1,720,964 research outputs found
Efficient use of the TM-2441 ambulatory blood pressure measurement device in patients with diabetes
No full textBackground and objective Ambulatory blood pressure monitoring (ABPM) requires automatic measurement and the use of a validated device, according to current guidelines and international standardization. The TM-2441 (A&D Co. Ltd, Tokyo, Japan) ABPM device is small, lightweight, and suitable for use in ambulatory settings. It was validated against the ISO 81060-2:2013 standard in the general population. This study investigated the reliability of the ABPM device for patients with type 2 diabetes. Methods Individuals aged more than 12 years affected with type 2 diabetes were recruited by our outpatient clinic. The blood pressure assessment was performed using the opposite limb simultaneous measurement according to the updated ISO 81060-2:2018. Results Forty-five subjects were included in the clinical investigation. The mean difference between blood pressure values measured by the TM-2441 ABPM device and the reference sphygmomanometer was within limits allowed by the ISO standard. Bland-Altman plots of the measurements and differences between the values obtained from the study device and those from the reference device showed no systematic variations in error. It was not possible to perform a stress test in most patients due to refusal or poor physical condition. Conclusion The TM-2441 ABPM device fulfilled all the requirements of the ISO standard for ambulatory testing not only in a general population but also in the subgroup of subjects with type 2 diabetes
Addressing Endothelial Dysfunction in Heart Failure: The Role of Endothelial Progenitor Cells and New Treatment Horizons
Full text link: Heart failure (HF) is closely linked to endothelial dysfunction, which contributes significantly to its progression. Endothelial dysfunction in HF is marked by reduced nitric oxide bioavailability, increased oxidative stress and inflammation, all of which impair vascular function. Endothelial progenitor cells (EPCs) - vital for vascular repair - are particularly affected, with their dysfunction further exacerbating HF outcomes. Emerging therapies targeting these mechanisms, including antioxidants, gene therapies enhancing endothelial nitric oxide synthase activity and EPCbased strategies, hold promise. Recent advances show encouraging results, especially with treatments improving EPC mobilisation and function. Additionally, pharmacological agents such as statins and sodium-glucose cotransporter 2 inhibitors demonstrate pleiotropic benefits, enhancing endothelial health and EPC activity. This review emphasises the therapeutic potential of these approaches, highlighting the critical need for further research to optimise endothelial-targeted treatments and improve outcomes for HF patients
IMPACT OF REMOTE MONITORING ON PATIENTS’ QUALITY OF LIFE. A SINGLE CENTRE STUDY
No full textObjective PROSIT (Patient Reported Outcomes and Smart Imaging in Telecardiology) is an innovative research initiative designed to explore the efficacy of remote patient monitoring in cardiovascular care. This project leverages wearable technology and patient-reported data to enhance the management of cardiac conditions, aiming to improve both patient outcomes and quality of life. Design and method We evaluated 100 Caucasian patients, affected by hypertension, who access to Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli” from April to October 2023. Patients were divided in three groups: group A, with a wearable device (Hi) for continuous monitoring and an app with manual vital signs reporting, group B with only manual vital signs reporting through app on personal devices, and group C as the control group. The app for A and B group was able to suggest patient-physician interaction evaluating data inputted. All patients were assigned in different groups with a randomized approach based on factors such as age, gender, ejection fraction, presence of atrial fibrillation, and pulmonary embolism. Results Telemonitoring usage has led patients to experience safe feelingsin their daily lives. In fact, patients in group B (app only) and A (app and Hi device) presented an improvement, notably significant for those in group A (p<0,05), compared to group C. In contrast, group C did not change their responses after one month of follow-up. Despite encountering minor issues during the trial, all enrolled patients believe that the telemonitoring program and telemedicine visits are commendable. Although the patients themselves have pointed out areas for improvement in the software, this does not diminish the substantial foundation that this technology signifies. No change was found in treatment adherence or blood pressure control. Conclusions This study leads up to a future where digital support to medical practice will play a crucial role in accessing patient care and therapies, both for patients and clinicians alike. Patients are ready to embrace a new method for accessing care and being monitored by clinicians, one that integrates the old and the new, keeping pace with the times
GENDER DISPARITIES IN HYPERTENSIVE PATIENTS ACROSS THE LIFETIME: AN AGE-STRATIFIED ANALYSIS
No full textObjective This study aims to explore the influence of gender on vascular and renal damage across distinct age brackets. In particular, investigates the intricate interplay between gender, aging and the onset of vascular and renal injuries. Additionally, the study incorporates an examination of the Triglyceride-Glucose (TYG) index, a surrogate indicator of insulin resistance, to discern its role in clarifying gender-specific variations in health outcomes across different life stages. This analysis aims to enhance our comprehension of age-specific vulnerabilities and contribute valuable insights to the field of gender-related health research. Design and method We selected 210 Caucasian patients, all affected by hypertension, and we divided them previously in two groups, male and female, and in each group we splitted 3 clusters based on their age (under 50, 50 to 70 and over 70 years old). All patients underwent a comprehensive physical examination, with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Blood samples obtained from all patients were analyzed for the complete blood count, low/high density lipoproteins and triglycerides, glycaemia and renal function, including albuminuria and proteinuria. Moreover, all patients went through ankle-brachial index (ABI) and pulse wave velocity. Lastly we calculated the TYG index of all patients. Results Regardless of the well-known correlation between TYG index and hypertension, we found that there was no gender difference between the TyG index and gender or aging. Moreover, no differences were underlined among vascular and renal injuries, neither changes in aortic stiffness were associated to gender but to age-related effects Conclusions Despite what expected, the menopausal transition was not associated with a higher renal or vascular damage, nor to a higher risk of insulin resistance. Large-scale prospective cohort studies are needed to validate these findings, also detecting the influence of gender and aging on heart damag
LIPIDS INCREASE IN HYPERTENSIVES DURING THE FIRST YEAR STEROID TREATMENT FOR GRANULOMATOSIS WITH POLYANGIITIS (GPA)
No full textObjective Granulomatosis with polyangiitis (GPA) is an ANCA-associated small-vessel vasculitis. Vessel wall inflammation induces multiple vascular damages leading to accelerated atherosclerosis. Metabolic profile and cardiovascular risk are marginally known in the GPA patients. Our purpose is to evaluate lipid profile and ASCVD-risk in GPA patients. Design and method We selected 36 patients who received GPA diagnosis (T0) and evaluated them after 1 (T1) and 2 (T2) years follow-up. All patients were treated with high-dose glucocorticoid, one-year tapered, associated with immunosuppressants. Pathological history and a complete list of drugs at different time points were recorded. Results The study reveals noteworthy alterations in lipid profiles, with a substantial increase observed in total cholesterol during both T1 and T2 in comparison to T0. A similar trend was noted in LDLand triglycerides. Conversely, no discernible differences were identified in HDL levels. Additionally, a considerable decrease in high-sensitivity C-reactive protein was observed at T1 and T2 in relation to T0, with no significant variance between T2 and T1. Furthermore, a notable reduction in erythrocyte sedimentation rate was noted at T2 as opposed to both T1 and T0, as well as at T1 compared to T0. Moreover, an interesting observation pertains to hypertensive patients who exhibited a marked escalation in lipid levels, juxtaposed with a gradual reduction in inflammation when compared to normotensive individuals. In particular, notable distinctions emerge between the two groups at both T1 and T2 concerning total cholesterol and LDL (p=0.027), despite comparable baseline values at T0. Then, while triglyceride levels start at similar values at T0, a substantial increase is observed at T1 in hypertensive patients and, conversely, at T2, normotensive individuals experience a significant rise in triglyceride levels, accompanied by a noteworthy reduction in hypertensive subjects. Conclusions The findings indicate that lipid profile alterations, likely influenced by glucocorticoid treatment, may not be directly linked to inflammation. Furthermore, there is a higher relation between hypertension and these alterations. Actual data doesn’t reveal increased mortality in hypertensive GPA patients but further research is required to pinpoint specific patterns characterizing cardiovascular risk and progression in this context
ROLE OF CIRCULATING ENDOTHELIAL PROGENITOR CELLS AND CORRELATION WITH VASCULAR STIFFNESS AND ORGAN DAMAGE
Full text linkObjective Atherosclerosis is a chronic cardiovascular disease. High plasma concentration of LDL is the main risk factor but the role of inflammation in all the stages become recently evident. Atherosclerosis and lipid metabolism change according to gender differences. Several possible markers of endothelial dysfunction and vascular stiffness have been identified, including clinical-instrumental and biochemical markers of inflammation and/or fibrosis (i.e., TNF-alpha, prostaglandin, L-Arginine/Asymmetric dimethylarginine - ADMA). A common mechanism identified in the pathogenesis of numerous CVD is endothelial dysfunction that correlates with circulating endothelial progenitor cells (EPCs). These cells are recruited from the bone marrow in response to vascular damage or tissue ischemia. In the peripheral blood, EPCs contribute to reendothelialization and neovascularization, acting as positive regulators of hemostasis and vascular integrity. A reduction in their number or function has been correlated to progression of CVD and MACE. Our project aims to assess the role of EPCs and L-ARG/ADMA in arterial stiffness and atherosclerosis. Design and method Our study is a prospective experimental investigation, enrolling all patients with cardiovascular disease. Patients will undergo routine hematological and biochemical tests as well as instrumental examinations in accordance with good clinical practice. The enrolled patients will undergo a series of clinical and instrumental examinations (ABI,PWV). In in vitro experiments, EPCs will be isolated from PBMCs and functional assays will be performed. Also, Proteome Profiler Target Analytes study and ELISA assay (L-Arg/ADMA) will be performed. Results There was a direct correlation between SCORE2/2-OP and PWV (r=0.70; p<0.0001). Preliminary data indicated a correlation between L-Arg/ADMA to SCORE2/2OP (r=0.36, p=0.04), Total Cholesterol (r=0.75, p=0.033) and LDL (r=0.75, p=0.031), as well as EPCs and their migration correlates to a change in folate cycle (P<0.007 Conclusions preliminary data suggests the importance of EPCs as specific read-out of cell activation and tissue damage in response to cardiovascular risk factors
Women HEalth and PREgnancy Complications (HER): a physician-based Survey on Hypertensive Disorders in Pregnancy of the Italian Society of Hypertension (SIIA)
No full textIntroduction: Management of hypertensive disorders in pregnancy (HDP) remains challenging, with various healthcare providers involved and no uniform approach with variability in medications, monitoring, and intervention timing reflecting gaps in research. Aim: To investigate Italian physicians' knowledge on the topic and examine their clinical practices. Methods: We collected multi-regional data from Italian experts on Hypertension and Gynecologists. The survey consisted of 18 multiple choice questions. Questions involved patient access pathways for suspected HDP, diagnostic assessments, first- and second-line therapies, follow-up visits modalities, and postpartum recommendations. Results: One-hundred and ten experts on hypertension and 31 gynecologists from third-referral centers of 16 over 20 Italian Regions participated in the survey. Only 27.7% of participants were aware of the actual risk of developing preeclampsia in women with chronic hypertension, and only one over two was aware of all long-term risks of cardiovascular disease. Hypertension specialists were in charge of the first antihypertensive prescription in less than 10% of HDP cases. Most common first-line agent was nifedipine and second-line agent nifedipine or methyldopa. Adding a second agent was slightly preferred over the use of maximum dosage of the first agent; 72.6% declared choosing the medication based on maternal hemodynamic profile. Consistent involvement of Hypertension Centers during both pregnancy and postpartum was reported only by 56.7% of physicians. Conclusions: The survey revealed significant gaps in awareness and management practices for women with HDP
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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