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BACKGROUND: Pasta plays an important role in human nutrition, nevertheless its organoleptic, structural and bromatologic properties have not been completely studied. OBJECTIVE: The study aims to compare the ultrastructure pasta cross-sections produced with reduced mechanic stress and low heat exposure technique (Pietro Massi Technology ™) to common samples obtained with traditional technology in order to assess if a different process can alter the ultrastructure of starch and then, its digestibility. METHODS: A comparative study was performed on the ultrastructure of pasta using scanning electron microscopy (S.E.M). 55 were pasta cross-sections made with Pietro Massi technology, 33 were samples from different pasta factory produced using traditional process, for a total of 88 samples analysed. RESULTS: According to an Index based on what it was observed at one slide at S.E.M we classified samples and compared the number of grains, caves and canals visible, their dimensions in μm and average size of grains. The number of grains in group 1 (9.06±5.01) in group 2 (5.71±5.77), in group 3 (5.93±7.65) resulted significative more elevated compared to group 4 (0.73±2.58); in group 1 and group 2 the number of caves observed was higher than group 4. The size in μm of canals resulted significantly more elevated in group 1 than group 3 (p = 0.008), group 2(p = 0.013), and group 4 (p = 0.02). CONCLUSION: The analysis of average size of caves and canals in μm, the number of caves and grains demonstrated in samples obtained with Massi technology elevated values compared to samples obtained with traditional technique. The number of caves, grains and canals visible in the starch surface demonstrate the high quality of this pasta because they likely ensure penetration of water during cooking, facilitating at the same time the penetration of pancreatic amylases during digestion, suggesting a better digestibility in pasta produced according to this methodology.

Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.

Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.

After almost a year in the COVID-19 era, nothing has been done to assess facial masks currently available for professionals and for the general public, to improve the efficacy of the masks or to promote their correct use.

COVID-19 struck the world in early 2020 changing the same perception of reality as we have known it in the last decades. The onset of a novel completely unknown infection presented some challenges no one was ready to deal with. In this very complex scenario, the first step is to understand the enemy in an attempt of finding its soft spots. Then, we have to consider the host and the way the human body responds to the virus, understanding that every human being is unique.

Consumption of omega-3 fatty acids, including the precursor α-linolenic acid (ALA) is often sub-optimal and not in line with international guidelines. Supplementation is debatable, but some individuals, e.g., pre-diabetic, low-grade inflammation, cardiometabolic yet otherwise healthy subjects, might benefit from supra-physiological omega-3 intake, particularly to lessen inflammation. We explored the feasibility of a large clinical trial by performing a pilot study to evaluate adherence, palatability, and self-reported side effects of ALA administration in a group of volunteers. We enrolled 12 individuals with borderline dyslipidemia or overweight, treated with dietary advice according to international guidelines and who had insufficient intakes of essential fatty acids. Subjects were followed for nutritional counselling and were matched with appropriate controls. Patients were administered 6 g/day of ALA, for two months. We report the absence of side effects. such as fishy aftertaste and gastrointestinal distress, in addition to a slight decrease of C-reactive protein concentrations (Identifier: ISRCTN13118704).

Peripheral arterial disease is associated with very high cardiovascular risk. The main symptom is intermittent claudication, which strongly affects the quality of life. Therefore, treatment goals in peripheral arterial disease consist of the reduction of cardiovascular events and the relief of symptoms. An increase in pain-free walking distance, evaluated based on the Initial Claudication Distance, was also a strong positive prognostic factor in patients with peripheral arterial disease. Our objective was to reassess whether sulodexide is effective in improving Initial Claudication Distance. For this, we searched the literature according to the PRISMA checklist for double blind clinical trials assessing the improvement in the Initial Claudication Distance after 90 days of standard therapeutic regimen with sulodexide in adult patients with peripheral arterial disease. We found and assessed for bias in 11 studies eligible for review and meta-analysis. Data extracted from those studies favoured the sulodexide group, showing an overall difference in Initial Claudication Distance of +68.9 (CI 95%; ± 11.9 m) at the end of treatment (p

Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.

CONTEXT: The COVID-19 pandemic is probably the most challenging health crisis of the modern era as international health systems were not prepared to fight a virus whose capacity of spread is still being debated. The following are the two main challenges: the management of patients with acute infection of SARS-CoV-2, which needs more attention to have results in brief time, and the prevention of resultant neglect of patients who are not infected but need constant care for their chronic diseases. AIMS: To prevent the deaths from the “indirect effect” of the virus, the main aim was, with the help of telemedicine, to follow-up patients with high risk of poor outcome and to develop a protective system to reduce emergency department and hospitalizations access. The secondary aim was to develop an efficient telehealth model to be applied also after the COVID-19 pandemic. SETTINGS AND DESIGN: The study was voluntary and observational on patients enrolled between March and May 2020, during the first wave of the Italian pandemic. The project involved primary care and specialist physicians, nurses, informatics, and administrative services in the complex unity of primary care in Catanzaro Lido, Calabria Region. MATERIALS AND METHODS: Data such as blood pressure, heart rate, blood oxygenation, and glycemia were recorded using sphygmomanometer, oximeter, and glucometer and were communicated with a smartphone or a Bluetooth directly to a control room. The alerts were stratified according to the common emergency code: green for low risk, yellow for intermediate risk, red for high risk, and critic red for very high risk. RESULTS: Regarding patients with glycemic alerts, totally, 2135 were alert, 25% of them were at high risk, but only in 1 single case (0.04%), the intervention of 118 was necessary. The rest was resolved by telemedicine system with the help, when necessary, of first-level medical intervention. In 6.1% of cases, a specialist advice was required. Moreover, cardiovascular alerts were all resolved by the telemedicine system. CONCLUSIONS: The results obtained are preliminary but satisfying, a clear sign of how telemedicine could improve the management of disease chronicity but also of infectious disease.

Air pollution remains a major issue in terms of health promotion. Many are the implications and the possible strategies aimed to solve the problem. Those are mainly related to the need to prevent the exposure or effectively reduce the effects on exposed people (pre-primary, primary, secondary and tertiary prevention).

Air pollution is a complex matter because of its inner features; because of its social, economic, political, and ethical implications; and because of the complex interactions between pollutants and the human organism. The effects of air pollution, in fact, are still largely unknown; some are, and will remain, unpredictable.

To overcome problems related to air pollution, and for protection against its negative effects on health, a number of actions are required at the individual, local, national, and international levels. The role of prevention is crucial, as the effects of pollution on health are still largely unknown; some of them could show up years after exposure. For this reason, international bodies and experts are needed to foster proper environmental administration, to coordinate research, and to promote healthy behaviors that could reduce the risk of exposure for communities and individuals.

In this chapter, we speak about the global problem of pollution, and we want to suggest the strategy that governments and citizens should adopt to oppose it. We want to explain the logic, ethical and scientific bases of air pollution prevention also inspired by that wisdom that should induce the community to use effective tools to protect themselves and the ones they care. Fostering healthy lifestyles is another option to fight pollution, provided that the cliche often associated with pollution are properly addressed.

Air pollution can be considered a model to describe complexity and its implication in medicine. The number of components and interactions, the distribution of airborne pollutants through space and time and the possible short- and long-term effects on cells, tissues, organs and apparatus are an exhaustive example. The whole human being is more complex than the sum of its parts which are systems more complex than the sum of their parts and so on.

This chapter is about the state of the art for the creation of a good and sharable in medical record. This kind of record should take into account the inception point; that means that it has to start with the first encounter with the patient, where his or her history has to be properly taken. To achieve such a result, the record is supposed to start with the prerequisites that come out from ethical, epistemological and logical consideration; it should not be in conflict with the data acquirement and should not create a medical record that aimed only to economise (that is the base of the critics where the medical record has been described as a disruptive innovation). That is a type of innovation that creates new networks and new organisational cultures involving new players” with a potential improvement of health, displacing “older systems and ways of doing things. This seems more a business and bureaucratic decision, rather than one guided by science.

In Italy the military research aims to introduce, as secondary, a technology transfer practice for civilian-use purposes. Specifically, the developed wireless body sensor network (WBSN), which started as a research to improve soldiers’ protection, has the potential to be beneficial also to the civilian population. Our advanced prototypical sensors are based on a context-aware sensing and activity recognition, intended to produce information flows for mobile health check. The wearable user-centred design allowed the implementation of sensing and recognition functions on several physiological signals, as well as space and temporal localisation. The concept is that WBSN can function as a “track and trigger” system through the listening/reading of a complex biofeedback algorithm. This concept allows for the development of the right setting for logistic intervention. Large-scale modular customisations could make the efficient home-setting monitor of numerous patients and other persons in need of care, deliverable by a single health worker. The expected effects of introducing WBSN are reduced costs, reduced admission and time spent in care institutions, improved interactions between patients and caregivers, development of prospective models and provision of an enriched information resource for health policy decision makers, based on the use of dynamic territorial maps.

Antonio V Gaddi1, Arrigo FG Cicero1, Giovanni Gambaro21Atherosclerosis and Metabolic disease Research Unit, Internal Medicine, Aging and Kidney diseases Dept., University of Bologna, Italy; 2Nephrology and Dialysis Unit, Gemelli University Hospital, Sacred Heart Catholic University, Rome, ItalyAbstract: A relatively large body of evidence supports the notion that glomerular capillary wall and mesangial alterations in diabetic nephropathy involve biochemical alterations of glycoproteins in these structures. Evidence in experimental animals rendered diabetic reveals that the administration of heparin and other anionic glycoproteins can effectively prevent the biochemical alterations that promote albuminuria. Moreover, angiotensin II inhibits heparan sulfate synthesis, while heparins modulate angiotensin II signaling in glomerular cells, inhibiting aldosterone synthesis and lowering proteinuria in diabetes patients. Sulodexide, a mixture of heparin and dermatan sulfate, appears to be a promising treatment for diabetic proteinuria partially resistant to renin–angiotensin system blocking agents. Sulodexide prevents heparan sulfate degradation, thus allowing reconstruction of heparan sulfate content and restoration of glomerular basement membrane ionic permselectivity. The antiproteinuric effect appears to be mainly related to the basal proteinuria and consequently to the duration of treatment in a relatively large number of small clinical trials. On the other hand, several sulodexide pharmacodynamic properties could improve the prognosis of chronic kidney disease patients, also independently from its antiproteinuric effect. However, sulodexide development as an antiproteinuric drug needs to be continued, in order to define which kind of patients could better respond to this treatment.Keywords: glycosaminoglycans, sulodexide, albuminuria, proteinuria, diabetic nephropathy

The aim of this study was to comparatively evaluate the long-term effects of psyllium husk and guar gum supplementation on metabolic syndrome (MS) components. We randomised 141 MS patients to soluble psyllium husk powder or guar gum 3.5 g t.i.d. to be taken 20 min before the main 2 meals, or to a standard diet for a cumulative period of 6 months. Both fibres significantly improved body mass index (−7.2% vs. −6.5%), fasting plasma glucose (−27.9% vs. −11.1%) and insulin (−20.4% vs. −10.8%), HOMA Index (−39.2% vs. −16.7%), glycated haemoglobin (−10.4% vs. −10.3%), low-density lipoprotein cholesterol (−7.9% vs. −8.5%) and apolipoprotein B (−10.5% vs. −5.6%), after 6 months of treatment. Only the psyllium supplementation exerted a significant improvement on plasma triglyceride concentration (−13.3%) and systolic (−3.9%) and diastolic blood pressure (−2.6%). No significant difference was observed regarding the standard diet group in comparison to the baseline. On the basis of our data, psyllium could be more strongly indicated for patients that have to reduce a large number of cardiovascular risk factors, while guar gum could be more rapidly efficacious in strengthening the effect of diets aimed at reducing body weight.

The aim of our study was to directly compare the metabolic effect of monounsaturated fatty acid rich oils and polyunsaturated fatty acid rich oils on the plasma lipid pattern of moderately hypercholesterolaemic subjects under controlled isocaloric condition. After a 30-day run-in diet, 44 healthy Caucasian subjects with moderate hypercholesterolaemia were randomly assigned to one of four different isocaloric diets, differing only regarding the oil used (corn oil, corn oil supplemented with vitamin E, extra-virgin olive oil or different self-selected oils), for 45 days. At the end of the study, when compared to the baseline value, low-density lipoprotein (LDL)-cholesterolaemia was significantly lower only in patients taking corn oil (-13.9%; 95%CI -5.9 to -20.1; p = 0.02) or corn oil with added vitamin E (-19.1%; 95%CI -6.9 to -24.1; p = 0.03). Differences in plasma high-density lipoprotein (HDL)-cholesterol and triglyceride levels from baseline levels and between the four diets did not reach statistical significance.

This study was aimed at evaluating the tolerability of a nutraceutical combination with anticholesterolaemic action in patients intolerant of statin treatment. A total of 32 hypercholesterolaemic patients, all intolerant to at least two statin treatments, were enrolled in the ambulatory service. None of the enrolled patients was diabetic or undergoing secondary prevention of cardiovascular disease. Patients consumed one yoghurt with 2 g of added phytosterols each morning (Pro-Activ, Unilever, Milan, Italy) and one tablet of a registered combined nutraceutical (Armolipid Plus, Rottapharm, Monza, Italy). We tested the efficacy of the treatment after 4 and 6 months. One tablet of Armolipid Plus contains: berberine 500 mg, monacolin 3 mg, and policosanol 10 mg. After 3 months of treatment the patients showed a significant decrease in total cholesterol, low-density lipoprotein cholesterol and triglycerides, and a significant increase in the plasma level of high-density lipoprotein cholesterol. These results were maintained after 6 months of treatment without a significant change in the mean values.

Epidemiological data from the Framingham and other prospective studies suggests an inverse correlation between the plasma concentration of HDL-cholesterol (HDL-C) and the incidence of cardiovascular disease. The relationship between HDL-C and its vascular-protective effects is particularly due to the heterogeneity of these particles and their important role in reverse cholesterol transport. It is well-known that many different factors are involved in metabolic regulation of HDL and can affect their plasma concentration. Apolipoprotein A-I, the principal apolipoprotein of HDL, is synthesized and secreted in the intestine and liver, where several enzymatic processes contribute to the biogenesis and the catabolism of HDLs. In this review we report and analyze the main clinical, genetic and environmental determinants of plasma HDL-C concentration; moreover we underline how different laboratory methods of HDL-C dosage can influence the correct assessment of these plasma values. We present a comparison of HDL-C...

Antonio V Gaddi† & Cristina Malvi †Author for correspondence GC Descovich Atherosclerosis & Dysmetabolic disease Research Center, D Campanacci Clinical Medicine & Applied Biotechnology Department, Alma Mater Studiorum, University of Bologna, Bologna, Italy Tel.: +39 051 636 3938; Fax: +39 051 390 646; gaddis@med.unibo.it ‘...a prompt and correct diagnosis of hyperlipidemia is still a hard task for many practitioners and cases are frequenty unrecognized for many years after the first event.’

Objective: Familial Combined Hyperlipoproteinemic (FCH) is a disorder of lipid metabolism characterized by an increased risk of premature coronary heart disease. Our aim is to estimate the prevalence of FCH subjects in a large North-Italian rural population monitored for 32 years (1972-2004). Methods: In the 2004 Brisighella Heart Study (BHS) survey, 1303 subjects were tested in five or more four-yearly surveys (mean age: 63.7±14.9 years). The individual plasma lipid phenotype by Fredrickson classification was attributed for each survey on the basis of low density lipoprotein (LDL)-cholesterol and triglycerides. A primary dyslipoproteinemia was suspected on the basis of personal and family history, body mass index and dietary habits. Results: At the end of the longitudinal study, the subjects with variable phenotype in the studied population were 17.2% and among primary hyperlipoproteinemics 36.3%. Mean IIb phenotype prevalence was 12.3 ± 6.3% in all hyperlipoproteinemics, while it was 33.4 ± 11.9% in potential FCH subjects. Only 7 subjects were constantly IIb during the observation time and four of them are certainly secondary hyperlipoproteinemics. The Ilb phenotype prevalence was significantly more variable than the Ila phenotypes. The 3.1% of the studied subjects have been selected as candidates for a FCH diagnosis without significant differences between sexes. Conclusion: Our data suggest the existence of a long-term primary variability of the individual plasma lipid phenotype. The prevalence of FCH in the general population appears to be near 2%.

Conference scene of the satellite meeting of the 14th International Congress on Atherosclerosis, on "Physical activity, exercise and cardiovascular health"

Aim The aim of this study was to evaluate and quantify the role of different risk factors in the long-term development of Type 2 diabetes mellitus in a rural Italian population. Methods The Brisighella Heart Study (BHS; 1972–2003) is a prospective, population-based longitudinal epidemiological cohort involving 2939 randomly selected subjects, aged 14–84 years, resident in the rural Italian town of Brisighella. For this study, we randomly selected 1441 adult subjects representative of the Brisighella population; consecutively visited during three BHS surveys. A step-wise Cox regression analysis determined the prognostic significance of each independent risk factor for the development of Type 2 diabetes in the 8-year long follow-up. Results Blood pressure, high-density lipoprotein cholesterol, triglycerides, physical activity, total energy intake, and drug treatment had no effect on the incidence of diabetes. Age was a significant predictor of Type 2 diabetes when inserted alone in the model (P = 0.007), but irrelevant when adjusted for baseline body mass index (BMI) and or fasting plasma glucose. Among these with impaired fasting glucose (IFG), the diabetes incidence/year was estimated to be 6.6% for men and 11.2% for women (P

Objective. – To describe the effect of Coenzyme Q10 (CoQ10) (added to either a fibrate, or polyunsaturated fatty acids (PUFA) or association of both) in patients affected by massive hypertriglyceridemia (MHTG) resistant to fibrates and PUFA. Design. – Open, sequential, comparative intervention study. Setting. – Specialised centres for dyslipidemia management. Subjects. – Fifteen subjects (mean age: 45.1 ± 12.5 years) affected by MHTG and hyporesponsive to either fibrates, or PUFA, or fibrates-PUFA association, and 15 age-matched subjects regularly responders to PUFA and fenofibrate treatment. Interventions – Treatment for periods of 6 weeks each with the following consecutive treatments: CoQ10 150 mg/day, PUFA 3000 mg/day, fenofibrate 200 mg/day, PUFA 3000 mg/day + fenofibrate 200 mg/day, PUFA 3000 mg/day + CoQ10 150 mg/day, fenofibrate 200 mg/day + CoQ10 150 mg/day, and finally, fenofibrate 200 mg/day + PUFA 3000 mg/day + CoQ10 150 mg/day. Results. – CoQ10 supplementation did not improve any monitored parameter in the control group except for systolic and diastolic blood pressure, creatinine and Lp(a) plasma levels, both during fenofibrate and/or PUFA treatment. In MHTG group, CoQ10 supplementation significantly improved TG, TC, Lp(a), uric acid and blood pressure during fenofibrate treatment, but only Lp(a) and blood pressure during PUFA treatment. Fenofibrate appeared to have better effect on hsCRP and γ -GT plasma levels than PUFA. No significant change was observed in any group and under any treatment in regards to homocysteinemia, PAI-1, or t-PA. Conclusion. – Even though the mechanism of action through which the effects were obtained is yet to be elucidated, adding CoQ10 to fenofibrate could improve the drug's efficacy in MHTG patients not responding to fenofibrate alone.

Study Objective. To evaluate the differential effect on coagulation and fibrinolysis parameters of combination therapy with glimepiride-metformin and with rosiglitazone-metformin beyond their effect on glucose metabolism in patients with type 2 diabetes and metabolic syndrome. Design. Multicenter, double-blind, randomized, controlled trial. Setting. Two university-affiliated medical centers in Italy. Patients. Ninety-five patients with type 2 diabetes for at least 6 months without glycemic control by diet and oral hypoglycemic agents to their maximum tolerated dosage and who also had metabolic syndrome. Intervention. All 95 patients received metformin 1500 mg/day In a randomized manner, 47 patients received glimepiride 2 mg/day and 48 patients received rosiglitazone 4 mg/day. Measurements and Main Results. Body mass index (BMI), glycemic control, and coagulation and fibrinolysis parameters were evaluated at 3, 6, 9, and 12 months of treatment. Compared with baseline values, significant decreases in BMI, fasting plasma glucose, postprandial plasma glucose, and hemoglobin A1c were observed at 12 months in both the glimepiride and rosiglitazone groups (p

One of the categories of drugs most frequently used by the elderly, and probably the most commonly self-prescribed class of drug in this age group, is NSAIDs. However, NSAIDs are one of the primary causes of adverse drug reactions and are notorious for their gastric toxicity. They also inhibit renal function and reduce the efficacy of diuretics and ACE inhibitors, drugs that are commonly used by elderly patients. Recent studies have shown that cyclo-oxygenase (COX)-2 is important in renal physiology. This means that selective COX-2 inhibitors, while undoubtedly safer than NSAIDs in terms of gastric toxicity, are not devoid of renal toxicity (in addition to their now clearly established adverse effects on coronary heart disease risk). Both the gastric and renal toxicities induced by traditional NSAIDs and selective COX-2 inhibitors seem to be related to inhibition of prostaglandin, but not leukotriene, synthesis. Maintaining the correct balance between prostaglandins and leukotrienes is essential for continuing good health, but both classes of mediators also play an important role in the pathogenesis of several diseases. Recently, a new class of anti-inflammatory drugs, the lipoxygenase (LOX)/COX inhibitors, has been developed as a means of simultaneously inhibiting the synthesis of prostaglandins, thromboxanes and leukotrienes. Inhibition of leukotriene synthesis increases anti-inflammatory efficacy, particularly in rheumatic diseases, while reducing the risk of gastric damage. The LOX/COX inhibitor licofelone, which is currently in phase III trials, is the first of this new class and in the most advanced stage of development. Preliminary data with this drug seem promising, but further well designed clinical trials of this agent in the elderly will be necessary before a final evaluation is possible.

Glimepiride is approved as monotherapy and in combination with metformin or with insulin, whereas the combination of glimepiride with other antihyperglycemic drugs is under investigation.The aim of this study was to assess the differential effect on glucose and lipid variables and tolerability of the combination of glimepiride plus pioglitazone or rosiglitazone in patients with type 2 diabetes mellitus (DM) and metabolic syndrome.This 12-month, multicenter, double-blind, randomized, controlled, parallel-group trial was conducted at 3 study sites in Italy. We assessed patients with type 2 DM (duration,or =6 months) and with metabolic syndrome. All patients were required to have poor glycemic control with, or to have experiencedor =1 adverse effect (AE) with, diet and oral hypoglycemic agents such as sulfonylureas or metformin, both given up to the maximum tolerated dose. All patients received a fixed oral dose of glimepiride, 4 mg/d divided into 2 doses, self-administered for 12 months. Patients also were randomized to receive oral pioglitazone (15 mg once daily) (G + P group) or oral rosiglitazone (4 mg once daily) (G + R group), self-administered for 12 months. We assessed body mass index (BMI), glycemic control (glycosylated hemoglobin [HbA(1c)], fasting and postprandial plasma glucose and insulin levels [FPG, PPG, FPI, and PPI, respectively], and homeostasis model assessment index), lipid profile (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides [TG]), and lipoprotein variables (apolipoprotein [apo] A-I and apo B) at baseline and at 3, 6, 9, and 12 months of treatment. Treatment tolerability was assessed at each study visit using a thorough interview of patients, and comparisons of clinical and laboratory values to baseline levels.A total of 91 patients were enrolled in the study; 87 patients completed it (G + P group: 24 women, 21 men; mean [SD] age, 53 [6] years; G + R group: 20 women, 22 men; mean [SD] age, 54 [5] years). Patients in the G + P and G + R groups experienced significant increases in mean BMI at 12 months compared with baseline (4.92% and 6.17%, respectively; both, P0.05). The combination of glimepiride with pioglitazone or rosiglitazone significantly improved glycemic control in the study patients. At 12 months, we observed a 1.3% improvement in mean values for plasma HbA(1c) concentration (P0.01) 19.3% in FPG (P0.01), 16.3% in PPG (P0.01), 42.4% in FPI ), and 23.3% in PPI (P0.05); no significant differences were found between treatment groups. Although the G + P group experienced a significant improvement at 12 months in almost all variables of lipid metabolism from baseline (TC, - 11%; LDL-C, -12%; HDL-C, 15%; and apo B, - 10.6% [all, P , 0.05]), the G + R group experienced a significant increase in mostly the lipid risk factors for cardiovascular disease (TC, 14.9%; LDL-C, 16.5%; TG, 17.9%; and apo B, 10.3% [all, P , 0.05]). Overall, no statistically significant changes in plasma aminotransferase activities were observed. Of the 87 patients who completed the study, 6.7% (3/45) of patients in the G + P group and 11.9% (5/42) of patients in the G + R group had transient, mild to moderate AEs that did not cause withdrawal from the trial.In this study of patients with type 2 DM and metabolic syndrome who did not respond adequately to, or experienced AEs with, diet and either a sulfonylurea or metformin previously, the combination of glimepiride plus pioglitazone was associated with a significant improvement in lipid and lipoprotein variables, whereas the combination of glimepiride plus rosiglitazone appears to not have had any clinically significant effect on lipid metabolism.

The Massa Lombarda program (MLP) is the first step of a European multi-center program, promoted and coordinated from Bologna University's Academic Spin off Health Research and Development, which attempts to manage advanced sanitary research in general population. The -instant individual definition (IID) study is the first phase of the program concerning the study of risk factors (RF) and early diagnosis of coronary heart disease (CHD), through a new diagnostic technology called myocardial perfusion scoring system (MPS). The study consists of a longitudinal observational epidemiological investigation of adult population (above 25 years of age) resident in Massa Lombarda (Ravenna), with the survey of social and biological parameters. The elderly part of the population (1000 subjects above 75 years) was submitted to a more complex analysis, as part of the study on health status in European aging populations, aimed at revealing the determinants influencing the healthy aging, and at identifying their impact on mortality, cardiovascular and respiratory morbidity, disability and decline of quality of life. Laboratory analyses were aimed at identifying the following factors: (i) Genetic markers related to pro-and anti-inflammatory cytokine- codifying genes. (ii) Oxidative stress-involved molecules, and inflammation-involved genes, and more in general genes involved in the brittleness (ApoE). (iii) Appraising the degree of interaction with non-genetic factors, like measurable immunological markers in the peripheral blood, markers of reactions to oxidative stress, evaluation of metabolic parameters. Moreover, old population is expected to answer the questionnaires for evaluation of the dietary habits, physical activity, self-sufficiency, cognitive ability, motor coordination, perceived stress and social relationships.

A previous study has demonstrated that L-carnitine reduces plasma lipoprotein(a) (Lp[a]) levels in patients with hypercholesterolemia.To test a tolerable Lp(a)-reducing agent in diabetic patients, we assessed the effect of a dietary supplementation of L-carnitine on plasma lipid levels, particularly Lp(a), of patients with type 2 diabetes mellitus (DM) and hypercholesterolemia.In this 6-month, randomized, double-masked, placebo-controlled clinical trial, patients were enrolled, assessed, and followed up at the Diabetic and Metabolic Diseases Center of the Department of Internal Medicine and Therapeutics at the University of Pavia, Pavia, Italy. All study patients had newly diagnosed type 2 DM that was managed through dietary restriction alone throughout the study, as well as hypercholesterolemia. Patients were randomized to 1 of 2 groups. One group received L-carnitine, one 1-g tablet BID. The other group received a corresponding placebo. We assessed body mass index, fasting plasma glucose, postprandial plasma glucose, glycosylated hemoglobin, fasting plasma insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein (apo) A-I, apo B, and Lp(a) at baseline and at 1, 3, and 6 months of treatment.This study included 94 patients. The treatment group included 24 men and 22 women (mean [SD] age, 52 [6] years). The placebo group included 23 men and 25 women (mean [SD] age, 50 [7] years). The baseline characteristics of the groups did not differ significantly. The mean (SD) body weight, height, and body mass index were 78.2 (5.8) kg, 1.70 (0.04) m, and 27.3 (2.5) kg/m(2), respectively, in the L-carnitine group and 77.6 (6.4) kg, 1.71 (0.05) m, and 26.8 (2.2) kg/m(2), respectively, in the placebo group. In the treatment group, Lp(a) was significantly reduced at 3 and 6 months compared with baseline (P0.05) and P0.01, respectively). We observed a significant improvement after 6 months (P0.05) in the Lp(a) value in patients taking L-carnitine compared with those taking placebo. Between-group differences in other variables did not reach a level of significance at months 3 and 6. No drug-related adverse events were reported or observed.In this preliminary study, after 3 and 6 months, L-carnitine significantly lowered the plasma Lp(a) level compared with placebo in selected hypercholesterolemic patients with newly diagnosed type 2 DM.

The objective of this study was to determine the contribution of elevated blood pressure parameters to the long-term incidence of cardiovascular events.A prospective, population-based longitudinal epidemiological cohort.The population of the town of Brisighella.The Brisighella Heart Study involved 2939 randomly selected residents of Brisighella, Italy aged 14 to 84 years, free of cardiovascular (CV) disease at enrollment and followed since 1972. Subjects were clinically evaluated at baseline and every 4 years following enrollment when extensive clinical and laboratory data were obtained in addition to the assessment of morbidity and mortality.The Cox regression analysis, adjusted for the main risk factors for CV disease was used to determine the independent prognostic significance of systolic, (SBP), diastolic (DBP), and pulse pressure (PP). The events of interest were coronary heart disease (CHD) and cerebrovascular disease (CVD).Adjusted hazard ratios (HRs) for combined CHD + CVD at SBP categories of 120-139, 140-159, and 159 mmHg were 1.45 [95% confidence interval, (CI), P= 0.035], 1.88 (95% CI, P= 0.0008), and 2.31 (95% CI, P0.0001), respectively. For DBP ranges of 70-79, 80-89, and 89 mmHg, HRs were 0.91 (95% CI, P= 0.677), 1.33 (95% CI, P= 0.169), and 1.65 (95% CI, P= 0.029), respectively. PP ranges from 54-67 and 67 mmHg were associated with HRs of 1.23 (95% CI, P= 0.149), and 1.38 (95% CI, P= 0.030), respectively. Similar results were seen for CVD and CHD as separate endpoints.The present study demonstrates that SBP is a stronger predictor of cardiovascular events than DBP in the Brisighella population. The added prognostic significance of PP is also demonstrated, particularly if PP exceeds 67 mmHg.

The debate over eHealth is alive as never before. Supporters suggest that it will result in dramatic innovations in healthcare, including a giant leap towards patient-centered care, new opportunities to improve effectiveness, and enhanced wellness and quality of life. In addition, the growing market value of investments in health IT suggests that eHealth can offer at least a partial cure for the current economic stagnation. Detractors counter these arguments by claiming that eHealth has already failed: the UK Department of Health has shut down the NHS National Program for IT, Google has discontinued its Health flagship, and doubts have arisen over privacy safeguards for both patients and medical professionals. This book briefly explains why caregivers, professionals, technicians, patients, politicians, and others should all consider themselves stakeholders in eHealth. It offers myth-busting responses to some ill-considered arguments from both sides of the trench, in the process allowing a fresh look at eHealth. In addition, it describes how the technical failures of previous eHealth systems can be avoided, examines the legal basis of eHealth, and discusses associated ethical issues.

We selected 247 subjects from 29 large familial hypercholesterolemia (FH) kindreds from 550 probable FH subjects in Emilia Romagna (Italy) on the basis of LDL-cholesterol plasmatic levels and family trees, in order to define the best diagnostic criteria for heterozygous patients. Familial hypercholesterolemia is a monogenic disease of cholesterol metabolism inherited as an autosomal dominant trait and characterised by early cardiovascular disease. A low xanthomas and xanthelasmas prevalence was found (8.6%); coronary heart disease (CHD) death occurs very frequently in heterozygous males (72% of all deaths; mean age at death 52 years), while in females the primary cause of death was thrombotic stroke (55%; mean age 69 years). Total cholesterol (TC) mean values were 389.8 (m) and 373.3 mg/dl (f) for FH trait carriers, and 223.3 (m) and 228.8 (f) for healthy relatives. No age-related change in TC was found in heterozygotes, while unaffected relatives of FH families showed mean TC and LDL-C values, and a TC frequency distribution and a TC age-related increasing trend similar to the expected values for the Italian population. The TC frequency distribution curve appeared bimodal, with a mid-point between heterozygous and homozygous FH modal values of 280 mg/dl. To identify the FH patients, the final FH heterozygosity risk was evaluated in an unselected free-living population (from 0.07 to 0.8%, respectively, for TC between 265-274 and 295-304 mg/dl) and in hypercholesterolemic families (31 to 83%, and the same TC classes). Our conclusion is that the clinical picture is rarely pathognomonic, while the FH heterozygosity final risk evaluation and the 280 mg/dl cut-off point can be used to guide the practical clinical diagnosis and to select the patients destined for B-E receptor activity evaluation.

The purpose of the present study was to evaluate the effects of MUFA vs PUFA enriched diets on the plasma and LDL lipid profile and antioxidant contents in mild hypercholesterolemic and triglyceridemic subjects. The study was divided in two consecutive diet periods. Two groups of 11 dyslipidemic patients each (type IIb and type IV) were recruited and during the first period (lasting four weeks) received a linoleic rich diet while during the following four weeks took an oleate rich diet. Both groups showed no significant changes in cholesterol and TG concentration either in plasma or in LDL. Coenzyme Q10 and vitamin E were also unaffected by the dietary treatments. LDL proneness to be oxidatively modified increased after dietary PUFA administration and markedly decreased following the virgin olive oil enriched diet. In fact, LDL from hypertrigliceridemic subjects on a oleate-enriched diet displayed a 26% (p < 0.05) longer lag-phase in conjugated dienes generation than during linoleate-enriched diet and at recruitment. In hypercholesterolemic subjects similar results were obtained: the lag-phase was 28% longer after MUFA diet that after PUFA diet. No differences were found in the maximum propagation rate and maximum concentration of conjugated dienes among dietary periods and at recruitment. Since we found that the vit. E and CoQ10 levels in plasma and in LDL particles remained unchanged during the course of the study, we may conclude that LDL proneness to undergo oxidative modifications is mainly the result of compositional change due to the enrichment from the different diets of the relative fats.

The future of eHealth and telemedicine has recently become a much debated and controversial subject. It is widely believed that eHealth will play an increasingly important role in shaping healthcare systems in the twenty-first century. The rising burden of chronic diseases and the potential of eHealth for cutting costs and improving quality and safety of health services make eHealth a great opportunity for providing more efficient health care.

Questa storia inizia da molto lontano. In un tempo in cui l’uomo viveva circondato da una natura indomita, e dove ogni giorno era l’inizio di una nuova lotta per la sopravvivenza. Come gli animali che lo circondavano, egli era costretto a procacciarsi il cibo ogni giorno, a rintanarsi in ripari naturali, e ad affrontare passivamente le intemperie. Aveva pochi strumenti, che egli stesso era riuscito a inventare, e che lentamente gli avevano concesso quel margine di vantaggio che il suo fisico non poteva garantire nei confronti di ben piu temibili predatori.

The aim was to look at the effect of sulodexide in diabetic and non-diabetic patients with peripheral occlusive arterial disease (POAD), by verifying, through meta-analysis of Italian data, if the drug affects the clinical course of claudication or the main risk factors for POAD. Sulodexide increases the pain-free walking distance (benefit 36% vs controls, P < 0.001). The meta-analysis confirmed the effectiveness of sulodexide in improving claudication (lower limit of the 95% CI for overall odds ratio always >1). There was a marked effect in lowering triglycerides (overall −28%, P = 0.0015), fibrinogen (−13%, P < 0.0001) and plasma and serum viscosities, and in increasing high-density-lipoprotein cholesterol (24.4%, P = 0.0007). The medium-term administration of sulodexide has a therapeutic effect on claudication of diabetic and/or hyperlipidaemic patients suffering from POAD stages – and also counteracts several POAD risk factors. Long-term use of sulodexide appears to be well tolerated. The treatment has a low daily cost; therefore, it has a favourable cost-benefit ratio, in view of the high general costs associated with global POAD care, particularly in diabetic patients.