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Annual arrhythmic sudden cardiac death ranges from 0.6% to 4% in ischemic cardiomyopathy (ICM), 1% to 2% in non-ischemic cardiomyopathy (NICM), and 1% in hypertrophic cardiomyopathy (HCM). Towards a more effective arrhythmic risk stratification (ARS) we hereby present a two-step ARS with the usage of seven non-invasive risk factors: Late potentials presence (≥ 2/3 positive criteria), premature ventricular contractions (≥ 30/h), non-sustained ventricular tachycardia (≥ 1episode/24 h), abnormal heart rate turbulence (onset ≥ 0% and slope ≤ 2.5 ms) and reduced deceleration capacity (≤ 4.5 ms), abnormal T wave alternans (≥ 65μV), decreased heart rate variability (SDNN < 70ms), and prolonged QTc interval (> 440 ms in males and > 450 ms in females) which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step. In the second step, these intermediate-risk patients undergo a programmed ventricular stimulation (PVS) for the detection of inducible, truly high-risk ICM and NICM patients, who will benefit from an implantable cardioverter defibrillator. For HCM patients, we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter. © 2022 Baishideng Publishing Group Co. All rights reserved.

Background: Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and “positive” invasive electrophysiologic testing. Methods: This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90 ± 18.28 years, 61.5% male, 57.88 ± 7.73 bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied. Results: The mean of reported syncope episodes was 2.23 ± 1.29 (or presyncope 2.36 ± 1.20) in the last 12 months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (50.39 ± 32.40 months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group (P =.002). Conclusions: Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing. © 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society

Background: Sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) in the context of primary prevention remains suboptimal. The purpose of this study was to examine the additional contribution of programmed ventricular stimulation (PVS) on established risk assessment. Methods: Two-hundred-and-three consecutive patients with diagnosed HCM and ≥ 1 noninvasive risk factors were prospectively enrolled over 19 years. Patients were risk stratified, submitted to PVS and received an implantable cardioverter-defibrillator (ICD) according to then-current American Heart Association (AHA) guidelines and inducibility. Participants were prospectively followed-up for primary endpoint occurrence (appropriate ICD therapy or SCD). Contemporary (2015) AHA and European Society of Cardiology (ESC) guidelines were retrospectively assessed. Results: During a median follow-up period of 60 months the primary endpoint occurred in 20 patients, 19 of whom were inducible and received an ICD. Overall, 79 patients (38.9%) were inducible and 92 patients (45.3%) received an ICD (PVS sensitivity = 95%, specificity = 67.2%, positive predictive value = 24%, negative predictive value = 99.2%). AHA and ESC guidelines application misclassified 3 and 9 primary endpoint-meeting patients, respectively. Inducibility was the most important determinant of event-free survival in multivariate Cox regression (hazard ratio = 33.3). A combined approach of ESC score ≥ 6% or AHA indication for ICD with PVS inducibility yielded absolute sensitivity and negative predictive value, the former at a more cost-effective and specific way. Conclusions: Inducibility at PVS predicts SCD or appropriate device therapy in HCM. Non-inducibility is associated with prolonged event-free survival, while the procedure was proven safe. Reintegration of PVS into established risk stratification models in HCM may improve patient assessment. © 2017 Elsevier Ireland Ltd

Syngas fermentation is one of the most promising approaches among second generation biofuel technologies due to the benefits derived from the combination of thermochemical and biochemical conversion processes. In this process, a wide array of feedstocks of different nature can be converted through gasification into synthesis gas, composed by mainly H2, CO and CO2, which can be further converted biologically into both gaseous and liquid biofuels. The fermentation of synthesis gas has been typically carried out by pure cultures. However, using open mixed cultures and taking thus advantage of their inherent microbial diversity may offer a series of benefits such as high adaptive capacity, resilience to syngas impurities and non-sterile operation [1][2]. All the above may contribute to reducing utility consumption. On the other hand, a poor understanding of the microbial interactions within microbial consortia usually leads to low product selectivity in fermentation processes. Thus, gaining a better control on the activity of microbial consortia is fundamental for the further development of mixed microbial consortia fermentations.In this work, a number of enrichment strategies were designed for enhancing the microbial activity of anaerobic sludge towards the production of methane and ethanol. The methanogenic potential of the anaerobic sludge was assessed through enrichments at different temperatures, developing a mesophilic (37˚C) and a thermophilic (60˚C) methanogenic consortium. The ethanologenic potential of the anaerobic sludge was evaluated based on enrichments at different initial pH conditions (6, 5.5 and 5).The results showed that the enrichments led to less complex microbial consortia with a higher microbial activity towards the targeted products. The study of the behaviour of the methanogenic enriched consortia revealed different patterns of activity and inhibition between the mesophilic and the thermophilic consortia, obtaining a methane yield at the end of the enrichments of 81.4% and 92.6% of the theoretical maximum, respectively. In turn, the ethanologenic potential of the enriched consortia was observed to increase as the initial pH was lowered, achieving a maximum ethanol yield of 17.7%, 33.3% and 59.8% of the theoretical maximum in enrichments at pH 6, 5.5 and 5, respectively.Overall, controlling the operational conditions of the enrichments enhanced both the product yields and the activity of certain catabolic routes towards methane and ethanol. This allowed increasing significantly the overall conversion rate in methanogenic enrichments as well as the product selectivity in ethanologenic enrichments.

Over the last decades, the development of second generation biofuel technologies have been posed as a necessity due to the increasing energy demand in the transportation sector and the rising concerns about the climate change. Common approaches for the production of second generation biofuels involve the conversion of recalcitrant biomasses via either biochemical or thermochemical methods such as biomass pretreatment and fermentation of carbohydrates, and biomass gasification coupled to Fischer-Tropsch (FT) processes. Syngas fermentation has also been proposed as a promising alternative to the aforementioned technologies as it presents higher biomass conversion efficiency compared to biochemical methods, and lower operational costs when compared to FT processes.1The fermentation of syngas into ethanol has been mostly studied using pure cultures. Nevertheless, several acetogenic species have been reported to be partially inhibited by the impurities of raw syngas, which would increase the raw syngas cleaning requirements.2 A possible alternative to circumvent the additional gas clean-up step is using open mixed microbial consortia (MMC) as their inherent microbial diversity confers them with a higher resilience towards toxic compounds, thus reducing partial inhibition phenomena.3 Additionally, the fact that sterile operation is not required in MMC-based processes contributes to reducing the operational costs by minimizing the utility consumption. On the other hand, the microbial interactions prevailing within microbial communities are often poorly understood, which leads to a decreased performance in terms of yield and product selectivity.In order to overcome these limitations, this work focused on studying the effects of operational conditions on the enrichment of MMC for enhancing the product selectivity towards ethanol, as well as on studying the effects of operational parameters on the ethanol yield and productivity of a MMC-based continuous process using a 2 L stirred tank reactor. The results showed that the enrichments at different pH conditions had a strong effect on the microbial activity and the final ethanol yield in batch experiments, obtaining a maximum ethanol yield of 17.7%, 33.3% and 59.8% of the theoretical maximum at pH 6, 5.5 and 5, respectively. Further experiments in continuous mode showed that pH, HRT and gas loading rate are essential operational parameters governing microbial interactions within the microbial consortium, and consequently the ethanol yield and product distribution.

The fermentation of synthesis gas is a promising approach for the production of biofuels as it combines benefits derived from both thermochemical and biochemical conversion processes. In this process, a wide range of feedstocks can be converted through gasification into synthesis gas, a mixture of H2, CO and CO2, which can be further converted biologically into gaseous and liquid biofuels. The fermentation of synthesis gas has been typically studied using pure microbial cultures. However, open mixed cultures may offer a series of advantages over pure cultures such as high adaptive capacity, resilience to syngas impurities and non-sterile operation [1, 2]. On the other hand, the poor understanding of the microbial interactions in mixed cultures usually leads to low product selectivity in fermentation processes. Thus, gaining a better control on the activity of the whole microbial community is fundamental for the further development of mixed culture-based fermentations.In this work, a number of batch and continuous enrichment strategies were designed for enhancing the microbial activity of anaerobic sludge towards the production of methane and ethanol. The methanogenic potential of the anaerobic sludge was assessed through batch enrichments at different temperatures (37˚C and 60˚C). The ethanologenic potential of the anaerobic sludge was evaluated through batch enrichments at different initial pH conditions (6, 5.5 and 5) and through a continuous enrichment using a 2 L CSTR fermenter operated at pH 4.5, HRT of 5 days and a gas inflow rate of 10 mL/min. Subsequently, the effect of the HRT and the mass transfer on the distribution of fermentation products was studied.The results showed that the batch enrichments led to less complex microbial consortia with a higher activity towards the targeted products. At the end of the batch enrichments, the methane yield of the mesophilic and the thermophilic methanogenic consortia corresponded to 81.4% and 92.6% of the theoretical maximum, respectively. Additionally, the study of the specific activity on H2/CO2, CO and acetate of the methanogenic enriched consortia revealed different patterns of activity between the two methanogenic microbial consortia. The ethanol yield obtained using the different ethanologenic enriched consortia was observed to increase as the initial pH was lowered, achieving a maximum ethanol yield of 17.7%, 33.3% and 59.8% of the theoretical maximum in enrichments at pH 6, 5.5 and 5, respectively. Similarly, the enrichment in continuous mode promoted a higher ethanologenic activity compared to the initial anaerobic sludge used, and both HRT and mass transfer were shown to be influencing parameters on the distribution of fermentation products under operation in continuous mode.

Polyhydroxyalkanoates (PHA) are biopolymers produced as internal carbon storage in bacteria. They are a potential alternative to petroleum derived plastics, although their competitiveness is still limited by their productions costs. These could be lowered by the use of waste substrates - such as crude glycerol, a major by-product of the biodiesel industry- and microbial mixed cultures - which do not require sterilisation 1.An important limitation for the PHA production from glycerol is the side accumulation of glycogen, a polymer with no market value. This can be circumvented by submitting first the substrate to anaerobic fermentation to produce volatile fatty acids (VFA), which are preferred substrates for PHA production2. However, the fermentation also leads to 1,3-propanediol (1,3-PDO), a compound not previously described for PHA production.Initial experiments aimed at the transformation of both VFA and 1,3-PDO to PHA. Using the classical feast-famine enrichment strategy, PHA production from 1,3-PDO was not observed. Conversely, the transformation was achieved by using a new strategy that limited the nitrogen during the feast phase. Nevertheless, the PHA yield obtained form 1,3-PDO was very low compared to the one obtained from VFA (0.24 vs 0.74 Cmol PHA/Cmol S).Given that 1,3-PDO is also a high value product, a third enrichment strategy was applied where only VFA were converted into PHA (up to 70% of the cells dry matter with a yield of 0.9 Cmol PHA/Cmol S) and 1,3-PDO was recovered from the process (97% recovery) in a biorefinery scheme. This strategy, based on the development of substrate preferences in mixed cultures, has the potential of being applied in other downstream processes of biological conversions, where fermentation side-products could be transformed into a high value product (PHA).

The current increasing trend in worldwide gasification capacity anticipates that thermochemical biomass conversion methods will play a significant role in the transition to a future bio-based economy. However, the development of more efficient syngas conversion processes to produce biofuels and chemicals is still needed. In this context, the process of syngas biomethanation is currently being considered as an alternative to the catalytic syngas methanation process. This biological process presents a number of inherent benefits such as the use of inexpensive biocatalysts, milder conditions of operation and higher tolerance to the impurities of the raw syngas, which may result in a more cost-effective process [1]. Nevertheless, a thorough understanding of the biological processes that prevail during the biomethanation of syngas is fundamental for the control and optimization of this process.This work focuses on the study of methanogenic syngas-converting microbial consortia, with the ultimate objective of enhancing the efficiency of the biomethanation of syngas in terms of yield and rate of conversion. A series of enrichment experiments were performed in order to generate two different microbial consortia, one of them enriched at mesophilic conditions and the other at thermophilic conditions. Subsequently, these enriched consortia were kinetically characterized in order to study their patterns of activity and determine the main syntrophic interactions present in each of the consortia. The results showed a significant increase in the conversion efficiency of syngas by the enriched consortia due to the selection and adaptation of the most efficient microbial groups. The maximum methane yields obtained at the end of the enrichment corresponded to 82,4% and 92,7% of the stoichiometric yield for the mesophilic and the thermophilic consortium, respectively. Additionally, the kinetic studies revealed significant differences between the patterns of activity of the mesophilic and the thermophilic consortia. Overall, the thermophilic consortium presented higher conversion rates along with a less complex microbial structure, both of which would ultimately favor a much higher methane productivity in a continuous syngas biomethanation process.

The present study focused on the impact of methicillin resistance of Staphylococcus aureus on cytokine production by monocytes. Cytokine stimulation was studied by 20 heat-killed isolates, 10 methicillin-susceptible Staphylococcus aureus (MSSA) and 10 methicillin-resistant Staphylococcus aureus (MRSA). Bacterial endocarditis was induced in 27 male rabbits by challenge with 1 MSSA isolate and 1 MRSA isolate. Blood was sampled for estimation of tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) and stimulation of monocytes. MSSA induced greater stimulation of TNF-α than MRSA, as shown after addition of a Toll-like receptor-4 (TLR4) antagonist. Survival of rabbits challenged by MRSA was prolonged compared to those challenged by MSSA. Serum MDA was greater after MSSA stimulation. Serum of animals challenged by MRSA stimulated greater release of interleukin (IL)-8 and IL-10 compared with MSSA: the opposite was observed for TNF-α. It is concluded that MSSA and MRSA induce a different pattern of TNF-α stimulation through a TLR4-independent mechanism, leading to shorter survival in experimental endocarditis. © 2012 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

The data regarding the role of serum uric acid (SUA) along with subclinical inflammation in the context of hypertensive vascular damage are rather scarce and controversial. Towards this end, we assess the links between SUA, high-sensitivity CRP (hs-CRP), adiponectin and carotid to femoral pulse wave velocity (c-f PWV) in 292 subjects with never-treated stage I-II essential hypertension. On the basis of the median SUA levels (0.31 mmol l -1), the study population was divided into subjects with low (n=149) and high (n=143) SUA values. By multiple regression analysis, it was revealed that SUA was independently associated with log hs-CRP (R 2 = 0.098; P=0.02), log adiponectin (R 2 = 0.102; P=0.03), waist circumference (R 2 = 0.049; P=0.04), 24-h systolic blood pressure (SBP) (R 2 = 0.179; P=0.001) and estimated glomerular filtration rate (R 2 = 0.156; β (s.e.)=-0.169 (0.023); P=0.02). In addition, c-f PWV was independently associated with age (R 2 = 0.116; P < 0.0001), waist circumference (R 2 = 0.088; P

We report a 31-year old woman with essential hypertension grade III and history of branch retinal vein occlusion in the setting of hyperhomocysteinemia due to homozygous MTHFR gene mutation and elevated Lp(a). The patient was treated successfully with antihypertensive treatment, acetylsalicylic acid and multivitamin complex supplementation. © 2008 Elsevier Ireland Ltd.

Moxifloxacin (MXF) is an 8-methoxyquinolone with high activity against Gram-positive bacteria. In an experimental model of aortic valve endocarditis (EAVE), the efficacy of MXF was evaluated against a strain of methicillin-resistant Staphylococcus aureus (MRSA). Rabbits with catheter-induced aortic valve vegetations were randomly assigned to a control group or to groups receiving MXF 20 mg/kg intravenous (i.v.) twice a day (bid) or vancomycin (VAN) 30 mg/kg i.v. bid for a total of eight doses (4 days). Rabbits were sacrificed 15 h after the last dose of antibiotics. In another group, treatment with MXF was extended to 5 days and rabbits were sacrificed 5 days after the last dose (10th dose) of MXF in order to detect possible relapses of endocarditis after the end of treatment (test-of-cure (TOC) study). Both MXF and VAN significantly reduced the bacterial load in vegetations (P < 0.001 vs. controls). All animals in the MXF-TOC group had sterile vegetations. MXF given at a dose of 20 mg/kg i.v. bid for 4 days was equally effective as VAN in the treatment of EAVE due to MRSA. When treatment with MXF was extended to 5 days, the cure rate reached 100% and no relapses of endocarditis were observed. © 2008 Elsevier B.V. and the International Society of Chemotherapy.

We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m-2, P < 0.01 and 1.4 mm m-2, P = 0.003, respectively) or LV-CR (by 1.3 mm m-2, P=0.003 and 1.6 mm m-2, P = 0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m-2, P < 0.001 and 3.4 ml m-2, P < 0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m-2, respectively, P < 0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.

Objectives: To evaluate the efficacy of oral linezolid, with or without rifampicin, on valve vegetations and secondary foci of infection compared with vancomycin, in the absence or presence of rifampicin, in experimental endocarditis caused by methicillin-resistant Staphylococcus aureus. Methods: Treatment groups were controls (n = 16), linezolid (n = 15), vancomycin (n = 15), linezolid and rifampicin (n = 15), vancomycin and rifampicin (n = 13), linezolid relapse (n = 11) and vancomycin relapse (n = 9). Therapy lasted 5 days in all groups, with survival of animals in the linezolid relapse and vancomycin relapse groups being recorded for an additional 5 days. Blood was drawn to determine the linezolid concentration, and valve vegetations, and kidney, liver, lung and spleen segments were collected for culture. Results: Survival in each individual group was higher than that in the control group; bacterial load in valve vegetations was reduced by all treatment regimens, with linezolid exhibiting bactericidal effects. Bactericidal activity of linezolid was noted in all secondary foci of infection except the lung, where only the combination of rifampicin with linezolid was bactericidal. Conclusions: Orally administered linezolid is effective in limiting bacterial growth in the secondary foci of endocarditis. Co-administration of rifampicin favoured the suppression of bacterial growth in the lung. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Aims: In this study, we investigated the combined effect of increased high-sensitivity C-reactive protein (hs-C-reactive protein) and hypoadiponectinaemia on aortic stiffness in essential hypertensive subjects. Methods and results: A total of 267 untreated patients with stage I-II essential hypertension underwent ambulatory BP and carotid-femoral pulse wave velocity (c-f PWV) evaluation. The distributions of hs-C-reactive protein and adiponectin were split by the median (1.3 mg/L and 7.8 μg/mL, respectively) and accordingly subjects were stratified into those with high and low values. Patients with high (n = 134) compared with those with low hs-C-reactive protein (n = 133) values exhibited greater c-f PWV levels (by 0.8 m/s, P < 0.0001), whereas patients with low (n = 133) compared with those with high (n = 134) adiponectin levels had higher c-f PWV (by 0.9 m/s, P < 0.0001). Stepwise regression analysis revealed that age, 24 h systolic BP, hs-C-reactive protein and adiponectin were independent predictors of arterial stiffness. In patients with low hs-C-reactive protein, hypoadiponectinaemia (n = 46) compared with high adiponectin (n = 87) was accompanied by increased c-f PWV (by 0.8 m/s, P < 0.0001). Similarly in patients with high hs-C-reactive protein, hypoadiponectinaemia (n = 84) compared with high adiponectin (n = 50) was related to heightened c-f PWV (by 0.7 m/s, P = 0.008). Conclusion: In essential hypertension, pronounced low-grade inflammation in conjunction with hypoadiponectinaemia exerts an additive detrimental effect on aortic stiffness, accelerating the vascular ageing process. © The European Society of Cardiology 2007. All rights reserved.

Current epidemiological trends of infective endocarditis (IE) in Greece were investigated via a prospective cohort study of all cases of IE that fulfilled the Duke criteria during 2000-2004 in 14 tertiary and six general hospitals in the metropolitan area of Athens. Demographics, clinical data and outcome were compared for nosocomial IE (NIE) and community-acquired IE (CIE). NIE accounted for 42 (21.5%) and CIE for 153 (78.5%) of 195 cases. Intravenous drug use was associated exclusively with CIE, while co-morbidities (cardiovascular disease, diabetes mellitus, chronic renal failure requiring haemodialysis and malignancies) were more frequent in the NIE group (p < 0.05). Prosthetic valve endocarditis (PVE) predominated in the NIE group (p 0.006), and > 50% of NIE cases had a history of vascular intervention. Coagulase-negative staphylococci and enterococci were more frequent in cases of NIE than in cases of CIE (26.2% vs. 5.2%, p < 0.01, and 30.9% vs. 16.3%, p 0.05, respectively). Enterococci accounted for 19.5% of total IE cases and were the leading cause of NIE. Staphylococcus aureus IE was hospital-acquired in only 11.9% of cases. In-hospital mortality was higher for NIE than for CIE (39.5% vs. 18.6%, p 0.02). Cardiac failure (New York Heart Association grade III-IV; OR 13.3, 95% CI 4.9-36.1, p < 0.001) and prosthetic valve endocarditis (OR 3.7, 95% CI 1.3-10.6, p 0.01) were the most important predictors of mortality.

Objective: Left atrial (LA) enlargement is an index of adverse cardiovascular events. We sought to investigate any possible correlation between haemodynamic load, neurohumoral factors and LA size in the early stages of essential hypertension. Methods: We studied 94 consecutive middle-aged subjects, with newly diagnosed stage I-II essential hypertension without left ventricular (LV) hypertrophy and 34 age and sex-matched normotensive individuals. Ambulatory blood pressure (BP) monitoring, plasma levels of brain natriuretic peptide (BNP), metabolic profile and left atrial volume index (LAVI), an echocardiographic measurement of LA volume indexed for the body surface area, constituted the work-up of all subjects. Results: Hypertensive compared with normotensive subjects had significantly increased office and ambulatory systolic and diastolic BP (P < 0.0001 for all cases) as well as body mass index and waist-to-hip ratio (P < 0.05 for both cases). BNP levels were greater in hypertensive compared with normotensive subjects but were not statistically significant (20.4 versus 17.1 pg/ml, P = NS). Hypertensive compared with normotensive subjects also had significantly increased LV mass index (105 versus 84 g/m2, P < 0.0001), LA diameter (39 versus 36 mm, P < 0.0001), and LAVI (22 versus 19 ml/m2, P < 0.05). In the hypertensive population, LAVI exhibited significant positive relationships with office systolic BP, ambulatory pulse pressure, LV mass index and BNP. In multiple linear regression analysis only LV mass index and BNP were significantly associated with LAVI (beta = 0.298, P = 0.030 and beta = 0.322, P = 0.009, respectively). Conclusions: Increased LAVI, closely associated with LV mass index and BNP, was still found in the early stages of essential hypertension. However, the clinical significance of these findings remains to be elucidated in future studies. © 2006 Lippincott Williams & Wilkins.

Background: Whether the blunted nocturnal blood pressure (BP) fall alters the potential beneficial effects of estrogen replacement therapy (ERT) on arterial elastic proper-ties in hypertensive postmenopausal women has not been clarified. The aim of this study was to determine the potential beneficial effects of ERT on arterial elastic properties and to investigate whether a blunted nocturnal BP fall could unfavorably modify the estrogen-induced alterations of large-artery stiffness in postmenopausal women with untreated essential hypertension. Methods: A total of 66 postmenopausal women with untreated essential hypertension underwent carotid-femoral pulse wave velocity (PWV) measurements at baseline and after 12 weeks of ERT with 0.625 mg conjugated estrogen. By 24-h ambulatory BP monitoring, women were classified according to dipping status (nondippers, n = 21; dippers, n = 45). Results: The two groups were similar regarding age, body mass index, time since menopause, and lipidemic profile. Initially, nondippers compared to dippers, although they had significantly greater office systolic BP (SBP), 24-h SBP, daytime SBP and night-time SBP (by 5, 2, 3, and 19 mm Hg, respectively, P &LT;.05 for all cases), did not differ regarding left ventricular (LV) mass index and aortic PWV (116 v 114 g/m(2) and 8.40 v 7.95 cm/sec, respectively, P = NS for both cases). Use of ERT, without affecting the office SBP and DBP, reduced significantly the aortic PWV in both nondippers and dippers (by 1.28 and 1.50 cm/sec, respectively, P &LT;.05 for both cases). However, these PWV reductions were not different between the two groups (P = NS). A multivariate analysis identified patient age and 24-h SBP as significant determinants of estrogen-induced aortic PWV reduction (P &LT;.05). Conclusions: A blunted nocturnal BP fall does not attenuate the estrogen-induced favorable modifications of large artery elastic properties in hypertensive postmenopausal women. Whether these findings suggest that hypertensive women with ERT-induced attenuation of PWV represent a specific clinical subgroup of patients with possible ERT-associated cardiovascular benefit remains to be determined by properly randomized trials. &COPY; 2005 American Journal of Hypertension, Ltd.

In order to clarify whether susceptible and multidrug-resistant Pseudomonas aeruginosa differ in the mechanism of induction of sepsis, three different isolates were used; one susceptible (isolate A) and two (isolates B and C) multidrug-resistant. Isolate B had moderately elevated MICs of antipseudomonal antimicrobials and isolate C highly elevated MICs. Each isolate was infused by a catheter inserted into the right jugular vein of six rabbits. Survival was recorded; blood was sampled at regular time intervals for estimation of bacterial blood counts, malondialdehyde (MDA) and turnout necrosis factor-alpha (TNFalpha). Quantitative cultures of various organs were performed after death or sacrifice. Mean survival after challenge by isolates A, B and C was 0.73, 2.58 and 11.00 days, respectively (P of comparisons A versus B, 0.0048; A versus C, 0.0012; B versus C, 0.0005). The number of viable organisms in the blood after challenge using isolates A and B was greater than the viable counts of C. Serum MDA was lower after challenge with B and C compared with A. Serum TNFalpha levels were higher after challenge by isolate A compared with isolate C. The bacterial loads of the liver, lower right lung lobe, spleen and mesenteric lymph nodes were greater after challenge by isolate A than the other isolates. It is concluded that infection by multidrug-resistant P. aeruginosa is accompanied by increased survival compared with infection by Susceptible isolates; that finding might be explained by the different mechanisms leading to sepsis. Further studies must be done to clarify the significance of these observations for therapeutics. (C) 2004 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.