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Prior cardiovascular event and kidney dysfunction are both strong risk factors for coronary artery disease. The aim of this study is to assess coronary atherosclerotic burden in a large population of patients undergoing coronary angiography, according to prior cardiovascular event or chronic kidney disease.We evaluated 700 consecutive patients who underwent coronary angiography (CA). Serum creatinine to estimate glomerular filtration rate (eGFR) was measured. Clinically significant coronary artery disease (CAD) was defined by the presence of a coronary lesion resulting in a luminal stenosis50%. For the purpose of the study, the whole population was divided into 4 subgroups according to the presence/absence of eGFR60 ml/min/1.73 m2 or prior cardiovascular event: eGFR≥60/no event (Group A), eGFR≥60/yes event (Group B), eGFR60/no event (Group C), eGFR60/yes event (Group D).As expected, patients in group D had the worst clinical and biochemical profile. These patients also presented the highest values of urinary albumin creatinine ratio (ACR, p0.001) and the lowest values of eGFR (p0.01). One-hundred-ninety-six patients had three-vessel disease. Patients who had undergone PCI procedure showed a lower eGFR as compared to patients who had not (p=0.009). Considering group A as reference, the risk of having three-vessel disease was increased in group B (OR= 2.09; 95% CI 1.37-3.19), in group C, (OR= 1.80; 95% CI 1.04-3.14), and finally in group D (OR= 3.35; 95% CI 2.01-5.58). The risk carried by group C was not significantly different from that carried by Group B: OR= 0.86; 95% CI 0.5-1.5.In our study, low eGFR seems to have the same excess risk of prior CV event.

In this study, ultrasound-assisted extraction (UAE) technique was used to examine and optimize the natural pigment extraction from Bougainvillea glabra flowers using four factors three level (extraction temperature, ultrasonic power, extraction time and solid–liquid ratio) Box-Behnken response surface design. From the results, second-order polynomial models were derived for the responses which were well correlated with experimental data (R2 > 0.98). From response surface plots, extraction temperature, ultrasonic power and extraction time exhibited individual and interactive effects on the pigments yield. An extraction temperature of 55 °C, ultrasonic power of 88 W, extraction time of 37 min and a SL ratio of 1:17 g/ml were identified as optimal condition. Under this condition, the actual yield of (betacyanin of 1.72 ± 0.001 and betaxanthin of 5.78 ± 0.23 mg/g) pigments was acquired and well correlated with predicted values (betacyanin was 1.76 mg/g and betaxanthin was 5.81 mg/g).

La difficoltà dei modelli politici-democratici ad offrire soluzioni e rispondere alle aspettative delle popolazioni evidenzia lacune, inadeguatezze e distorsioni del modello politico democratico rispetto al suo profilo teorico. Il saggio offre una lettura delle patologie e del costante rischio di degenerazioni in cui si trova la democrazia contemporanena.

The present study investigates the effect of independent variables such as extraction temperature (35-55 °C), time (1-5h) and solid-liquid ratio (1:5-1:25 g/ml) over the extraction yield of polysaccharide from Gossypium arboreum L. seeds was investigated and optimized. Aqueous extraction method was opted for the extraction of polysaccharide. Central composite response surface design was utilized for developing the experimental design. A second order polynomial mathematical model was developed from the obtained results. From the results, Significance of process variables over the extraction process can be clearly depicted. At the extraction temperature of 45 °C, extraction time of 3h and solid-liquid ratio of 1:15 g/ml maximum yield of polysaccharide (8.67%) from Gossypium arboreum L. seed was obtained. Characteristics of the extracted polysaccharide are analyzed through physico-chemical property analysis and Fourier Transform Infrared Spectroscopy (FTIR).

In this study, ultrasound assisted extraction (UAE) conditions on the yield of polysaccharide from corn silk were studied using three factors, three level Box–Behnken response surface design. Process parameters, which affect the efficiency of UAE such as extraction temperature (40–60 °C), time (10–30 min) and solid–liquid ratio (1:10–1:30 g/ml) were investigated. The results showed that, the extraction conditions have significant effects on extraction yield of polysaccharide. The obtained experimental data were fitted to a second-order polynomial equation using multiple regression analysis with high coefficient of determination value (R2) of 0.994. An optimization study using Derringer's desired function methodology was performed and the optimal conditions based on both individual and combinations of all independent variables (extraction temperature of 56 °C, time of 17 min and solid–liquid ratio of 1:20 g/ml) were determined with maximum polysaccharide yield of 6.06%, which was confirmed through validation experiments.

E opinione comune considerare l’obesita e i disturbi alimentari come due patologie diverse con cause molto differenti tra loro. Tuttavia, una serie di recenti ricerche su gruppi di adolescenti, ha evidenziato una serie di elementi comuni: apparentemente, comportamenti di controllo alimentare estremi — come il digiuno, l’uso di lassativi e l’induzione di vomito — sono tra le cause sia dei disturbi alimentari che dell’obesita (Haines e Neumark-Sztainer, 2006; Johnston, 2004; Neumark-Sztainer, 2009; Stice et al., 2005, 2008). Per esempio, Neumark-Sztainer e colleghi (Neumark-Sztainer et al., 2006), discutendo i risultati del Progetto EAT II (Eating Among Teens), uno studio longitudinale su 2516 adolescenti differenziati sia per gruppo etnico che per status socioculturale, evidenziano come cinque anni piu tardi, l’uso di strumenti estremi di controllo alimentare aumenta di sei volte il rischio di abbuffate compulsive, di tre volteil rischio di essere sovrappeso e da due a cinque volte il rischio di disturbi alimentari. Un risultato simile e stato ottenuto da Stice e colleghi (Stice et al., 2005): negli adolescenti l’impiego di comportamenti compensatori per il controllo alimentare portava, quattro anni piu tardi, a un rischio significativamente superiore di sviluppo dell’obesita.

The aim of this study was to determine if low-dose dobutamine stress echocardiography (LD-DSE) is associated with functional capacity in unselected elderly patients with chronic heart failure.This was a prospective trial. Thirty five consecutive patients were included, with age65 years and left ventricular dysfunction (12 ischemic), by blindly assessed LD-DSE and cardiopulmonary exercise testing (CPT). Contractile reserve was defined as a change (D) in wall motion score index (WMSI) = or0.2 at peak dose dobutamine. At CPT treadmill exercise time, peak VO2, %Vo2 and VE/VCO2 slope were determined. Preserved functional capacity was defined as percent of maximal predicted O2 consumption (%VO2)80%. Baseline NT-proBNP plasma levels were assessed.CPT variables were not related to clinical and baseline echocardiography characteristics but were related to DWMSI (exercise time, P=0.004; peak VO2, P=0.008; %VO2, P0.001; VE/Vco2, P0.001). Contractile reserve was present in 16 of 17 patients with preserved functional capacity (sensitivity=94%) and in 2 of 13 patients without (specificity=85%). Baseline NT-proBNP levels were lower in patients with contractile reserve (476+/-365 pg/mL) than in those without (1 345+/-1 219 pg/mL) (P=0.019), but were mildly related to CPT variables (P=0.049 and 0.027 with exercise time and %VO2, respectively).Contractile reserve elicited at LD-DSE is associated with functional capacity in unselected elderly patients with chronic heart failure.

Although coronary artery disease is a frequent cause of left bundle branch block, the prognostic value of myocardial ischemia in patients with this conduction abnormality has not been defined. We investigated the value of pharmacologic stress echocardiography in risk stratification of patients with left bundle branch block.Three hundred eighty-seven patients [230 men and 157 women, mean (+/- SD) age, 64 +/- 9 years] with complete left bundle branch block on the resting electrocardiogram underwent dobutamine (n = 217) or dipyridamole (n = 170) stress echocardiography to evaluate suspected or known coronary artery disease. A summary wall motion score (on a one to four scale) was calculated. The primary end points were cardiac death and nonfatal myocardial infarction.A positive echocardiographic result (evidence of ischemia) was detected in 109 (28%) patients. During a mean follow-up of 29 +/- 26 months, there were 21 cardiac deaths and 20 myocardial infarctions, 63 patients underwent coronary revascularization, and 1 patient received a heart transplant. In a multivariate analysis, four clinical and echocardiographic variables were associated with increased risk of cardiac death: resting wall motion score index [hazard ratio (HR) = 7.5 per unit; 95% confidence interval (CI), 2.8 to 20; P = 0.001], previous myocardial infarction (HR = 2.9; 95% CI, 1.1 to 7.3; P = 0.02), diabetes (HR = 2.7; 95% CI, 1.1 to 6.6; P = 0.03), and the change in wall motion score index from rest to peak stress (HR = 3.0 per unit; 95% CI, 1.0 to 8.6; P = 0.04). The 5-year survival was 77% in the ischemic group and 92% in the nonischemic group (P = 0.02). Four variables were associated with increased risk of cardiac death or infarction: previous myocardial infarction (HR = 3.4; 95% CI, 1.7 to 6.8; P = 0.0005), diabetes (HR = 2.4; 95% CI, 1.2 to 4.6; P = 0.01), resting wall motion score index (HR = 2.2 per unit; 95% CI, 1.1 to 4.1; P = 0.02), and positive echocardiographic result (HR = 2.2; 95% CI, 1.1 to 4.5; P = 0.03). The 5-year infarction-free survival was 60% in the ischemic group and 87% in the nonischemic group (P0.0001). Stress echocardiography significantly improved risk stratification in patients without previous myocardial infarction (P = 0.0001), but not in those with previous myocardial infarction (P = 0.08). In particular, it provided additional value over clinical and resting echocardiographic findings in predicting cardiac events among patients without previous infarction.Myocardial ischemia during pharmacologic stress echocardiography is a strong prognostic predictor in patients with left bundle branch block, particularly in those without previous myocardial infarction.

Chronic heart failure leads to renal hypoperfusion. Clinical methods for monitoring renal artery flow have several limitations. We analyzed the renal artery flow-velocity in patients with left ventricular dysfunction and normal controls by pulsed-wave (PW) color-guided Doppler technique. The relation between PW Doppler quantitative indexes and left ventricular ejection fraction (LVEF), creatinine clearance, and age, was also assessed.We studied 53 patients with left ventricular dysfunction (LVEF by 2D echoor = 40%) and no systemic hypertension, diabetes, parenchymal nephropathy, serum creatinine levels150 mmol/l, nor renal artery stenosis. Five patients were excluded for suboptimal renal artery PW Doppler recordings. Thus, the study group was constituted of 48 patients (mean age: 64 +/- 13 years). Twenty-eight normal subjects (mean age: 61 +/- 9 years) were the control group. By PW Doppler we measured the maximum (Vmax), the minimum (Vmin) and the mean (Vmean) velocities of both renal arteries. The resistivity index (RI), obtained from the formula (Vmax-Vmin)/ Vmax, and the pulsatility index (PI), obtained from the formula (Vmax-Vmin)/Vmed were calculated. Creatinine clearance was determined in each patient.RI and PI were greater in patients with left ventricular dysfunction than in normal controls. In normal controls, RI and PI were related to age (r: 0.63, p0.001; and r: 0.45, p0.05) and creatinine clearance (r: -0.44 and -0.40, respectively; both: p0.05), not to LVEF. In patients with left ventricular dysfunction, RI and PI were related to LVEF (r: -0.67 and -0.59; both: p0.001), other than to age (r: 0.57 and 0.55; both: p0.001) and creatinine clearance (r: -0.59, p0.001, and r = -0.46, p0.01, respectively). In this group, however, there was no sharp separation of RI and PI between patients with different degree of left ventricular dysfunction (LVEFor = 30% and30%).In patients with left ventricular dysfunction, by renal artery PW Doppler analysis it is possible to detect noninvasively a reduction in regional flow-velocity and an increase in Doppler-derived vascular resistance indexes. These Doppler changes mainly depend on severity of left ventricular dysfunction and less on age of patients.

We report on a patient with pulmonary thromboembolism, primarily diagnosed by urgent TEE. The thrombus was localized in the distal portion of the right pulmonary artery and was easily recognized by transversal plane TEE inspection. Pulmonary scintigraphy was subsequently performed and confirmed TEE findings.

Portal and hepatic vein flow-velocity profiles were examined by pulsed Doppler in 66 patients with tricuspid regurgitation (color Doppler grading: severe: 37, moderate: 18; mild: 11) and 20 normal subjects to determine if portal vein flow analysis is useful in the evaluation of tricuspid regurgitation. Portal vein flow was defined as one of the following categories: subcontinuous (dependent on respiration), pulsatile systolic (not inverted), inverted after systole, and continuous (not dependent on respiration). An index of portal vein flow pulsatility was also calculated. Standard classification of hepatic vein flow pattern was performed. Portal vein flow was pulsatile in 20% of normals subjects, and in 27.3% 44.5% and 51.3% of patients with respectively mild, moderate and severe tricuspid regurgitation; portal vein flow was inverted after systole in further 32.4% of patients with severe tricuspid regurgitation. Portal vein pulsatility index correlated with color Doppler grading of tricuspid regurgitation (r:0.63; p0.001) and right ventricle-atrium pressure gradient (r:0.39; p0.01). However, when compared with hepatic vein flow, both sensitivity and specificity of quantitative portal vein flow analysis was less reliable in diagnosing and grading tricuspid regurgitation. In particular, in patients with severe tricuspid regurgitation, the portal vein flow pattern was quite variable (pulsatile in 19 patients, inverted after systole in 12, and continuous in six). Liver biopsy was performed in nine patients, four of them with severe tricuspid regurgitation and continuous portal vein flow. Histology showed severe liver fibrosis in all four.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the study was to investigate if evidence at transthoracic echocardiography (TTE) of left atrial (LA) thrombus and LA spontaneous echo-contrast (LA SEC), which are potential precursors of embolization, can be predicted by clinical and TTE variables in nonanticoagulated mitral valve stenosis (MS).Clinical (age, NYHA class, rhythm, previous embolization) and TTE variables were related to transesophageal echocardiography (TEE) evidence of LA thrombus and/or LA SEC.Nonanticoagulated MS was the setting.Fifty-nine patients had MS, and they were not receiving anticoagulant or antiplatelet therapy (24 in sinus rhythm and 35 in atrial fibrillation). Previous arterial embolization had occurred in 12 patients (20.3 percent).The following TTE variables were analyzed: mitral orifice area (pressure half-time method), mitral gradient (Bernouilli's equation), LA end-systolic area, and mitral regurgitation (color Doppler grading). LA thrombus and LA SEC were analyzed by monoplane TEE.LA thrombus was found by TEE in 12 patients (20.3 percent). Of these 12, 11 (91.6 percent) were in atrial fibrillation. LA SEC was found by TTE in 2 patients (3.5 percent) and by TEE in 40 (67.8 percent) (p0.001). Previous embolization had occurred only in patients with LA SEC, of whom 5 had and 7 did not have LA thrombus. Patients with LA SEC, compared with those without LA SEC, were characterized by more frequent advanced NYHA class, atrial fibrillation, smaller mitral valve area, and larger LA size. By multivariate regression analysis, atrial fibrillation and LA end-systolic area were factors related to both LA thrombus and LA SEC, whereas mitral area was related only to LA SEC. However, whereas LA SEC was accurately predicted by the presence of atrial fibrillation (sensitivity: 87.5 percent; specificity: 100 percent) and a LA areaor = 30 cm2 (sensitivity: 72.5 percent; specificity: 89.5 percent), among patients with LA SEC no clinical or TTE variable accurately identified those with actual LA thrombus.TEE is not necessary in many patients with MS in order to recognize LA SEC. However, when actual LA thrombus detection is necessary for clinical decision making, TEE should be performed.

diabetes (HR 5 2.7; 95% CI, 1.1 to 6.6; P 5 0.03), and the change in wall motion score index from rest to peak stress (HR 5 3.0 per unit; 95% CI, 1.0 to 8.6; P 5 0.04). The 5-year survival was 77% in the ischemic group and 92% in the nonischemic group (P 5 0.02). Four variables were associated with increased risk of cardiac death or infarction: previous myocardial infarction (HR 5 3.4; 95% CI, 1.7 to 6.8; P 5 0.0005), diabetes (HR 5 2.4; 95% CI, 1.2 to 4.6; P 5 0.01), resting wall motion score index (HR 5 2.2 per unit; 95% CI, 1.1 to 4.1; P 5 0.02), and positive echocardiographic result (HR 5 2.2; 95% CI, 1.1 to 4.5; P 5 0.03). The 5-year infarction-free survival was 60% in the ischemic group and 87% in the nonischemic group (P ,0.0001). Stress echocardiography significantly improved risk statification in patients without previous myocardial infarction (P 5 0.0001), but not in those with previous myocardial infarction (P 5 0.08). In particular, it provided additional value over clinical and resting echocardiographic findings in predicting cardiac events among patients without previous infarction. CONCLUSIONS: Myocardial ischemia during pharmacologic stress echocardiography is a strong prognostic predictor in patients with left bundle branch block, particularly in those without previous myocardial infarction. Am J Med. 2001;110

We report on a 25-year-old man, referred for atypical chest pain and negative T waves in leads V5-V6. A cardiac tumor, localized in the posterolateral left ventricular wall was diagnosed in this patient by nuclear techniques and bidimensional echocardiography. A complex form of pluridistrectual dysmorphic disorder (hypertelorism, prognathism, frontal bossing, multiple cysts of the mandible, calcification in falx cerebri, etc) was also present, suggesting a limited form of Gorlin's syndrome (nevoid basal cell carcinoma syndrome).

In this study, four factors at three level central composite face centered design was employed to study and optimize the process variables on extraction of bioactive compounds (total anthocyanin, phenolic and flavonoid content) from Nephelium lappaceum L. fruit peel. The effect of process variables such as extraction temperature (30–50 °C), power of ultrasound (20–40 W), extraction time (10–30 min) and solid–liquid ratio (1:10–1:20 g/ml) is studied. Multiple regression analysis was done on the experimental data to develop second-order polynomial models with high coefficient of determination value (R2 > 0.99). The optimal conditions based on both individual and combinations of all process variables (extraction temperature of 50 °C, ultrasound power of 20 W, extraction time of 20 min and solid–liquid ratio of 1:18.6 g/ml) were determined by Derringer’s desired function methodology. Under these conditions, total anthocyanin (10.26 ± 0.39 (mg/100 g)), phenolics (552.64 ± 1.57 (mg GAE/100 g)) and flavonoid (104 ± 1.13 (mg RE/100 g)) content values were determined and it is closely related with the predicted values (10.17 mg/100 g of total anthocyanin, 546.98 mg GAE/100 g of total phenolics and 100.93 mg RE/100 g of total flavonoid content) and indicted the suitability of the developed models.

In a 50-year-old man presenting with dyspnoea and palpitations, cardiomegaly, incomplete right bundle branch block and bursts of ventricular tachycardia, Two-Dimensional Echocardiography revealed an impressive enlargement of the right ventricle, particulary in the outflow tract. Arrhythmogenic right ventricular dysplasia was suggested and confirmed by right ventricular angiography and electrophysiologic study. We emphasize the role of Two-Dimensional Echocardiography in the appropriate planning of cardiac catheterization for a definitive diagnosis of arrhythmogenic right ventricular dysplasia.

Una rilettura di Marx alla luce dell'ermeneutica della finitezza

Il saggio si situa nel contesto della complessiva discussione dei temi di etica ambientale. Affronta le questioni della globalizzazione, del rischio globale, e della solidarietà in un'ottica cosmopolitica.

Il saggio riflette sulla capacità della ragione di esercitare attività critica e di autoemendarsi rispetto all'espansione continua delle relazioni cognitive e di quelle etiche e alla capacità di accogliere il nuovo. Attraverso il percorso kantiano, dall' "osa pensare" all' "osa pensare liberamente" all' "osa pensare pubblicamente", si delinea un modello di responsabilità inteso come compito e orizzonte regolativo della ragione e della moralità ancora valido anche per noi.

Il saggio discute le questioni della sovranità nazionale e dell'interdipendenza globale e presenta le prospettive cosmopolitiche fra democrazia e giustizia.