In vitro Inhibitory Effects of Limonium contortirameum and L. virgatum Extracts from Sardinia on α-Amylase, α-Glucosidase and Pancreatic Lipase

Pancreatic triacylglycerol lipase (PL), α-amylase and α-glucosidase are interesting pharmacological targets for the management of dyslipidemia, atherosclerosis, and obesity-diabetes. Limonium spp (Plumbaginaceae) are endemic to Sardinia, Italy. Comparable with acarbose, aqueous extracts (AE) of L. contortirameum and L. virgatum, and their phytoconstituent gallic acid concentration gradients (mg/mL) were identified as in vitro potent ( p<0.001, n=3) and efficacious dual inhibitors of α-amylase and α-glucosidase with respective IC50 (mg/mL) values of 0.6 ± 0.1, 1.2 ± 0.1 and 0.15 ± 0.02. Equivalent to orlistat (PL IC50 of 0.114 ± 0.004 μg/mL), L. contortirameum, L. virgatum AE and their phytoprinciple gallic acid inhibited PL substantially ( p<0.001, n=3) in a dose-dependent manner in vitro with PL- IC50 (μg/mL) of 920.4 ± 105.2, 593.1 ± 56.8 and 8.4 ± 0.9, respectively. LC-MS analysis of extracts revealed the presence of several phenolic compounds in their aglycon and glycoside forms. These are catechins, flavones, epigallocatechins and flavonols. Flavonoid- and polyphenol-rich L contortirameum and L. virgatum, modulating gastrointestinal carbohydrate and lipid digestion and absorption, may be advocated as candidates for obesity-diabetes prevention and phytotherapy.

In vitro inhibitory effects of Limonium contortirameum and L. virgatum extracts from sardinia on alpha-amylase, alpha-glucosidase and pancreatic lipase

Pancreatic triacylglycerol lipase (PL), alpha-amylase and alpha-glucosidase are interesting pharmacological targets for the management of dyslipidemia, atherosclerosis, and obesity-diabetes. Limonium spp (Plumbaginaceae) are endemic to Sardinia, Italy. Comparable with acarbose, aqueous extracts (AE) of L. contortirameum and L. virgatum, and their phytoconstituent gallic acid concentration gradients (mg/mL) were identified as in vitro potent (p<0.001, n=3) and efficacious dual inhibitors of alpha-amylase and alpha-glucosidase with respective IC50 (mg/mL) values of 0.6 +/- 0.1, 1.2 +/- 0.1 and 0.15 +/- 0.02. Equivalent to orlistat (PL IC50 of 0.114 +/- 0.004 microg/mL), L. contortirameum, L. virgatum AE and their phytoprinciple gallic acid inhibited PL substantially (p<0.001, n=3) in a dose-dependent manner in vitro with PL- IC50 (microg/mL) of 920.4 +/- 105.2, 593.1 +/- 56.8 and 8.4 +/- 0.9, respectively. LC-MS analysis of extracts revealed the presence of several phenolic compounds in their aglycon and glycoside forms. These are catechins, flavones, epigallocatechins and flavonols. Flavonoid- and polyphenol-rich L contortirameum and L. virgatum, modulating gastrointestinal carbohydrate and lipid digestion and absorption, may be advocated as candidates for obesity-diabetes prevention and phytotherapy.

[Art therapy for hospitalised congenital heart disease patients: a method of psychological intervention at the IRCCS Policlinico San Donato Milanese Hospital]

The current work is the presentation of a new project at the IRCSS San Donato Milanese University hospital, in the sphere of Psychocardiology. Hospitalised children and adolescents often face psychosocial difficulties and the psychological condition of their parents frequently has an impact on their wellbeing. A strong need to take care, beyond the mere cure, is necessary in the hospital settings - that is a need to pay attention also to psychological aspects apart from the medical ones. Art therapy could be an answer for this need: the literature has outlined its efficacy in hospital, also due to the higher inclination of children and adolescents toward creativity. By providing and analysing the drawings of 10 young patients with congenital heart disease (CHD), this study outlines how the art therapy program gives these patients the opportunity to freely and directly express fears and anxieties about medical procedures and their disease. Moreover, through the creation of a tangible product, psychologists can better evaluate the psychological troubles of young patients and provide them and their parents with more focused and personalized support. This study also focuses on the perception of the utility that parents have of this new therapeutic intervention, offered at the Department of Paediatric Cardiac Surgery, confirming that art therapy is perceived as being effective and is definitely a good instrument in helping to "take care" of children and adolescents suffering from CHD.

Chemical, biological, morphoanatomical and antimicrobial study of Ocotea puchury-major Mart

Ocotea puchury-major Mart. is a tree native to the Brazilian rain forest, where it is popularly known as puxurì. In local folk medicine the leaves are used for their sedative, gastroenteric and antireumatic properties. The morphoanatomical study determined those features useful in distinguishing this species from other closely related taxa. Chemical analysis was focused on the study of the volatile oil. Gas chromatography-mass spectrometry analyses indicated safrol as the main compound of the volatile oil (39%). The results confirm and authenticate the use of its leaves in folk medicine. Furthermore, safrol is economically important as the starting material for hemisynthesis of several products. The antimicrobial activity of the essential oil was studied which showed promising activity against environmental microorganisms as well as anti-inflammatory activity.

Genetic and metabolite diversity of Sardinian populations of Helichrysum italicum

Background

Helichrysum italicum (Asteraceae) is a small shrub endemic to the Mediterranean Basin, growing in fragmented and diverse habitats. The species has attracted attention due to its secondary metabolite content, but little effort has as yet been dedicated to assessing the genetic and metabolite diversity present in these populations. Here, we describe the diversity of 50 H. italicum populations collected from a range of habitats in Sardinia.

Methods

H. italicum plants were AFLP fingerprinted and the composition of their leaf essential oil characterized by GC-MS. The relationships between the genetic structure of the populations, soil, habitat and climatic variables and the essential oil chemotypes present were evaluated using Bayesian clustering, contingency analyses and AMOVA.

Key results

The Sardinian germplasm could be partitioned into two AFLP-based clades. Populations collected from the southwestern region constituted a homogeneous group which remained virtually intact even at high levels of K. The second, much larger clade was more diverse. A positive correlation between genetic diversity and elevation suggested the action of natural purifying selection. Four main classes of compounds were identified among the essential oils, namely monoterpenes, oxygenated monoterpenes, sesquiterpenes and oxygenated sesquiterpenes. Oxygenated monoterpene levels were significantly correlated with the AFLP-based clade structure, suggesting a correspondence between gene pool and chemical diversity.

Conclusions

The results suggest an association between chemotype, genetic diversity and collection location which is relevant for the planning of future collections aimed at identifying valuable sources of essential oil.

A novel device for the study of antimicrobial activity by vapor-contact of volatile substances on food products

A novel device for the study of antimicrobial activity by vapour contact of volatile substances have been designed. This "big size" system, made up in inert acrylic material, is furnished with a fan and a hot plate with the aim to have a quick evaporation of volatile substances. It is able to contain fruits or other food products under controlled atmosphere and it can simulate real condition of storage or as well real condition of food pre-treatment by antimicrobial volatile substances. Such system is suitable to perform both in vitro (disk diffusion test) and in vivo (exposure and testing of food products) experiments. To shed light on the behaviour of this chamber the concentration in the head space of several substances have been monitored by GC-MS analysis during the time. Both single (mono-terpene compounds) and mixture of terpenoids have been studied. Different behaviours have been founds depending on the starting molecules studied. Limonene, myrcene and eucalyptol, in single standard experiment, show a similar shape of head space concentration curve versus the time: the concentration increases at the beginning, then reaches a maximum and decreases until it reaches a plateau. In contrast linalool shows a head space concentration curve constant during the time, whereas mixtures of terpenes like myrcene and linalool show a concentration curve of vapour phase in agreement with Raloult's Law. The experiments carried out with Essential Oils (EOs) shows that in our system only more volatile fraction of EOs compose the vapour phase.

Chemical and biological study on the essential oil of Artemisia caerulescens L. ssp. densiflora (Viv.)

Artemisia caerulescens L. ssp. densiflora (Viv.) is a wild shrub that grows in the archipelago of La Maddalena, Sardinia, Italy. The antifungal activity of the volatile oil of this sub-species has not been evaluated earlier. This study aimed to identify the main components of the essential oil of A. caerulescens L. ssp. densiflora and to investigate its antifungal activity. Identification of the different components of the essential oil obtained by hydrodistillation from A. caerulescens L. ssp. densiflora was done by both techniques: GC-MS and NMR analyses ((1)H, (13)C, HSQC-NMR). Antifungal activity was evaluated by agar disc diffusion technique against environmental isolates of fungal strains: two yeasts (Rhodotorula spp., Candida spp.), three moulds (Aspergillus spp., Alternaria spp., Fusarium spp.) and a mixture of moulds. GC-MS analysis of the essential oil yielded 42 compounds, out of which, 26 compounds were identified. The main compound was identified as terpinen-4-ol (22%) followed by p-cymene (7.6%) and α-terpineol (3.02%). The significant inhibition spectrum of the essential oil of A. caerulescens L. ssp. densiflora can be considered as an alternative to common disinfectants.

Chemical composition and antibacterial activity of the essential oil from Mentha requienii Bentham

The chemical composition of essential oil obtained by hydrodistillation of the fresh aerial parts of Mentha requienii Bentham (Lamiaceae) collected on the Gennargentu Mountains (Sardinia, Italy) has been investigated by gas chromatography and gas chromatography-mass spectrometry. The main constituents that resulted were pulegone (78%), menthone (0.5%), isomenthone (18%), isopulegone (1.3%) and limonene (1.76%). In vitro antifungal activity is evaluated in order to identify new means that could be helpful in the prevention of contamination in indoor environments.

Postoperative nutrition of neonates undergoing heart surgery

OBJECTIVE

Postoperative nutrition of newborns undergoing heart surgery (HS) is ill-defined. We compared the postoperative growth rates (grams/day) of neonates with congenital heart defects (CHDs) fed with their own mothers' milk (HU), a starting formula (SF; 67 kcal/100 mL), or a "preterm formula" (PF; 80 kcal/100 mL).

PATIENTS AND METHODS

We studied 122 newborns undergoing HS: 81 underwent corrective surgery (group A), and 41 palliative surgery (group B).

RESULTS

No statistically significant differences were found in the growth rate between group A and B. Moreover, in both groups, no differences in terms of growth rate between infants fed HU, SF, or PF were observed. This was also true when analyses were limited to infants undergoing HS either with or without cardiopulmonary bypass.

CONCLUSIONS

In neonates undergoing HS, human milk allowed a growth rate similar to that observed with starting formulas and "preterm formulas". This effect may depend on the particular features of human milk and its protective properties for the intestinal mucosa.

Pattern of cerebral ultrasound in neonatal heart surgery

AIM

No study described reliably the changes in cerebral ultrasound (CUS) findings in neonatal heart surgery. We tried to define the modifications of CUS before and after heart surgery in neonates.

PATIENTS

We studied 48 neonates with congenital heart defects were studied. Of these, 33 had correction of the malformation with cardiopulmonary bypass (CPB group); 15 underwent coarctation repair/shunting procedures (no-CPB group). Patients had CUS pre-operatively, 48-72 hours after surgery, and at discharge.

RESULTS

Pre-operative studies did not show significant differences between the groups. In CPB group, preoperatively, 6/33 infants showed echogenicity of basal ganglia and 1/33 grade I IVH. In the early postoperative evaluation, 24/33 infants had abnormal scans: increased echogenicity of basal ganglia in 24 and grade I IVH in 14. At discharge, abnormal scans persisted in 20/33 (basal ganglia echogenicity in 20, grade I IVH in 12). In the no-CPB group, preoperatively, 1/15 infant showed echogenicity of basal ganglia. In the early postoperative evaluation, 6/15 had abnormal scans: increased echogenicity of basal ganglia in 6, grade I IVH in 4. At discharge, abnormal scans persisted in 3/15.

CONCLUSIONS

CUS after neonatal heart surgery shows a definite pattern of increased echogenicity of the basal ganglia, more consistent after CPB. These changes may reflect disturbances of deep grey matter, and last 10-15 days at least.

[Infective endocarditis in patients with congenital heart disease]

The incidence of infective endocarditis (IE) in patients with congenital heart disease (CHD) is higher than in general population; this is a major problem considering the continuous expansion of such group of patients. Generally the more complex is the congenital heart disease the higher is the risk of IE. The aetiology, clinical features, complications, basis for diagnosis and treatment of IE in CHD patients don't differ from those in acquired cardiac disease; however, right-sided IE is more frequent in CHD patients. Due to the complex anatomy or presence of artificial material in many CHD, the transesophageal echocardiogram is extremely useful although echocardiographic assessment remains difficult. Prognosis is better than in other forms of IE with a mortality rate <10%. Primary prevention is crucial: a good oral-dental hygiene and regular dental review are as important as antibiotic prophylaxis; however this awareness in the CHD population is still not satisfactorily spread due to an educational problem. New IE guidelines from International Cardiology Societies emphasize the role of primary prevention and limit antibiotic prophylaxis to the highest risk patients undergoing the highest risk procedures. This article reviews the main reasons justifying the revision of previous IE guidelines, focuses on criteria to select CHD patients requiring antibiotic prophylaxis and gives information about antibiotic therapy to use.

[Cardiopulmonary exercise test in adults with congenital heart disease]

Cardiopulmonary exercise testing (CPET) gives important information about functional capacity by direct measurement of exercise respiratory gas exchange. It provides assessment of the integrative exercise responses involving the cardiovascular, respiratory and muscle-skeletal systems which are not adequately investigated through the measurement of individual organ system function. CPET involves measurements of oxygen uptake (VO2), carbon dioxide production (VCO2) and several ventilatory measures. CPET is increasingly being used as a clinical tool to determine functional capacity, prognosis and potential need for medical or surgical interventions in patients affected by congenital heart disease (CHD). Also in this population, peak VO2 and slope VE/VCO2 are the most predictive parameters in terms of mortality and need of hospitalization. Cyanotic patients with Esisenmenger syndrome show the worst functional limitation and consequently the worst prognosis. This article provides basic and practical information about CPET and focuses on its interpretation in patients with CHD.

[Psychosocial difficulties and hospitalisation experiences in adults with congenital heart disease. The utility of psychological interventions]

Adults with congenital heart disease, especially the ones who require constant medical care, encounter many psychosocial difficulties. These difficulties also occur in the interventional departments of cardiology and cardiac surgery, where they often have to make important decisions, undergo cardiology interventions and cardiac surgeries, and more rarely they also have to deal with unexpected complications that can lengthen their hospitalisation duration considerably. The literature has also outline predictive factors when it comes to the psychological difficulties encountered in this population. For these reasons, the inclusion of the psychologist in this context is essential.

[Interventional procedure in the Cath Lab: the state of art]

Many paediatric cardiac patients now survive to adulthood following early surgery. This population of adult patients with a congenital heart disease offer distinct challenges such as unusual anatomy and demands such as pregnancy and exercise tolerability not found in conventional paediatric or traditional adult interventional patients. Starting with neonatal balloon atrial septostomy for transposition of the great arteries, improving and changing percutaneous interventional techniques have increasingly replaced surgery as a treatment option in several congenital heart diseases. There has been a rapid growth in interventional cardiology techniques to treat adults with congenital heart disease, mirroring the rise of interventional cardiology as a cardiology subspecialty and the increasing population of adults with congenital abnormalities. We review current indications for adult congenital heart disease intervention and best practice, reviewing the patient spectrum commonly treated, devices used, and emerging treatments.

[Adult with congenital heart disease: an overview]

The improvement of surgical procedures over the past 40 years has changed the medical history of the congenital heart defect. It is estimated that 85% of children with congenital heart disease now have the opportunity to reach adulthood and that this percentage will increase over the next two decades. This special issue of the Journal aims to offer a basic information on key topics of this field of cardiology not newer, but still rapidly evolving.

Rosmarinus officinalis L.: Chemical Modifications of the Essential oil and Evaluation of Antioxidant and Antimicrobial Activity

Rosmarinus officinalis essential oil was separated into its hydrocarbon and oxygenated fractions. The major compounds in the hydrocarbon fraction were α-pinene (44.2%), camphene (24.5%), and limonene (11.7%), while in the oxygenated fraction they were 1,8-cineole (37.6%), camphor (16.5%), and bornyl acetate (21.4%). The hydrocarbon fraction was submitted to a hydroformylation process and the antioxidant activity of the product was screened by the DPPH and β-carotene/linoleic acid tests. The hydroformylated fraction maintained the antioxidant activity of the whole oil. The MIC (minimal inhibitory concentration) and the MBC (minimal bactericidal concentration) of the essential oil, hydrocarbon, oxygenated and hydroformylated fractions were also tested on several microorganisms. Aeromonas sobria and Candida strains were the most susceptible micro-organisms. The hydroformylated fraction exhibited a MBC against Candida strains resistant to the other fractions.

Rosmarinus officinalis L.: chemical modifications of the essential oil and evaluation of antioxidant and antimicrobial activity

Rosmarinus officinalis essential oil was separated into its hydrocarbon and oxygenated fractions. The major compounds in the hydrocarbon fraction were alpha-pinene (44.2%), camphene (24.5%), and limonene (11.7%), while in the oxygenated fraction they were 1,8-cineole (37.6%), camphor (16.5%), and bornyl acetate (21.4%). The hydrocarbon fraction was submitted to a hydroformylation process and the antioxidant activity of the product was screened by the DPPH and beta-carotene/linoleic acid tests. The hydroformylated fraction maintained the antioxidant activity of the whole oil. The MIC (minimal inhibitory concentration) and the MBC (minimal bactericidal concentration) of the essential oil, hydrocarbon, oxygenated and hydroformylated fractions were also tested on several microorganisms. Aeromonas sobria and Candida strains were the most susceptible micro-organisms. The hydroformylated fraction exhibited a MBC against Candida strains resistant to the other fractions.

Giant mid-esophageal diverticulum. Conservative treatment of postoperative leakage

Mid-esophageal diverticula are rare entities. Only symptomatic patients usually receive surgical treatment. Esophageal leakage is one of the most common complications after these procedures. Though in literature, operative management is the preferred treatment for esophageal fistula, conservative approach is described in case of small leaks. We report a case of an operated giant mid-esophageal diverticulum complicated with an esophageal fistula. The patient underwent a surgical treatment and recovered completely.