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Hypertensive subjects can be subdivided into 2 groups, dippers and nondippers, according to the presence or the lack of a nocturnal fall of blood pressure of more than 10%. Several studies have investigated cardiac organ damage in the 2 groups with discordant results, but they included subjects with different onset, severity, and treatment of hypertension. The authors selected 23 dippers and 17 nondippers affected by newly (< 1 year) diagnosed grades 1 and 2 hypertension, never treated, who underwent 24-hour ambulatory blood pressure monitoring and M-mode echocardiography. They did not find significant differences between the 2 groups as regards the echocardiographic left ventricular and atrial dimensions or regarding the left ventricular mass, left ventricular mass index, or relative wall thickness. Also no significant differences were found in the rate of either left ventricular remodeling or left ventricular hypertrophy. These data suggest that nondipping status is not associated with a higher level of cardiac involvement in the early phases of hypertension compared to dipping status. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the exercise tolerance by expired gas analysis during stress test in patients with Systemic Sclerosis (SSc).Methods: Eighteen women (mean age 48.56+/-12.48 years) affected by SSc were studied. A complete echocardiographic examination including pulmonary artery systolic pressure estimation, pulmonary function tests, diffusion lung capacity for carbon monoxide (DLCO), and exercise test were performed. During exercise, breath-by-breath expired gas analysis was performed.Results: Seven patients (39%) had baseline pulmonary systolic hypertension (group A) and 11 patients (61%) did not (group B). Six patients had reduced DLCO values. Both maximal oxygen consumption (VO2max) and anaerobic threshold (VO2AT) values were markedly decreased compared to the predicted values. Seven of 18 patients were unable to complete a maximal exercise (5 of whom affected by pulmonary systolic hypertension). Group A patients showed reduced VO2max, VO2AT, and O2 pulse compared with patients with group B patients (p=0.004, 0.017, and 0.013, respectively); VO2max, VO2AT and O2 pulse were significantly correlated to baseline pulmonary artery systolic pressure.Conclusions: An exercise intolerance in patients affected by SSc is present. Impairment of exercise performance is associated with pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Presents information on a study investigating the relationship of plasma endothelin (ET)-1 levels, pulmonary hypertension and lung fibrosis in patients with systemic sclerosis. ET-1 concentration of patients with systemic sclerosis; Effect of high plasma ET-1 on systemic hypertensive patients.

A 32-year-old man with family history of amyloidosis was admitted to the hospital because of orthostatic hypotension. An echocardiogram was suggestive for cardiac amyloidosis. Heart rate variability analysis, performed on 24-h Holter monitoring, showed markedly low values in both frequency and time domain, reflecting a severe autonomic nervous system dysfunction. [Copyright &y& Elsevier]

Objective: To investigate whether parathyroidectomy (PTx) reverses risk factors for arrhythmias related to the QT dynamic changes evaluated during bicycle ergometry exercise test (ET). Methods: Twenty-four postmenopausal women with primary hyperparathyroidism (PHPT) (mean age 60.0±8.4 years) and 30 sex- and age-matched controls underwent ET, echocardiography, and biochemical evaluation. The following stages were considered during ET: rest, peak exercise, and recovery. The patients were randomized to two groups: 12 underwent PTx (group A) and 12 were followed-up conservatively (group B). After 6 months, the patients were studied again. Results: Groups A and B showed no differences in mean baseline biochemical values, echocardiographic parameters, and QTc interval. PHPT patients showed an increased occurrence of ventricular premature beats (VPBs) during ET compared with controls (37.0 vs 6.6%, P=0.03). Serum calcium level was a predictor of VPBs (P=0.05). Mean value of QTc was in the normal range at baseline (group A: 401±16.9; group B: 402.25±13.5 ms) but significantly lower than controls (417.8±25.1 ms, P<0.01). A negative correlation was found between QTc and calcium values (P=0.03). Physiological reduction of QTc interval from rest to peak exercise was not observed in PHPT patients before surgery. After PTx, group A had a significant reduction in VPBs compared with baseline (at baseline, 5 of 12 vs none of 12 patients after PTx, P=0.03) and a restored normal QT adaptation during ET. Group B showed no significant changes after a 6-month period. Conclusions: PTx reduces the occurrence of VPBs and restored the QTc adaptation during ET. [ABSTRACT FROM AUTHOR]

Background Hypercalcemia induces arrhythmias and shortening of QT. The aim of this study was to investigate risk factors for occurrence of arrhythmias in patients with primary hyperparathyroidism ( PHPT) during bicycle ergometer exercise test ( ET). Methods Thirty PHPT postmenopausal women (mean age, 60·9 ± 8·0 years) and 30, sex and age-matched, controls underwent ET, echocardiogram and mineral metabolism biochemical evaluation. The following stages were considered during ET: rest, peak exercise, recovery (early recovery, 2 and 10 min after peak exercise). QT was corrected with Bazett's formula ( QTc). Results Compared with controls, PHPT patients showed an increased occurrence of ventricular premature beats ( VPBs) during ET (26·6% vs. 6·6%, P = 0·03). Being affected by PHPT predicted the onset of VPBs at peak exercise ( P = 0·04) and recovery ( P = 0·03), as shown by logistic regression analysis. In PHPT patients, serum calcium level was a predictor of VPBs at peak exercise ( P = 0·05). QTc in patients with PHPT was in the normal range. Serum calcium level showed a negative correlation with QTc ( P = 0·01) in whole sample. Compared with controls, PHTP patients had QTc significantly shorter for every stage of ET, except at peak exercise. Physiological reduction of QTc interval from rest to peak exercise was not seen in patients with PHPT, QTc at rest being the only predictor of QTc in every stage, as shown by multivariate regression analysis. Conclusions In patients with PHPT, an increased occurrence of VPBs and a different QTc adaptation during ET were observed and may represent risk factors for major arrhythmias. [ABSTRACT FROM AUTHOR]

Aeromonas hydrophila has been infrequently reported as a cause of infection in humans. It has been associated with a variety of clinical syndromes but Aeromonas-related endocarditis is extremely rare. We present the case of a 76- year-old diabetic patient who was admitted to our hospital due to severe lumbar pain resistant to nonsteroidal anti-inflammatory drugs accompanied by fever (up to 38.5°C). The vital signs were normal and the physical examination was unremarkable except for tenderness over right flank. Laboratory investigation showed a mild leukocytosis (white blood cell count of 11,360×106/L) with elevation of inflammatory markers. Cardiac ultrasound showed a large vegetation on the mitral valve. Abdominal computed tomogrpahy revealed a ruptured aneurysm of the right renal artery. Multiple sets of blood culture grew A. hydrophila. [ABSTRACT FROM AUTHOR]

Introduction. We report a case of stroke in a crack smoker with occlusion of the middle cerebral artery and a large thrombus in the carotid artery. Case Presentation. A 34-year-old female presented with left upper arm weakness, associated with paresthesia with onset of symptoms more than 24 hours before. Angio-RM sequences showed an area of ischemia, with occlusion of the M2 segment of the middle cerebral artery. Carotid ultrasound showed a soft plaque with distal end floating. Anticoagulant treatment was started, and seriated ultrasound evaluations showed its gradual dissolution. Conclusions. In atherothromboembolic stroke from carotid thrombosis, repeated ultrasound studies may be useful for either diagnosis and monitoring the efficacy of anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Background: Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas - recently defined as possible autonomous cortisol secretion (pACS) - has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. Subjects and methods: Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. Results: According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 nonfunctioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMIBSA) was increased in pACS compared to NFA (P = 0.006) and mildly correlated to the post-DST cortisol level (rho = 0.347; P = 0.004). The post-DST cortisol levels explained up to 13.7% of LVMIBSA variance (P = 0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P = 0.001) and worse arterial stiffness assessed by pulse wave velocity (P = 0.033). Conclusions: In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition. [ABSTRACT FROM AUTHOR]

Background Clostridioides difficile infection (CDI) might be complicated by the development of nosocomial bloodstream infection (n-BSI). Based on the hypothesis that alteration of the normal gut integrity is present during CDI, we evaluated markers of microbial translocation, inflammation, and intestinal damage in patients with CDI. Methods Patients with documented CDI were enrolled in the study. For each subject, plasma samples were collected at T0 and T1 (before and after CDI therapy, respectively), and the following markers were evaluated: lipopolysaccharide-binding protein (LPB), EndoCab IgM, interleukin-6, intestinal fatty acid binding protein (I-FABP). Samples from nonhospitalized healthy controls were also included. The study population was divided into BSI+/BSI- and fecal microbiota transplantation (FMT) +/FMT- groups, according to the development of n-BSI and the receipt of FMT, respectively. Results Overall, 45 subjects were included; 8 (17.7%) developed primary n-BSI. Markers of microbial translocation and intestinal damage significantly decreased between T0 and T1, however, without reaching values similar to controls (P <.0001). Compared with BSI-, a persistent high level of microbial translocation in the BSI+ group was observed. In the FMT+ group, markers of microbial translocation and inflammation at T1 tended to reach control values. Conclusions CDI is associated with high levels of microbial translocation, inflammation, and intestinal damage, which are still present at clinical resolution of CDI. The role of residual mucosal perturbation and persistence of intestinal cell damage in the development of n-BSI following CDI, as well as the possible effect of FMT in the restoration of mucosal integrity, should be further investigated. [ABSTRACT FROM AUTHOR]

Tregs can contribute to tumor progression by suppressing antitumor immunity. Exceptionally, in human colorectal cancer (CRC), Tregs are thought to exert beneficial roles in controlling pro-tumor chronic inflammation. The goal of our study was to characterize CRC-infiltrating Tregs at multiple levels, by phenotypical, molecular and functional evaluation of Tregs from the tumor site, compared to non-tumoral mucosa and peripheral blood of CRC patients. The frequency of Tregs was higher in mucosa than in blood, and further significantly increased in tumor.Ex vivo, those Tregs suppressed the proliferation of tumor-infiltrating CD8+and CD4+T cells. A differential compartmentalization was detected between Helioshighand HelioslowTreg subsets (thymus-derived versus peripherally induced): while HelioslowTregs were enriched in both sites, only HelioshighTregs accumulated significantly and specifically in tumors, displayed a highly demethylated TSDR region and contained high proportions of cells expressing CD39 and OX40, markers of activation and suppression. Besides the suppression of T cells, Tregs may contribute to CRC progression also through releasing IL-17, or differentiating into Tfr cells that potentially antagonize a protective Tfh response, events that were both detected in tumor-associated Tregs. Overall, our data indicate that Treg accumulation may contribute through multiple mechanisms to CRC establishment and progression. [ABSTRACT FROM AUTHOR]