Italy (Area Brianza and Area Friuli) and one in Central Italy (Area Latina). This report concerns the comparison of the first year mortality and registration data of two areas, Area Latina (1983) and Area Brianza (1985), for men and women aged 25-64. In Area Latina, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 483, 83 and 42 per 100,000 for males, and 252, 14 and 32 per 100,000 for females. In Area Brianza, the age-standardized mortality rates for all causes, for all coronary heart disease, and for stroke are respectively 541, 94 and 38 per 100,000 for males, and 249, 19 and 24 per 100,000 for females. For males the attack rate for coronary events is similar in Area Latina and Area Brianza but the distribution of events in the several diagnostic categories is different. For females the coronary attack rate is higher in Area Latina than in Area Brianza. The implications of these data are discussed mainly from the methodological point of view.