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Pantano I, Mauro D, Simone D, Costa L, Capocotta D, Raimondo M, Birra D, Cuomo G, D'Errico T, Ferrucci M, Comentale F, Italiano G, Moscato P, Pappone N, Russo R, Scarpato S, Tirri R, Buono P, Postiglione A, Guida R, Scarpa R, Trama U, Tirri E, Ciccia F. The data project: a shared approach between stakeholders of the healthcare system in definition of a therapeutic algorithm for inflammatory arthritis. Reumatismo 2023; 74. [PMID: 36942981 DOI: 10.4081/reumatismo.2022.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/05/2022] [Indexed: 03/23/2023] Open
Abstract
Rheumatic musculoskeletal diseases or RMD [rheumatoid arthritis (RA) and spondyloarthritis (SpA)] are systemic inflammatory diseases for which there are no biomarkers capable of predicting treatments with a higher likelihood of response in naive patients. In addition, the expiration of the anti-TNF blocking drugs' patents has resulted in the availability of anti-TNF biosimilar drugs with the same efficacy and safety than originators but at significantly reduced prices. To guarantee a personalized therapeutic approach to RMD treatment, a board of rheumatologists and stakeholders from the Campania region, Italy, developed a clinically applicable arthritis therapeutic algorithm to guide rheumatologists (DATA project). The general methodology relied on a Delphi technique forecast to produce a set of statements that summarized the experts' consensus. Selected clinical scenarios were discussed in light of the available evidence, and there were two rounds of voting on the therapeutic approaches. Separate discussions were held regarding rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The decision-making factors for each disease were clinical presentation, demographics, and comorbidities. In this paper, we describe a virtuous process between rheumatologists and healthcare system stakeholders that resulted in the development of a shared therapeutic algorithm for RMD patients naive to bDMARDs.
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Affiliation(s)
- I Pantano
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - D Mauro
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - D Simone
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - L Costa
- Rheumatology Unit, University Federico II of Naples, Naples.
| | - D Capocotta
- Rheumatology Unit, San Giovanni Bosco Hospital, Local Health Company, ASL NA1, Naples.
| | - M Raimondo
- Internal Medicine, S. Giuseppe Moscato Hospital, Avellino.
| | - D Birra
- Rheumatology Service, San Giovanni di Dio e Ruggi Hospital, Salerno.
| | - G Cuomo
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - T D'Errico
- Rheumatologist, Local Health Company, ASL NA1, Naples.
| | - M Ferrucci
- Rheumatology Unit, Rummo Hospital, Benevento.
| | - F Comentale
- Rheumatologist, Local Health Company, ASL NA3 Sud, Naples.
| | - G Italiano
- Internal Medicine, Sant'Anna e San Sebastiano Hospital, Caserta.
| | - P Moscato
- Rheumatology Service, San Giovanni di Dio e Ruggi Hospital, Salerno.
| | - N Pappone
- Rheumatological Rehabilitation Unit, Maugeri Foundation, Telese.
| | - R Russo
- Rheumatology Unit, Antonio Cardarelli Hospital of Naples, Naples.
| | - S Scarpato
- Rheumatology Unit, Scarlato Hospital, Scafati (SA).
| | - R Tirri
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - P Buono
- STAFF 91 Unit, Regione Campania, Naples.
| | - A Postiglione
- General Direction for Health Protection and Coordination of the Regional Health System, Regione Campania, Naples.
| | - R Guida
- Drug Policy and Devices Unit, Regione Campania Health Department, Naples.
| | - R Scarpa
- Rheumatology Unit, University Federico II of Naples, Naples.
| | - U Trama
- Drug Policy and Devices Unit, Regione Campania Health Department, Naples.
| | - E Tirri
- Rheumatology Unit, San Giovanni Bosco Hospital, Local Health Company, ASL NA1, Naples.
| | - F Ciccia
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
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Prigioniero A, Geraci A, Schicchi R, Tartaglia M, Zuzolo D, Scarano P, Marziano M, Postiglione A, Sciarrillo R, Guarino C. Ethnobotany of dye plants in Southern Italy, Mediterranean Basin: floristic catalog and two centuries of analysis of traditional botanical knowledge heritage. J Ethnobiol Ethnomed 2020; 16:31. [PMID: 32493364 PMCID: PMC7268309 DOI: 10.1186/s13002-020-00384-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Since ancient times, man has learned to use plants to obtain natural dyes, but this traditional botanical knowledge (TBK) is eroding. In the late, during, and the early 1800s, there was an increase in research related to dye species, and this allowed the development of industry and economy in rural contexts of Southern Italy. Today, dyes are mainly obtained from synthetic products, and this leads to risks for human health related to pollution. METHODS Starting from the literature, three catalogs of the dyeing species (plants, algae, fungi, and lichens) used in the Mediterranean Basin and mainly in Southern Italy have been created. Percentages of parts used and colors extracted from species have been recorded and analyzed. The plant species present in the catalogs have been verified in the territories of Southern Italy, and the data have been registered. An ethnobotanical survey was conducted, in the region of Southern Italy, to verify the erosion level of traditional botanical knowledge, linked to the ethnobotanical dyeing, over time. RESULTS A total of 524 species were recorded among plants, algae, fungi, and lichens, and related parts used and extracted pigments. Most uses concern the stems and leaves, and the most frequent color is yellow. From the on-field survey operations, 283 plant species have been verified. These represent 64.31% of the species reported in the flora of the dye plants produced. The results, from the ethnobotanical survey, show that only 8.6% of TBK remained in the collective memory. CONCLUSIONS This catalog is among the largest in this sector and is the basis for studies related to the restoration of an eco-sustainable economy which would allow the development of marginal areas present throughout Southern Italy.
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Affiliation(s)
- A Prigioniero
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - A Geraci
- Department of Agricultural, Food and Forestry Sciences, University of Palermo, Viale delle Scienze, Ed, 490128, Palermo, Italy
| | - R Schicchi
- Department of Agricultural, Food and Forestry Sciences, University of Palermo, Viale delle Scienze, Ed, 490128, Palermo, Italy
| | - M Tartaglia
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - D Zuzolo
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - P Scarano
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - M Marziano
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - A Postiglione
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - R Sciarrillo
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy
| | - C Guarino
- Department of Sciences and Technologies, University of Sannio, Via De Sanctis snc, 82100, Benevento, Italy.
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De Luca V, Tramontano G, Del Giudice C, Grimaldi I, Romano R, Liguori I, Carpinelli Mazzi M, Di Carluccio N, Riccio PA, Speranza P, Iavarone A, Abete P, Postiglione A, Cataldi M, Vallone C, Giallauria F, Cittadini A, Triggiani M, Savastano S, Menditto E, Leonardini L, Colao A, Triassi M, Iaccarino G, Postiglione A, Coscioni E, Illario M. Innovative Approaches to Active and Healthy Ageing: Campania Experience to Improve the Adoption of Innovative Good Practices. Transl Med UniSa 2019; 19:116-123. [PMID: 31360676 PMCID: PMC6581492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The demographic projections on the European population predict that people aged over 60 will increase by about two million/year in the next decades. Since 2012, the Campania Reference Site of the European Innovation Partnership on Active and Healthy Ageing supports the innovation of the Regional Health System, to face up demographic changes and sustainability. Campania Reference Site provides the opportunity to connect loco-regional stakeholders in social and health care services (universities, healthcare providers, social services, local communities and municipalities), with international organizations, in order to adopt and scale up innovative solutions and approaches. This paper describes the building process of Campania Reference Site and the main results achieved, that have been allowing it to become a hub for open innovation in the field of active and healthy aging at regional, national and international level.
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Affiliation(s)
- V De Luca
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy,
| | - G Tramontano
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - C Del Giudice
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - I Grimaldi
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - R Romano
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - I Liguori
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - M Carpinelli Mazzi
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - PA Riccio
- Associazione Progetto Alfa Onlus, Marigliano NA, Italy
| | - P Speranza
- Unità Operativa Complessa Gestione Affari Generali, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - A Iavarone
- Unità Operativa Complessa di Neurologia, Azienda Ospedaliera Specialistica Dei Colli - Monaldi-Cotugno-CTO, Naples, Italy
| | - P Abete
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - A Postiglione
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - M Cataldi
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università degli Studi di Napoli Federico II, Naples, Italy
| | - C Vallone
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - F Giallauria
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - A Cittadini
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - M Triggiani
- Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Salerno, Salerno, Italy
| | - S Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - E Menditto
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - L Leonardini
- Progetto Mattone Internazionale Salute, Ministero della Salute, Rome, Italy
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - M Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - G Iaccarino
- Dipartimento di Scienze biomediche avanzate, Università degli Studi di Napoli Federico II, Naples, Italy
| | - A Postiglione
- Direzione Generale per la Tutela della Salute e il Coordinamento del Sistema Sanitario Regionale (DG04), Regione Campania, Naples, Italy
| | - E Coscioni
- Struttura Dipartimentale di Chirurgia dell’Aorta Ascendente e Toracica, Azienda Ospedaliera Universitaria Ospedali Riuniti San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - M Illario
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy,Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy,Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy,Consorzio Farmacie Servizi (COFASER), Sarno SA, Italy,Associazione Progetto Alfa Onlus, Marigliano NA, Italy,Unità Operativa Complessa Gestione Affari Generali, Azienda Ospedaliera Universitaria Federico II, Naples, Italy,Unità Operativa Complessa di Neurologia, Azienda Ospedaliera Specialistica Dei Colli - Monaldi-Cotugno-CTO, Naples, Italy,Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università degli Studi di Napoli Federico II, Naples, Italy,Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy,Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Salerno, Salerno, Italy,Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy,Progetto Mattone Internazionale Salute, Ministero della Salute, Rome, Italy,Dipartimento di Scienze biomediche avanzate, Università degli Studi di Napoli Federico II, Naples, Italy,Direzione Generale per la Tutela della Salute e il Coordinamento del Sistema Sanitario Regionale (DG04), Regione Campania, Naples, Italy,Struttura Dipartimentale di Chirurgia dell’Aorta Ascendente e Toracica, Azienda Ospedaliera Universitaria Ospedali Riuniti San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy,Unità Operativa Dipartimentale Promozione e potenziamento di programmi Health Innovation (DG04), Regione Campania, Naples, Italy
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Illario M, Coscioni E, De Luca V, Cataldi M, Postiglione A, Iaccarino G. Editorial: Multi-Actor Collaboration in Healthcare to Address the Emerging Health Needs of an Aging Population. Transl Med UniSa 2019; 19:1-4. [PMID: 31360660 PMCID: PMC6581499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Illario
- Campania Region Division for Health Innovation, and Department of Public Health, Federico II University and Hospital, Naples, Italy
| | - E Coscioni
- Department of Heart Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy
| | - V De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - M Cataldi
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - A Postiglione
- General Directorate for Health Protection and the Coordination of Regional Health System, Campania Region, Naples, Italy
| | - G Iaccarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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5
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Illario M, De Luca V, Leonardini L, Kucharczyk M, Parent AS, Dantas C, Jegundo AL, van Staalduinen W, Ganzarain J, Comisso L, Bramezza C, Carriazo AM, Maritati A, Tramontano G, Capozzi P, Goossens E, Cotrone C, Costantini A, Ciliberti M, Femiano M, d’Amore A, Forlenza M, Ruggiero R, Bianchi A, Augustin L, Marrazzo V, Dello Ioio T, Capaldo S, Crudeli A, De Cesare G, Cuccaro F, Bracale G, Tramontano D, Postiglione A, Matera C, Coscioni E, Bousquet J. Health tourism: an opportunity for sustainable development. Transl Med UniSa 2019; 19:109-115. [PMID: 31360675 PMCID: PMC6581494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.
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Affiliation(s)
- M Illario
- Health Innovation Division of Campania Region (DG04), Federico II University and Hospital, Naples, Italy
| | - V De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - L Leonardini
- Programma Mattone Internazionale Salute, Italian Ministry of Health, San Donà di Piave VE, Italy
| | | | - AS Parent
- AGE Platform Europe Network, Brussels, Belgium
| | - C Dantas
- Caritas Coimbra, Coimbra, Portugal
| | | | | | - J Ganzarain
- Academy on Age-friendly Environments BV, Gouda, the Netherlands
| | - L Comisso
- Azienda per i Servizi Sanitari n.5 “Bassa Friulana”, Udine, Italy
| | - C Bramezza
- Azienda ULSS n. 4 Veneto Orientale, San Donà di Piave VE, Italy
| | | | - A Maritati
- Programma Mattone Internazionale Salute, Italian Ministry of Health, San Donà di Piave VE, Italy
| | - G Tramontano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - P Capozzi
- Health Innovation Division of Campania Region (DG04), Federico II University and Hospital, Naples, Italy
| | - E Goossens
- Center for Gastrology, Brussels, Belgium
| | - C Cotrone
- Relations with European and extra-European countries Division, Campania Region, Naples, Italy
| | - A Costantini
- Azienda Sanitaria Locale Napoli 3 Sud, Castellamare di Stabia NA, Italy
| | - M Ciliberti
- Azienda Sanitaria Locale Napoli 3 Sud, Castellamare di Stabia NA, Italy
| | - M Femiano
- Azienda Sanitaria Locale Napoli 2 Nord, Frattamaggiore NA, Italy
| | - A d’Amore
- Azienda Sanitaria Locale Napoli 2 Nord, Frattamaggiore NA, Italy
| | - M Forlenza
- Azienda Sanitaria Locale Napoli 1 Centro, Naples, Italy
| | - R Ruggiero
- Azienda Sanitaria Locale Napoli 1 Centro, Naples, Italy
| | - A Bianchi
- Istituto Nazionale Tumori Pascale, Naples, Italy
| | - L Augustin
- Istituto Nazionale Tumori Pascale, Naples, Italy
| | - V Marrazzo
- Regional Coordination of Tourism Districts of Campania, Naples, Italy
| | - T Dello Ioio
- Parco regionale dei Monti Lattari, Castellammare di Stabia NA, Italy
| | - S Capaldo
- Federalberghi Terme, Rome, Italy
- Federterme, Rome, Italy
| | | | - G De Cesare
- Centro Mediterranea Diagnostica Srl, Castellamare di Stabia NA, Italy
| | - F Cuccaro
- Centro Mediterranea Diagnostica Srl, Castellamare di Stabia NA, Italy
| | - G Bracale
- Mediterranean Federation for Advancing Vascular Surgery, Naples, Italy
| | - D Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - A Postiglione
- General Directorate for Health Protection and the coordination of Regional Health System, Campania Region, Naples, Italy
| | - C Matera
- Regional Ministry for Tourism, Campania Region, Naples, Italy
| | - E Coscioni
- Department of Heart Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy
| | - J Bousquet
- Department of Pneumology and Addictology, Montpellier University Hospital Center, Montpellier, France
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6
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Montefusco S, Gnasso A, Scarpato N, Rubba P, Nappi G, Cortese C, Pandolfi G, Postiglione A. Hemorheological effects of LDL-apheresis in familial hypercholesterolemia. Clin Hemorheol Microcirc 2018. [DOI: 10.3233/ch-1989-9108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Montefusco
- Institute of Internal Medicine & Metabolic Diseases, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - A. Gnasso
- Institute of Internal Medicine & Metabolic Diseases, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - N. Scarpato
- Dept. of ImmunoHematogy, 2nd Medical School, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - P. Rubba
- Institute of Internal Medicine & Metabolic Diseases, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - G. Nappi
- Dept. of ImmunoHematogy, 2nd Medical School, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - C. Cortese
- Institute of Internal Medicine & Metabolic Diseases, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - G. Pandolfi
- Dept. of ImmunoHematogy, 2nd Medical School, University of Naples, via S. Pansini 5,80131 Naples, Italy
| | - A. Postiglione
- Institute of Internal Medicine & Metabolic Diseases, University of Naples, via S. Pansini 5,80131 Naples, Italy
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7
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Arcopinto M, Cataldi M, De Luca V, Orlando V, Simeone G, D’Assante R, Postiglione A, Guida A, Trama U, Illario M, Ferrara N, Coscioni E, Iaccarino G, Cuccaro P, D’Onofrio G, Vigorito C, Cittadini A, Menditto E. Implementing an ICT-Based Polypharmacy Management Program in Italy. Transl Med UniSa 2017; 16:24-29. [PMID: 28775966 PMCID: PMC5536159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed.
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Affiliation(s)
- M. Arcopinto
- Dipartimento Assistenziale ad Attività Integrata di Medicina Interna e Patologia Clinica, Dipartimento di Scienze Mediche Traslazionali, Divisione di Medicina Interna e Riabilitazione Cardiologica, Università di Napoli Federico II, Milano, Italy
| | - M. Cataldi
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Divisione di Farmacologia, Università di Napoli Federico II, Milano, Italy
| | - V. De Luca
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - V. Orlando
- Facoltà di Farmacia, CIRFF/Centro di Farmacoeconomia, Università di Napoli Federico II, Milano, Italy
| | - G. Simeone
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Divisione di Farmacologia, Università di Napoli Federico II, Milano, Italy
| | - R. D’Assante
- Dipartimento di Cardiochirurgia, IRCCS Policlinico San Donato, Milano, Italy
| | - A. Postiglione
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - A. Guida
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - U. Trama
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - M. Illario
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - N. Ferrara
- Divisione di Geriatria, Dipartimento di Scienze Mediche Traslazionali, Divisione di Medicina Interna e Riabilitazione Cardiologica, Università di Napoli Federico II, Salerno, Italy
| | - E. Coscioni
- Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d’Aragona, Salerno, Italy
| | - G. Iaccarino
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Scuola Medica Salernitana, Università di Salerno, Italy
| | - P. Cuccaro
- U.O.S. Ricerca e Sviluppo, Azienda Ospedaliera Universitarià Federico II, Milano, Italy
| | - G. D’Onofrio
- Direzione Sanitaria, Azienda Ospedaliera Universitaria Federico II, Napoli, Italia
| | - C. Vigorito
- Dipartimento Assistenziale ad Attività Integrata di Medicina Interna e Patologia Clinica, Dipartimento di Scienze Mediche Traslazionali, Divisione di Medicina Interna e Riabilitazione Cardiologica, Università di Napoli Federico II, Milano, Italy
| | - A. Cittadini
- Dipartimento Assistenziale ad Attività Integrata di Medicina Interna e Patologia Clinica, Dipartimento di Scienze Mediche Traslazionali, Divisione di Medicina Interna e Riabilitazione Cardiologica, Università di Napoli Federico II, Milano, Italy
| | - E. Menditto
- Facoltà di Farmacia, CIRFF/Centro di Farmacoeconomia, Università di Napoli Federico II, Milano, Italy
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Postiglione A, Soricelli A, Scarpato N, Lamenza F, Mancini M. Increased cerebral blood flow after plasma-exchange in patients with familial hypercholesterolemia. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1982-2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Postiglione
- Centre for Arteriosclerosis and Metabolic Diseases, Semeiotica Medica, 2nd Faculty of Medicine, University of Naples, Naples,Italy
| | - A. Soricelli
- Centre for Arteriosclerosis and Metabolic Diseases, Semeiotica Medica, 2nd Faculty of Medicine, University of Naples, Naples,Italy
| | - N. Scarpato
- Centro Trasfusionale, 2nd Faculty of Medicine, University of Naples, Naples, Italy
| | - F. Lamenza
- Centre for Arteriosclerosis and Metabolic Diseases, Semeiotica Medica, 2nd Faculty of Medicine, University of Naples, Naples,Italy
| | - M. Mancini
- Centre for Arteriosclerosis and Metabolic Diseases, Semeiotica Medica, 2nd Faculty of Medicine, University of Naples, Naples,Italy
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Bruni AC, Bernardi L, Colao R, Rubino E, Smirne N, Frangipane F, Terni B, Curcio SAM, Mirabelli M, Clodomiro A, Di Lorenzo R, Maletta R, Anfossi M, Gallo M, Geracitano S, Tomaino C, Muraca MG, Leotta A, Lio SG, Pinessi L, Rainero I, Sorbi S, Nee L, Milan G, Pappatà S, Postiglione A, Abbamondi N, Forloni G, St George Hyslop P, Rogaeva E, Bugiani O, Giaccone G, Foncin JF, Spillantini MG, Puccio G. Worldwide distribution of PSEN1 Met146Leu mutation: a large variability for a founder mutation. Neurology 2010; 74:798-806. [PMID: 20164095 DOI: 10.1212/wnl.0b013e3181d52785] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Large kindreds segregating familial Alzheimer disease (FAD) offer the opportunity of studying clinical variability as observed for presenilin 1 (PSEN1) mutations. Two early-onset FAD (EOFAD) Calabrian families with PSEN1 Met146Leu (ATG/CTG) mutation constitute a unique population descending from a remote common ancestor. Recently, several other EOFAD families with the same mutation have been described worldwide. METHODS We searched for a common founder of the PSEN1 Met146Leu mutation in families with different geographic origins by genealogic and molecular analyses. We also investigated the phenotypic variability at onset in a group of 50 patients (mean age at onset 40.0 +/- 4.8 years) by clinical, neuropsychological, and molecular methodologies. RESULTS EOFAD Met146Leu families from around the world resulted to be related and constitute a single kindred originating from Southern Italy before the 17th century. Phenotypic variability at onset is broad: 4 different clinical presentations may be recognized, 2 classic for AD (memory deficits and spatial and temporal disorientation), whereas the others are expressions of frontal impairment. The apathetic and dysexecutive subgroups could be related to orbital-medial prefrontal cortex and dorsolateral prefrontal cortex dysfunction. CONCLUSIONS Genealogic and molecular findings provided evidence that the PSEN1 Met146Leu families from around the world analyzed in this study are related and represent a single kindred originating from Southern Italy. The marked phenotypic variability might reflect early involvement by the pathologic process of different cortical areas. Although the clinical phenotype is quite variable, the neuropathologic and biochemical characteristics of the lesions account for neurodegenerative processes unmistakably of Alzheimer nature.
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Affiliation(s)
- A C Bruni
- Centro Regionale di Neurogenetica, Azienda Sanitaria Provinciale Catanzaro, Viale A. Perugini, 88046 Lamezia Terme (CZ), Italy.
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10
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Milan G, Lamenza F, Iavarone A, Galeone F, Lorè E, de Falco C, Sorrentino P, Postiglione A. Frontal Behavioural Inventory in the differential diagnosis of dementia. Acta Neurol Scand 2008; 117:260-5. [PMID: 17922889 DOI: 10.1111/j.1600-0404.2007.00934.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate diagnostic properties of the Frontal Behavioural Inventory (FBI) in patients suffering from different forms of dementia. METHODS The FBI was administered with other psychometric tests investigating cognitive performances and behavioral scales to the caregivers of 35 patients with the frontal variant of frontotemporal dementia (fv-FTD), 22 patients with Alzheimer's disease (AD) and 15 with vascular dementia (VaD). All patients were comparable for degree of dementia severity and level of executive impairment. RESULTS The FBI showed high concurrent validity, internal consistency and good inter-rater and test-retest reliability. The discriminant validity was also very high. A new FBI cut-off score of 23 gave 97% sensitivity and 95% specificity in distinguishing fv-FTD from non-FTD patients. Conversely, the Neuropsychiatic Inventory (NPI) score was unable to differentiate fv-FTD from AD. CONCLUSIONS The FBI is a neurobehavioral tool suitable to distinguish fv-FTD from other forms of dementia also when data from cognitive testing or other behavioral scales fail to support the differential diagnosis.
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Affiliation(s)
- G Milan
- Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy
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11
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Montefusco S, Gallotta G, Lamenza F, De Renzo A, Postiglione A. [Association of visceral Leishmaniosis and pulmonary tuberculosis: description of a patient]. Infez Med 2003; 6:160-163. [PMID: 12768089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Leishmaniosis, whether localised or disseminated, is mainly correlated to cell-mediated immunodeficiency. Immunodeficient patients are also particularly prone to diseases due to Mycobacterium tuberculosis, in whom either the disseminated form or a localisation of the lungs prevails. We report a rather uncommon association of both pathologies successufully treated with N-methylglucamine antimonium followed by an association of rifampycin, isoniazid and ethambutol. The ethiopathogenetic mechanisms, are described.
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Affiliation(s)
- S. Montefusco
- Dipartimento di Medicina Clinica e Sperimentale, Facolta di Medicina e Chirurgia, Universita Federico II, Napoli, Italy
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12
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Patern R, Ruocco A, Santillo M, Ser R, Cuda G, Bifulco M, Laezza C, Postiglione A, Avvedimento E, Mancini M. 2P-0527 Farnesyl transferase inhibitors, by RAS P21 inactivation, induce stroke protection. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Postiglione A, Milan G, Ruocco A, Gallotta G, Guiotto G, Di Minno G. Plasma folate, vitamin B(12), and total homocysteine and homozygosity for the C677T mutation of the 5,10-methylene tetrahydrofolate reductase gene in patients with Alzheimer's dementia. A case-control study. Gerontology 2001; 47:324-9. [PMID: 11721146 DOI: 10.1159/000052822] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elevated total plasma homocysteine (tHcy) levels are considered a risk factor for cerebrovascular disease and may also play an important role in the pathogenesis of Alzheimer's disease (AD). High values of plasma tHcy and low levels of vitamin B(12) and folate are frequently present in AD patients. Moreover, the homozygous mutation (C677T) of the methylene tetrahydrofolate reductase (MTHFR) gene, related to a thermolabile type of the encoded enzyme, causes hyperhomocysteinemia by reducing the 5-methyltetrahydrofolate availability. OBJECTIVE The aim of the study was to investigate plasma levels of folate, vitamin B(12) and tHcy in patients with AD. These values were also related to the severity and the duration of the disease and to the possible role of the MTHFR genotype (C677T). METHOD Plasma tHcy levels, homozygosity for the C677T mutation of the MTHFR gene, and folate and vitamin B(12) plasma levels were evaluated in 74 patients with AD (45 men, 29 women, mean age 68 years) and in 74 healthy matched controls (42 men, 32 women, mean age 68 years). RESULTS AD patients had higher mean (+/- SD) plasma levels of tHcy (20.9 +/- 15 micromol/l compared to 11.8 +/- 5 micromol/l, p < 0.001) and lower mean plasma folate (5.7 +/- 2.1 ng/ml compared to 8.5 +/- 3.2 ng/ml, p < 0.001) and vitamin B(12) (491 +/- 144 pmol/l compared to 780 +/- 211 pmol/l, p < 0.001) concentrations. Homozygosity for the C677T mutation of the MTHFR gene had a similar prevalence among controls (18%) and AD patients (20%). Homozygous AD patients (n = 15) had higher plasma tHcy values than nonhomozygotes, in spite of similar mean plasma folate and vitamin B(12) levels. This difference in plasma tHcy levels was not observed in controls. Patients with levels of plasma tHcy above and of plasma folate below the normal limits were more frequent in the homozygous AD group. The duration of the disease correlated with plasma levels of tHcy (r = +0.832, p < 0.001), plasma folate (r = -0.580, p < 0.05), and vitamin B(12) (r = -0.460, p < 0.05). However, when all the data were corrected for age, serum creatinine levels, and duration of the disease, mean plasma tHcy, folate, and vitamin B(12) levels were not statistically different between controls and AD patients. CONCLUSIONS Our data suggest that rather than a risk factor for AD, hyperhomocysteinemia is related to its progression and increasing severity. This might be particularly relevant in homozygotes for the C677T mutation of the MTHFR gene and supports the possible need for continuous supplements in this setting.
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Affiliation(s)
- A Postiglione
- Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy.
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14
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Hasselbalch SG, Knudsen GM, Capaldo B, Postiglione A, Paulson OB. Blood-brain barrier transport and brain metabolism of glucose during acute hyperglycemia in humans. J Clin Endocrinol Metab 2001; 86:1986-90. [PMID: 11344196 DOI: 10.1210/jcem.86.5.7490] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is controversial whether transport adaptation takes place in chronic or acute hyperglycemia. Blood-brain barrier glucose permeability and regional brain glucose metabolism (CMR(glc)) was studied in acute hyperglycemia in six normal human subjects (mean age, 23 yr) using the double indicator method and positron emission tomography and [(18)F]fluorodeoxyglucose as tracer. The Kety-Schmidt technique was used for measurement of cerebral blood flow (CBF). After 2 h of hyperglycemia (15.7 +/- 0.7 mmol/L), the glucose permeability-surface area product from blood to brain remained unchanged (0.050 +/- 0.008 vs. 0.059 +/- 0.031 mL/100 g.min). The unidirectional clearance of [(18)F]fluorodeoxyglucose (K(1)*) was reduced from 0.108 +/- 0.011 to 0.061 +/- 0.005 mL/100 g.min (P < 0.0004). During hyperglycemia, global CMR(glc) remained constant (21.4 +/- 1.2 vs. 23.1 +/- 2.2 micromol/100 g.min, normo- and hyperglycemia, respectively). Except for a significant increase in white matter CMR(glc), no regional difference in CMR(glc) was found. Likewise, CBF remained unchanged. The reduction in K(1)* was compatible with Michaelis-Menten kinetics for facilitated transport. Our findings indicate no major adaptational changes in the maximal transport velocity or affinity to the blood-brain barrier glucose transporter. Finally, hyperglycemia did not change global CBF or CMR(glc).
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Affiliation(s)
- S G Hasselbalch
- Neurobiology Research Unit, Department of Neurology, and the PET and Cyclotron Unit, University Hospital, Rigshospitalet,Copenhagen, Denmark.
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15
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Bertolini S, Cantafora A, Averna M, Cortese C, Motti C, Martini S, Pes G, Postiglione A, Stefanutti C, Blotta I, Pisciotta L, Rolleri M, Langheim S, Ghisellini M, Rabbone I, Calandra S. Clinical expression of familial hypercholesterolemia in clusters of mutations of the LDL receptor gene that cause a receptor-defective or receptor-negative phenotype. Arterioscler Thromb Vasc Biol 2000; 20:E41-52. [PMID: 10978268 DOI: 10.1161/01.atv.20.9.e41] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seventy-one mutations of the low density lipoprotein (LDL) receptor gene were identified in 282 unrelated Italian familial hypercholesterolemia (FH) heterozygotes. By extending genotype analysis to families of the index cases, we identified 12 mutation clusters and localized them in specific areas of Italy. To evaluate the impact of these mutations on the clinical expression of FH, the clusters were separated into 2 groups: receptor-defective and receptor-negative, according to the LDL receptor defect caused by each mutation. These 2 groups were comparable in terms of the patients' age, sex distribution, body mass index, arterial hypertension, and smoking status. In receptor-negative subjects, LDL cholesterol was higher (+18%) and high density lipoprotein cholesterol lower (-5%) than the values found in receptor-defective subjects. The prevalence of tendon xanthomas and coronary artery disease (CAD) was 2-fold higher in receptor-negative subjects. In patients >30 years of age in both groups, the presence of CAD was related to age, arterial hypertension, previous smoking, and LDL cholesterol level. Independent contributors to CAD in the receptor-defective subjects were male sex, arterial hypertension, and LDL cholesterol level; in the receptor-negative subjects, the first 2 variables were strong predictors of CAD, whereas the LDL cholesterol level had a lower impact than in receptor-defective subjects. Overall, in receptor-negative subjects, the risk of CAD was 2.6-fold that of receptor-defective subjects. Wide interindividual variability in LDL cholesterol levels was found in each cluster. Apolipoprotein E genotype analysis showed a lowering effect of the epsilon2 allele and a raising effect of the epsilon4 allele on the LDL cholesterol level in both groups; however, the apolipoprotein E genotype accounted for only 4% of the variation in LDL cholesterol. Haplotype analysis showed that all families of the major clusters shared the same intragenic haplotype cosegregating with the mutation, thus suggesting the presence of common ancestors.
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Affiliation(s)
- S Bertolini
- Department of Internal Medicine, University of Genoa, Italy
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16
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Brunetti A, Postiglione A, Tedeschi E, Ciarmiello A, Quarantelli M, Covelli EM, Milan G, Larobina M, Soricelli A, Sodano A, Alfano B. Measurement of global brain atrophy in Alzheimer's disease with unsupervised segmentation of spin-echo MRI studies. J Magn Reson Imaging 2000; 11:260-6. [PMID: 10739557 DOI: 10.1002/(sici)1522-2586(200003)11:3<260::aid-jmri4>3.0.co;2-i] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In 16 patients with probable Alzheimer's disease (AD; NINDS criteria, age range 56-78 years), gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) absolute and fractional volumes were measured with an unsupervised multiparametric post-processing segmentation method based on estimates of relaxation rates R1, R2 (R1 = 1/T1; R2 = 1/T2) and proton density [N(H)] from conventional spin-echo studies (Alfano et al. Magn. Reson. Med. 1997;37:84-93). Global brain atrophy, and GM and WM fractions significantly correlated with Mini-Mental Status Examination and Blessed Dementia Scale scores. Compared with normals, brain compartments in AD patients showed decreased GM (-6.84 +/- 1.58%) and WM fractions (-9.79 +/- 2.47%) and increased CSF fractions (+58.80 +/- 10.37%). Changes were more evident in early-onset AD patients. In AD, measurement of global brain atrophy obtained by a computerized procedure based on routine magnetic resonance studies could complement the information provided by neuropsychological tests for the assessment of disease severity.
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Affiliation(s)
- A Brunetti
- Diagnostic Imaging Department, CNR, Università di Napoli Federico II, Napoli, Italy.
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17
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Chockalingam A, Balaguer-Vintro I, Achutti A, de Luna AB, Chalmers J, Farinaro E, Lauzon R, Martin I, Papp JG, Postiglione A, Reddy KS, Tse TF. The World Heart Federation's white book: impending global pandemic of cardiovascular diseases: challenges and opportunities for the prevention and control of cardiovascular diseases in developing countries and economies in transition. Can J Cardiol 2000; 16:227-9. [PMID: 10694594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Guglielmucci G, Stranges S, Cascone E, Postiglione A, Farinaro E. [The pandemic of cardiovascular diseases, available resources and international cooperation]. Ann Ig 2000; 12:25-30. [PMID: 10900750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- G Guglielmucci
- Dipartimento di Scienze Mediche Preventive, Università degli Studi di Napoli Federico II
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Varrone A, Soricelli A, Postiglione A, Salvatore M. Comparison between cortical distribution of I-123 iomazenil and Tc-99m HMPAO in patients with Alzheimer's disease using SPECT. Clin Nucl Med 1999; 24:660-5. [PMID: 10478740 DOI: 10.1097/00003072-199909000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare brain perfusion and synaptic density in Alzheimer's disease assessed using I-123 iomazenil SPECT with brain perfusion assessed using Tc-99m HMPAO SPECT. MATERIALS AND METHODS Early and delayed I-123 iomazenil SPECT images acquired 20 and 180 minutes after injection were compared with Tc-99m HMPAO SPECT studies acquired 15 to 20 minutes after injection in five patients with Alzheimer's disease. RESULTS Visual analysis of I-123 iomazenil images showed more severe (n = 4) and extensive (n = 3) defects than did Tc-99m HMPAO. Semiquantitative analysis was performed by normalizing the uptake of Tc-99m HMPAO and I-123 iomazenil in individual brain regions in the cerebellum and expressing these values as a ratio of the occipital regions. The analysis of brain regional ratios in Tc-99m HMPAO studies showed a low but significant correlation with ratios of delayed (r = 0.325, P < 0.05) images in the I-123 iomazenil studies. Furthermore, when compared with Tc-99m HMPAO, early (P < 0.01) and delayed mean ratios (P < 0.05) were significantly less in the frontal regions; early mean ratios were significantly less in the temporal regions (P < 0.05), and delayed (P < 0.05) mean ratios were significantly less in the parietal regions. CONCLUSIONS Tc-99m HMPAO images were better correlated with I-123 iomazenil images, indicating cortical synaptic density (delayed images). I-123 iomazenil SPECT in patients with Alzheimer's disease provided more sensitive information than Tc-99m HMPAO, allowing evaluation of brain perfusion and synaptic density.
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Affiliation(s)
- A Varrone
- The Center for Nuclear Medicine of The National Research Council, University Federico II, Naples, Italy
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21
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Singh RB, Beegom R, Mehta AS, Niaz MA, De AK, Mitra RK, Haque M, Verma SP, Dube GK, Siddiqui HM, Wander GS, Janus ED, Postiglione A, Haque MS. Social class, coronary risk factors and undernutrition, a double burden of diseases, in women during transition, in five Indian cities. Int J Cardiol 1999; 69:139-47. [PMID: 10549837 DOI: 10.1016/s0167-5273(99)00010-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To find out the association between social class and coronary risk factors in women. DESIGN AND SETTING Cross-sectional surveys were conducted in six-twelve urban streets in each of five cities from various regions of India following a common study protocol and criteria of diagnosis. SUBJECTS AND METHODS We randomly selected 3257 women, aged 25-64 years inclusive, from the cities of Moradabad (n=902), Trivandrum (n=760) Calcutta (n=410), Nagpur (n=405) and Bombay (n=780). Evaluation was by questionnaires validated at Moradabad. All subjects, after pooling of data, were divided into social class 1 (n=985), social class 2 (n=790), social class 3 (n=674), social class 4 (n=602) and social class 5 (n=206), based on various attributes of socioeconomic status. RESULTS The prevalence of hypertension, diabetes mellitus, family history of coronary disease, obesity, central obesity and sedentary lifestyle were significantly associated with higher social classes and tobacco consumption was not associated with social class. Oral contraceptive intake and postmenopausal status were also more common among higher social classes, which may be due to more education and a longer lifespan among the higher social classes, respectively. Mean total cholesterol, high density lipoprotein cholesterol, systolic and diastolic blood pressure, mean body mass index and waist-hip ratio showed significant association with higher social classes. Mean age, body weight, body mass index, waist-hip ratio, systolic and diastolic blood pressure, total cholesterol and 2-h blood glucose were significantly positively correlated with social class, as assessed by Spearman's rank correlation. Higher social classes 1-3 were more common in Trivandrum and Bombay than in Moradabad. The prevalence of hypertension, diabetes mellitus and being overweight (body mass index >25 kg/m2) were also more common in Trivandrum and Bombay compared to Moradabad. Undernutrition was negatively associated with higher social classes and was more common in Moradabad and Nagpur than Trivandrum. CONCLUSIONS Higher social classes among Indian urban women have a higher prevalence of coronary risk factors, hypertension, diabetes mellitus, being overweight, central obesity, sedentary lifestyle, family history of coronary disease, oral contraceptive intake and postmenopausal status. Mean concentrations of total and high density lipoprotein cholesterol were also significantly associated with higher social classes.
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Affiliation(s)
- R B Singh
- Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India
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Singh RB, Rastogi SS, Niaz MA, Postiglione A. Association of central obesity and insulin resistance with high prevalence of diabetes and cardiovascular disease in an elderly population with low fat intake and lower than normal prevalence of obesity: the Indian paradox. Coron Artery Dis 1998; 9:559-65. [PMID: 9861517 DOI: 10.1097/00019501-199809090-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that high prevalences of cardiovascular disease and diabetes in urban population of India are manifestations of insulin-resistance syndrome. DESIGN AND SETTING Cross-sectional surveys were conducted in 20 streets in the city of Moradabad and in two villages. SUBJECTS AND METHODS There were 566 subjects (255 rural and 311 urban) aged 60-84 years. All subjects were divided on the basis of their insensitivity to insulin into groups with mild, moderate and high insensitivity to insulin and data from both sexes were pooled for analysis. RESULTS Overall increases in the prevalences of coronary disease, diabetes, hypertension, central obesity and associated disturbances were observed with increasing insensitivity to insulin and the trend was more significant among urban than it was among rural subjects. Multivariate logistic regression analysis revealed a significant positive association of level of insulin insensitivity with the age-adjusted prevalences of coronary disease, hypertension, diabetes, hypertriglyceridaemia, intolerance of glucose and central obesity among urban subjects. We observed a significant inverse association between insensitivity to insulin and physical activity both for rural and for urban subjects and between insensitivity to insulin and high-density lipoprotein cholesterol level for urban subjects. For rural subjects, we found significant associations of sensitivity to insulin with coronary artery disease and intolerance of glucose without significant associations with other risk factors. CONCLUSION Insensitivity to insulin was significantly associated with risks of cardiovascular disease and diabetes, despite there being a low prevalence of obesity (9.0%) among urban subjects. Hypertension, diabetes, hypertriglyceridaemia, intolerance of glucose and central obesity were significantly associated with insensitivity to insulin and coronary disease for urban but not for rural people.
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Affiliation(s)
- R B Singh
- Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India
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del Puente A, Postiglione A, Esposito-del Puente A, Carpinelli A, Romano M, Oriente P. Peripheral body fat has a protective role on bone mineral density in elderly women. Eur J Clin Nutr 1998; 52:690-3. [PMID: 9756127 DOI: 10.1038/sj.ejcn.1600630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine whether bone mineral density is lower in women living in homes for the elderly as compared to free dwelling control subjects, and to investigate factors affecting possible differences. This is the first study with this objective as the primary aim. DESIGN Case-control study. SUBJECTS AND METHODS Institutionalised independent elderly women (n = 22, mean age = 75.1 y+/-6.43 s.d.) randomly selected in a home for the elderly and 22 age-matched control women randomly selected from a sample representative of the independent non institutionalised local population who underwent dual energy X-ray absorptiometry (DXA) at the lumbar spine and right femoral neck; anthropometric measurements (height, weight, subscapular and triceps skinfold thickness); general questionnaire. RESULTS Mean bone mineral density at the femoral neck was 0.618 g/cm2 (+/-0.130s.d.) in institutionalised women and 0.709 g/cm2 (+/-0.106 s.d.) in controls (P = 0.02, t-test). Controlling for confounding factors in the analysis of covariance, triceps skinfold thickness and living in a home for the elderly turned out to be significant determinants of bone mineral density. CONCLUSION When compared to free dwelling control subjects, institutionalised women show lower bone density, that is the main risk factor for fracture. Reduced peripheral body fat was significantly associated with the low bone mineral density observed. Health programs aimed at decreasing the incidence of fractures among institutionalised subjects will also have to consider the effect of nutritional or life style factors that reduce peripheral body fat.
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Affiliation(s)
- A del Puente
- Department of Rheumatology, University Federico II, Naples, Italy
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De Michele G, Mainenti PP, Soricelli A, Di Salle F, Salvatore E, Longobardi MR, Postiglione A, Salvatore M, Filla A. Cerebral blood flow in spinocerebellar degenerations: a single photon emission tomography study in 28 patients. J Neurol 1998; 245:603-8. [PMID: 9758299 DOI: 10.1007/s004150050253] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We used single photon emission tomography to study regional cerebral perfusion in patients with different forms of spinocerebellar degeneration: 6 patients with Friedreich's ataxia (FA), 6 with early-onset cerebellar ataxia with retained tendon reflexes (EOCA), 5 with autosomal dominant cerebellar ataxia type 1 (ADCA I) and 11 with idiopathic late-onset cerebellar ataxia (ILOCA). The results were related to clinical and magnetic resonance imaging (MRI) findings. Cerebellar hypoperfusion was constant in ADCA I and frequent in patients with other spinocerebellar degenerations. Brain stem hypoperfusion was constant in ADCA I, frequent in ILOCA patients with pontocerebellar atrophy and absent in FA and EOCA. FA and EOCA often showed a reduction in the parietotemporal cortex blood flow, which was not related to cortical atrophy. ILOCA patients had an asymmetric pattern in the temporal areas with decreased blood flow in the right side only. Caudate hypoperfusion was found in ADCA I patients. Cerebral atrophy did not account for changes in regional blood flow, which probably indicate early involvement of cerebral structures.
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Affiliation(s)
- G De Michele
- Clinica Neurologica, Università Federico II, Napoli, Italy
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25
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Postiglione A, De Chiara S, Soricelli A, Oriente A, Ruocco A, Spadaro G, Montefusco S, Marone G, Genovese A. Alterations of cerebral blood flow and antiphospholipid antibodies in patients with systemic lupus erythematosus. Int J Clin Lab Res 1998; 28:34-8. [PMID: 9594361 DOI: 10.1007/s005990050015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Twenty-two patients with systemic lupus erythematosus and 13 healthy controls were included in a cerebral blood flow study and underwent brain-dedicated single-photon emission computed tomography using 99m technetium-d, l-hexamethylpropylene amine oxime together with a brain computed tomography scan. Plasma levels of antiphospholipid antibodies (lupus anticoagulant and anticardiolipin IgM and IgG antibodies) were also determined. Brain computed tomography showed signs of focal cerebral ischemia in 4 patients (18%), whereas cerebral blood flow by single-photon emission computed tomography was abnormal in 13 of 22 patients (59%), who showed bilateral or monolateral hypoperfusion in the temporo-parietal regions. Patients with abnormal cerebral blood flow had a longer duration of disease than those with normal blood flow (8.9 +/- 1.9 years vs. 5.3 +/- 1.5 years, P < 0.05). Plasma antiphospholipid antibodies were present in 15 patients (68%), but the prevalence was similar in those with normal (6/9, 66%), or abnormal (9/13, 69%) cerebral blood flow. No statistically significant difference in lupus anticoagulant or anticardiolipin antibodies was observed between patients with and without cerebral blood flow abnormalities. Our study shows that patients with systemic lupus erythematosus frequently have cerebral blood flow abnormalities, which could precede those observed by computed tomography. Plasma lupus anticoagulant and anticardiolipin titers were not correlated with normal cerebral blood flow.
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Affiliation(s)
- A Postiglione
- Department of Clinical and Experimental Medicine, University of Naples Federico II, School of Medicine, Italy
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26
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Soricelli A, Cuocolo A, Varrone A, Discepolo A, Tedeschi E, Mainenti PP, Grivet-Fojaja MR, Covelli EM, Postiglione A, Salvatore M. Technetium-99m-tetrofosmin uptake in brain tumors by SPECT: comparison with thallium-201 imaging. J Nucl Med 1998; 39:802-6. [PMID: 9591579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Thallium-201 is clinically used for the assessment of primary and recurrent brain tumors. The biologic properties of 201Tl that allow it to accumulate within the tumor cells render 201Tl useful in evaluating tumor malignancy, but its physical characteristics and nonroutine availability limits its use in some institutions, as compared to 99mTc-labeled compounds. The aim of this study was to assess the feasibility of using 99mTc-tetrofosmin for imaging brain tumors and to compare its uptake with that of 201Tl. METHODS Twenty-six patients with 27 intracranial masses were studied with SPECT. In the first group of seven patients (Group A), the timing for optimal acquisition of the 99mTc-tetrofosmin scan was assessed. In the second group of 19 patients (Group B), two sequential 201Tl (74-148 MBq intravenous) and 99mTc-tetrofosmin (740-925 MBq intravenous) studies were performed 20 min after tracer injection and compared. RESULTS In Group A, no significant difference in the tumor-to-background (T/B) ratio among the 20-, 40- and 120-min postinjection studies was observed. In Group B, the quality of reconstructed images with 99mTc-tetrofosmin, judged visually, was superior to that of 201Tl in 47% of all studies and was comparable in the remaining 53%. A significant relationship between 201Tl and 99mTc-tetrofosmin T/B ratio (r = 0.75, p < 0.01) was found. The T/B ratio of 99mTc-tetrofosmin was significantly higher than that of 201Tl (23.3 +/- 21.5 compared to 6.1 +/- 2.9, p < 0.005). CONCLUSION Technetium-99m-tetrofosmin is a suitable radiotracer for the imaging of intracranial lesions with SPECT. Moreover, a better definition of tumor margins and a higher contrast between neoplastic and normal brain tissue can be achieved.
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Affiliation(s)
- A Soricelli
- Department of Diagnostic Imaging, University of Naples Federico II, Nuclear Medicine Center of the National Research Council, Italy
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27
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Margaglione M, Seripa D, Gravina C, Grandone E, Vecchione G, Cappucci G, Merla G, Papa S, Postiglione A, Di Minno G, Fazio VM. Prevalence of apolipoprotein E alleles in healthy subjects and survivors of ischemic stroke: an Italian Case-Control Study. Stroke 1998; 29:399-403. [PMID: 9472880 DOI: 10.1161/01.str.29.2.399] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The epsilon4 allele of the apolipoprotein E (apoE) has been related to the occurrence of myocardial infarction, but its association with ischemic stroke is controversial. We have evaluated the relation between apoE alleles and the occurrence of cerebrovascular ischemia. METHODS The apoE epsilon genotypes of 100 patients with a documented history of ischemic stroke without clinically apparent dementia (stroke+) and 108 subjects without such history (stroke-) were determined. The relative frequency of the apoE alleles and genotypes was estimated in 398 healthy subjects aged < 40 years from the same ethnic background. RESULTS The frequency of the apoE epsilon4 allele in stroke+ (0.18 [95% CI, 0.12 to 0.25]) was higher than in stroke- (0.07 [95% CI, 0.03 to 0.12]; P<.001) or in healthy subjects (0.09 [95% CI, 0.07 to 0.12]; P<.001). Carriers of the epsilon4 allele differed between stroke+ (0.30 [95% CI, 0.19 to 0.42]) and stroke- (0.12 [95% CI, 0.5 to 0.22]; P=.004) or healthy subjects (0.16 [95% CI; 0.12 to 0.22]; P=.015). Accordingly, epsilon3/epsilon3 homozygotes were less frequent in stroke+ (0.59 [95% CI, 0.45 to 0.71]) than in stroke- (0.72 [95% CI, 0.59 to 0.82]; P=.063) or in healthy subjects (0.73 [95% CI, 0.67 to 0.78]; P=.01). In a multiple logistic regression analysis, age (P<.03), positive family history (P<.04) and apoE (P<.002) independently contributed to a stroke history, with epsilon4 carriers exhibiting a higher estimated risk (odds ratio, 5.05). CONCLUSIONS Our data show an association between apoE gene and a personal history of ischemic stroke and support the possibility that the apoE gene is a susceptibility locus for the risk of cerebrovascular ischemic disease.
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Affiliation(s)
- M Margaglione
- Unità di Aterosclerosi e Trombosi, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
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28
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Singh RB, Beegom R, Mehta AS, Niaz MA, De AK, Haque M, Bhattacharyya PR, Dube GK, Pandit RB, Thakur AS, Wander GS, Janus ED, Postiglione A, Moshiri M. Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group. Int J Cardiol 1998; 63:165-73. [PMID: 9510491 DOI: 10.1016/s0167-5273(97)00296-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. Evaluation was by a physician and a dietitian, an administered questionnaire, a physical examination and using a sphygmomanometer. The diagnosis of hypertension was based on old World Health Organisation criteria and new World Health Organisation/International Society of Hypertension criteria. The prevalence of hypertension (>140/90 mm Hg) was significantly (P<0.01) high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% (n=823) and isolated diastolic hypertension was the most common form of hypertension (50.5%, n=1506) in the five Indian cities. According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.
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Affiliation(s)
- R B Singh
- Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India
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Napoli C, D'Armiento FP, Mancini FP, Postiglione A, Witztum JL, Palumbo G, Palinski W. Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions. J Clin Invest 1997; 100:2680-90. [PMID: 9389731 PMCID: PMC508471 DOI: 10.1172/jci119813] [Citation(s) in RCA: 666] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To determine whether oxidized LDL enhances atherogenesis by promoting monocyte recruitment into the vascular intima, we investigated whether LDL accumulation and oxidation precede intimal accumulation of monocytes in human fetal aortas (from spontaneous abortions and premature newborns who died within 12 h; fetal age 6.2+/-1.3 mo). For this purpose, a systematic assessment of fatty streak formation was carried out in fetal aortas from normocholesterolemic mothers (n = 22), hypercholesterolemic mothers (n = 33), and mothers who were hypercholesterolemic only during pregnancy (n = 27). Fetal plasma cholesterol levels showed a strong inverse correlation with fetal age (R = -0.88, P < 0.0001). In fetuses younger than 6 mo, fetal plasma cholesterol levels correlated with maternal ones (R = 0.86, P = 0.001), whereas in older fetuses no such correlation existed. Fetal aortas from hypercholesterolemic mothers and mothers with temporary hypercholesterolemia contained significantly more and larger lesions (758,651+/-87,449 and 451,255+/-37,448 micron2 per section, respectively; mean+/-SD) than aortas from normocholesterolemic mothers (61,862+/-9,555 micron2; P < 0.00005). Serial sections of the arch, thoracic, and abdominal aortas were immunostained for recognized markers of atherosclerosis: macrophages, apo B, and two different oxidation-specific epitopes (malondialdehyde- and 4-hydroxynonenal-lysine). Of the atherogenic sites that showed positive immunostaining for at least one of these markers, 58.6% were established lesions containing both macrophage/foam cells and oxidized LDL (OxLDL). 17.3% of all sites contained only native LDL, and 13.3% contained only OxLDL without monocyte/ macrophages. In contrast, only 4.3% of sites contained isolated monocytes in the absence of native or oxidized LDL. In addition, 6.3% of sites contained LDL and macrophages but few oxidation-specific epitopes. These results demonstrate that LDL oxidation and formation of fatty streaks occurs already during fetal development, and that both phenomena are greatly enhanced by maternal hypercholesterolemia. The fact that in very early lesions LDL and OxLDL are frequently found in the absence of monocyte/macrophages, whereas the opposite is rare, suggests that intimal LDL accumulation and oxidation contributes to monocyte recruitment in vivo.
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Affiliation(s)
- C Napoli
- Department of Clinical and Experimental Medicine, Federico II University of Naples, 80131 Naples, Italy
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Napoli C, Paternò R, Faraci FM, Taguchi H, Postiglione A, Heistad DD. Mildly oxidized low-density lipoprotein impairs responses of carotid but not basilar artery in rabbits. Stroke 1997; 28:2266-71; discussion 2271-2. [PMID: 9368575 DOI: 10.1161/01.str.28.11.2266] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial blood vessels appear to be relatively resistant to development of atherosclerosis. The goal of this study was to compare effects of mildly oxidized LDL (ox-LDL) on endothelium-dependent responses of intracranial and extracranial arteries in vitro. METHODS LDL was purified from plasma of healthy subjects and mildly oxidized by means of a xanthine/xanthine oxidase reaction. Contraction of the rabbit basilar and carotid arteries in response to histamine and phenylephrine and relaxation in precontracted vessels to acetylcholine and sodium nitroprusside were evaluated after 30 minutes of exposure to LDL or ox-LDL (100 micrograms/mL). RESULTS Exposure to LDL had little or no effect on vascular responses. After exposure to ox-LDL, contraction to histamine and phenylephrine and relaxation to acetylcholine were impaired significantly in carotid (P < .05) but not in basilar artery. Relaxation to sodium nitroprusside was not significantly impaired by ox-LDL in the basilar artery. In the carotid artery, relaxation to sodium nitroprusside was significantly impaired by ox-LDL when the vessels were precontracted with phenylephrine but not histamine. Impairment of vascular responses by ox-LDL was prevented by addition of superoxide dismutase, catalase, or dimethylthiourea to the LDL solution before addition of xanthine/xanthine oxidase. CONCLUSIONS Mildly ox-LDL impairs contraction and endothelium-dependent relaxation in the carotid but not in basilar artery. Thus, intracranial arteries may be relatively resistant to mildly ox-LDL.
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Affiliation(s)
- C Napoli
- Department of Internal Medicine and Pharmacology, University of Iowa, Iowa City 52242-1081, USA
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31
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Napoli C, D'Armiento FP, Corso G, Ambrosio G, Palumbo G, Zuliani P, Malorni A, Gallotta G, Somma P, Postiglione A, Chiariello M. Occurrence of the same peroxidative compounds in low density lipoprotein and in atherosclerotic lesions from a homozygous familial hypercholesterolemic patient: a case report. Int J Cardiol 1997; 62:77-85. [PMID: 9363507 DOI: 10.1016/s0167-5273(97)00180-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Oxidative modification of low density lipoprotein (LDL) and its byproducts may play a fundamental role in atherosclerosis. We report an in vitro analysis of LDL peroxidative compounds in an homozygous familial hypercholesterolemic (HFH) patient who subsequently died. During the autopsy, we analyzed lipids extracted directly from different atherosclerotic plaques, and we also provided an immunocytochemical analysis using the specific monoclonal antibody MDA2 (directed against malondialdeyde-lysine epitopes of oxidized LDL). The results showed that the same species of peroxidative compounds were present both in LDL in vitro and in lipids extracted directly from atherosclerotic lesions. Moreover, the immunocytochemistry analysis revealed a positive staining of atherosclerotic plaques, confirming the presence of LDL oxidation-specific epitopes. Although observation of a single case is necessarily limited, our findings are consistent with the hypothesis that oxidative modification of LDL is involved in human atherogenesis.
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Affiliation(s)
- C Napoli
- Division of Cardiology, School of Medicine, Federico II University of Naples, Italy
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Gallotta G, Iazzetta N, Milan G, Ruocco A, Napoli C, Postiglione A. Prevalence of peripheral arterial disease in an elderly rural population of southern Italy. Gerontology 1997; 43:289-95. [PMID: 9309419 DOI: 10.1159/000213865] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Blood pressure was measured at the posterior tibial artery by Doppler ultrasonography in 440 elderly subjects (205 men and 235 women) living in a rural community of Southern Italy, together with the evaluation of traditional risk factors for cardiovascular disease. An ankle/arm systolic pressure ratio below 0.90 was considered as a definite pathological sign of peripheral arterial disease (PAD). About 10% of both men and women had a value below 0.90. Elderly subjects with PAD had higher serum triglyceride levels and a higher ratio between the cholesterol content in atherogenic (VLDL + LDL) versus non-atherogenic (HDL) lipoproteins than subjects free of PAD. The mean blood pressure was also higher in patients with PAD. The prevalence of PAD was much lower than what we have observed in institutionalized old subjects in Southern Italy.
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Affiliation(s)
- G Gallotta
- Department of Clinical and Experimental Medicine, Medical School, University Federico II, Naples, Italy
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Napoli C, Mancini FP, Corso G, Malorni A, Crescenzi E, Postiglione A, Palumbo G. A simple and rapid purification procedure minimizes spontaneous oxidative modifications of low density lipoprotein and lipoprotein (a). J Biochem 1997; 121:1096-101. [PMID: 9354382 DOI: 10.1093/oxfordjournals.jbchem.a021700] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Usual purification procedures of LDL and Lp(a) require numerous, extensive and prolonged sample handlings: this greatly increases the possibility of spontaneous oxidation. We have developed a method which, making use of two short-run ultracentrifugations in vertical rotors alternated by two rapid column-chromatography steps (SRUC), significantly shortens the preparation time to 3.5 h (LDL) and does not demand additional instrumentation or particular accuracy. Purification of Lp(a) requires a further wheat germ agglutinin chromatographic step, which can be accomplished within 30 min. More importantly, the method significantly reduces spontaneous oxidation as compared with classical isolation procedures. LDL isolated by the standard sequential method exhibits more extensive apolipoprotein B100 degradation, lipid peroxidation, and endogenous antioxidant (vitamin E) loss than the same lipoproteins obtained by means of the SRUC. This procedure may have be particularly valuable in experiments evaluating the effects of oxygen radical-induced modifications, especially in vitro.
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Affiliation(s)
- C Napoli
- Dipartimento di Medicina Clinica e Sperimentale, Facolta' di Medicina e Chirurgia, Universita' di Napoli Federico II, Naples, Italy
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Postiglione A, Salvatore M, Lassen NA. 123I-iomazenil as a clinical tool for studying neuronal loss. J Am Geriatr Soc 1997; 45:534-6. [PMID: 9100734 DOI: 10.1111/j.1532-5415.1997.tb05191.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
BACKGROUND Oxidative modification of low-density lipoprotein (LDL) appears to play a pivotal role in atherogenesis. The specific role played by LDL peroxidation in aging is not known. Since estrogens may protect LDL from peroxidation in vitro and in vivo, we chose to investigate only men of various ages. OBJECTIVE To determine whether LDL from healthy elderly men was differently susceptible to peroxidation than LDL of young and adult men. SUBJECTS AND METHODS LDL was isolated from 15 normolipidemic young (aged 19-23 years), 17 adult (aged 35-55 years), and 16 elderly (aged 77-90 years) healthy men. None of the men included in the study was a smoker or a hypertensive. LDL peroxidation was achieved by exposure to 5 mumol/l copper sulfate for 18 h at 37 degrees C, and some markers of lipid peroxidation (estimating various levels of peroxidation) were evaluated. RESULTS The levels of lipid peroxides in LDL from our elderly men were already higher under basal conditions than were those both of adult and of young men. LDL from elderly men was more susceptible to peroxidation than was that of adult and young men. Furthermore, the lag time correlated inversely to age (r = -0.68, P < 0.01), whereas lipid peroxide and malonyldialdehyde levels correlated highly to age (r = 0.79 and r = 0.77, P < 0.0002 and P < 0.0012, respectively). With aging the vitamin E content in LDL decreased whereas the arachidonic fatty acid content increased. More importantly, the relationship between the vitamin E content and the lag time made evident the parallel increase in lag time and in vitamin E level with aging. The vitamin E concentration also correlated inversely to levels of thiobarbituric acid-reactive substances in LDL from elderly patients (r = -0.61, P < 0.05). CONCLUSIONS The present study shows that LDL peroxidation increases with age. This phenomenon may favor the progression of atherosclerosis in elderly men.
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Affiliation(s)
- C Napoli
- Department of Clinical and Experimental Medicine, School of Medicine, Federico II University of Naples, Italy
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36
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Corso G, Trivellone E, Motta A, Postiglione A, Mancini FP, Carbone V, Napoli C. Effect of low density lipoprotein fatty acid composition on copper-induced peroxidation: 1H-nuclear magnetic resonance analysis. Clin Chim Acta 1997; 258:193-200. [PMID: 9074815 DOI: 10.1016/s0009-8981(96)06461-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Oxidation of low density lipoprotein (LDL) has been implicated in atherogenesis. An increased content of oleic acid in LDL and the substitution of monounsaturated for polyunsaturated fatty acids in the diet reduce LDL oxidation. With 1H-NMR analysis, all LDL modifications, including the production of copper-induced aldehyde products, can be evaluated simultaneously. The aim of the present study was to investigate whether the fatty acid composition of LDL affected the NMR evaluation of aldehyde compounds. The LDL of the samples utilized were rich in oleic fatty acid (26.9%). After 48 h of exposure to copper sulfate, the mean production of malonyldialdehyde (MDA) by LDL was 31.2 nmol/mg of protein. Moreover, in the present study NMR did not reveal large amounts of peroxidative compounds since the nanomolar amounts of MDA produced after exposure to copper sulfate could not be detected. This study also demonstrated that the fatty acid composition (i.e. the oleic:linoleic acid ratio) must be taken into account in the evaluation of LDL peroxidation by NMR. In particular, a high concentration of oleic acid may limit the formation of large amounts of peroxidative compounds generated after exposure to the oxidant copper sulfate.
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Affiliation(s)
- G Corso
- Department of Clinical and Experimental Medicine, School of Medicine, Federico II University of Naples, Italy
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37
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Janus ED, Postiglione A, Singh RB, Lewis B. The modernization of Asia. Implications for coronary heart disease. Council on Arteriosclerosis of the International Society and Federation of Cardiology. Circulation 1996; 94:2671-3. [PMID: 8941084 DOI: 10.1161/01.cir.94.11.2671] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Singh RB, Rastogi V, Singh R, Niaz MA, Srivastav S, Aslam M, Singh NK, Moshir M, Postiglione A. Magnesium and antioxidant vitamin status and risk of complications of ageing in an elderly urban population. Magnes Res 1996; 9:299-306. [PMID: 9247878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This cross-sectional survey was conducted in 20 randomly selected streets in Moradbad city in North India to determine the association of magnesium and antioxidant vitamins with risk of ageing. There were 595 subjects (314 males, 281 females) between 50-84 years of age inclusive. The overall prevalence of hypo-magnesemia was 11.8 per cent (n = 60) with a prevalence of 13.2 per cent (n = 33) in males and 10.6 per cent (n = 27) in females. The prevalence of hypomagnesemia showed significant declining trend in the concentration of serum magnesium, vitamin C, vitamin E and beta-carotene and a rising trend in lipid peroxides and diene conjugates with increase in age from 50-59 years to 70-84 years in both men and women. Multivariate logistic regression analysis showed that serum magnesium, vitamin C, vitamin E and beta-carotene were significant risk factors of ageing in both men and women. The findings suggest that some urban populations of India can benefit by consuming higher dietary magnesium, potassium and antioxidant vitamins for prevention of ageing.
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Affiliation(s)
- R B Singh
- Centre of Nutrition, Medical Hospital and Research Centre, Moradabad, India
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39
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Tedeschi E, Soricelli A, Brunetti A, Romano M, Bucciero A, Iaconetta G, Alfieri A, Postiglione A, Salvatore M. Different thallium-201 single-photon emission tomographic patterns in benign and aggressive meningiomas. Eur J Nucl Med 1996; 23:1478-84. [PMID: 8854846 DOI: 10.1007/bf01254472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate the possibility of preoperatively obtaining an index of aggressiveness for intracranial meningiomas, we prospectively studied 22 patients with computed tomographic or magnetic resonance imaging evidence of meningeal tumour, using single-photon emission tomography (SPET) of the brain and thallium-201 (201Tl). On a brain-dedicated SPET scanner, a rapid acquisition protocol with early, short scans was started simultaneously with the intravenous administration of 111 MBq 201Tl, covering the initial intratumoral distribution of the tracer. Twenty minutes post injection, a delayed SPET scan was also obtained. On the reconstructed and attenuation-corrected images we calculated the 201Tl concentration in tumour and normal contralateral brain tissue, and compared intratumoral tracer concentration in the initial and the final part of the rapid acquisition protocol. Benign and malignant meningiomas were classified as such based on histological examination. In malignant lesions, the ratio of the 201Tl concentration at 2-4 min post injection to that at 14-16 min was found to be significantly higher than in non-aggressive neoplasms (mean+/-1 SD: 1.14+/-0.31 and 0.56+/-0.13, respectively, P <0.01). Conversely, in the delayed scan, most lesions showed high tracer concentration, and the two groups could not be distinguished. In addition, three recurrent meningiomas displayed the same imaging behaviour as the malignant group, i.e. had similar 201Tl concentration values at 2-4 and at 14-16 min. Our findings suggest that the comparative assessment of intratumoral 201Tl concentration at 2-4 and at 14-16 min post injection could provide a fast, simple method to differentiate preoperatively intracranial meningiomas with different biological behaviour.
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Affiliation(s)
- E Tedeschi
- Dipartimento di Diagnostica per Immagini-Centro CNR per la Medicina Nucleare, Napoli, Italy
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Soricelli A, Postiglione A, Grivet-Fojaja MR, Mainenti PP, Discepolo A, Varrone A, Salvatore M, Lassen NA. Reduced cortical distribution volume of iodine-123 iomazenil in Alzheimer's disease as a measure of loss of synapses. Eur J Nucl Med 1996; 23:1323-8. [PMID: 8781136 DOI: 10.1007/bf01367587] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Iodine-123 labelled iomazenil (IMZ) is a specific tracer for the GABAA receptor, the dominant inhibitory synapse of the brain. The cerebral distribution volume (Vd) of IMZ may be taken as a quantitative measure of these synapses in Alzheimer's disease (AD), where synaptic loss tends indiscriminately to affect all cortical neurons, albeit more so in some areas than in others. In this pilot study we measured Vd in six patients with probable AD and in five age-matched controls using a brain-dedicated single-photon emission tomography scanner allowing all cortical levels to be sampled simultaneously. Reduced values were found in all regions except in the occipital (visual) cortex. In particular, temporal and parietal cortex Vd was significantly (P<0.02) reduced: temporal Vd averaged 69 ml/ml in normals and 51 ml/ml in AD, and parietal Vd averaged 71 ml/ml in normals and 48 ml/ml in AD. These results accord well with emission tomographic studies of blood flow or labelled glucose. This supports the idea that while only measuring a subpopulation of synapses, the IMZ method reflects synaptic loss and hence functional loss in AD. The method constitutes an in vivo version of synaptic quantitation that in histopathological studies has been shown to correlate closely with the mental deterioration in AD.
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Affiliation(s)
- A Soricelli
- Department of Diagnostic Imaging, University of Naples Federico II, Nuclear Medicine Center of the National Research Council, Naples, Italy
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41
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Pinto MR, Caterina G, Bianchi A, De Medici S, Postiglione A, Napoli C. Ergonomic approach in aging: experimental procedures to assess cognitive and balance impairments. Riv Eur Sci Med Farmacol 1996; 18:153-6. [PMID: 9177614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This brief commentary is focused on the experimental procedures employed in the evaluation of both cognitive and balance impairments of aging patients. This is an important ergonomic issue that might be used for research purposes. In fact, the corrected assessment of impairments during aging may favor the development of new integrated ergonomic strategies to ameliorate ADL together with the reduction of environmental risks.
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Affiliation(s)
- M R Pinto
- Department of Clinical and Experimental Medicine, School of Medicine, Federico II University, Naples, Italy
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42
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Postiglione A, Soricelli A, Covelli EM, Iazzetta N, Ruocco A, Milan G, Santoro L, Alfano B, Brunetti A. Premature aging in Werner's syndrome spares the central nervous system. Neurobiol Aging 1996; 17:325-30. [PMID: 8725892 DOI: 10.1016/0197-4580(96)00033-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Werner's Syndrome is a rare genetic disease, characterized by premature aging of many tissues and organs. We studied the brain morphology and function in two patients with Werner's syndrome to assess the possible involvement of the central nervous system in this premature aging process. The two patients (brother and sister, respectively) were studied by magnetic resonance imaging (MRI) and angiography (MRA), single photon emission computed tomography (SPECT) with (99mTc)-d,l-hexamethyl propilene amine oxime (HMPAO), positron emission tomography (PET) with 2(18F)-Fluoro-2-deoxyglucose (FDG), electroencephalography (EEG), and electromyography (EMG). Some of these investigations were also repeated after 1 year. The results of all these studies were normal. The premature aging process in patients with Werner's syndrome, while affecting most tissues, seems to spare the central nervous system.
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Affiliation(s)
- A Postiglione
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Italy
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43
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Napoli C, Postiglione A, Scarpato N, Corso G, Ambrosio G, Condorelli M, Mancini M, Chiariello M. [LDL oxidation in homozygous familial hypercholesterolemia: effects of selective LDL-apheresis treatment]. Cardiologia 1996; 41:435-9. [PMID: 8767632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Homozygous familial hypercholesterolemia (HFH) results from a mutation affecting both the structure and function of a cell surface receptor that removes low density lipoproteins (LDL) from plasma. The disorder is characterized by autosomal dominant inheritance, a lifelong elevation in the concentration of LDL-bound cholesterol in blood and by cholesterol deposits that form xanthomas and early coronary artery disease. HFH patients, as a result of the increased levels and prolonged residence time of LDL in plasma, have a strong tendency toward accumulation of LDL-cholesterol in the arterial wall causing premature atherosclerosis. Selective LDL-apheresis (LA) on dextran/sulphate cellulose columns is the best therapy reducing mortality of these patients. We previously showed that prolonged lifelong enhanced LDL oxidation in HFH. LDL undergo oxidation before being taken up by macrophages then transformed into foam cells. At the present time, the relevance of the in vitro macrophages studies to the accumulation of cholesterol esters in scavenger cells of HFH patients is not yet established. The aim of this study was to investigate LDL oxidation, induced by xanthine (2 mM)+xanthine oxidase (100 mU), and cholesterol esterification in macrophages, in 8 HFH patients before and after LA. LDL peroxidation by conjugated-diene absorbance showed an increased resistance against oxidation after LA: lag time 129 +/- 25 vs 112 +/- 27 min, p < 0.05; diene production 9.1 +/- 2.1 vs 13.9 +/- 2.5 nM/min/mg LDL, p < 0.01. Peroxidation was also evaluated from lipid peroxides (158 +/- 34 vs 57 +/- 18 nM/mg protein after LA, p < 0.05) and malonyldialdehyde (38 +/- 12 vs 27 +/- 8 nM/mg protein after LA, p < 0.05) content. When oxidized LDL was run on polyacrylamide gel extensive apo-B100 fragmentation was observed in LDL before LA, vs a less fragmentation after LA. A similar reduction was obtained in LDL agarose mobility after LA (1.7 +/- 0.2 vs 2.5 +/- 0.2, p < 0.05). Cholesterol esterification in mouse peritoneal macrophages was also decreased after LA (8.5 +/- 1.8 vs 14.6 +/- 2.7 nM/mg cell protein/12 hours, p < 0.05). Vitamin E content of LDL (mg/g protein) was increased after LA (4.44 +/- 1.0 vs 3.9 +/- 1.2, p < 0.05). Thus, selective LA, not only decreases the pool of LDL, but it also induces changes that render LDL less susceptible to oxidation and decreased high cholesterol esterification in macrophages. The prevention of these mechanisms by LA contributes actively to retard atherogenesis in HFH patients.
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Affiliation(s)
- C Napoli
- Cattedra di Cardiologia, Università degli Studi, Federico II, Napoli
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44
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Margaglione M, DiMinno G, Grandone E, Celentano E, Vecchione G, Cappucci G, Grilli M, Mancini FP, Postiglione A, Panico S, Mancini M. Plasma lipoprotein(a) levels in subjects attending a metabolic ward. Discrimination between individuals with and without a history of ischemic stroke. Arterioscler Thromb Vasc Biol 1996; 16:120-8. [PMID: 8548412 DOI: 10.1161/01.atv.16.1.120] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this cross-sectional study we compared the abilities of lipoprotein(a) [Lp(a)], plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (TPA) to discriminate between individuals with and without a history of stroke from among subjects in a metabolic ward. A total of 210 subjects (108 men and 102 women; mean age, 63.8 years; range, 31 to 86 years) provided plasma and DNA samples for the study. Of these, 51 men and 50 women had a history of ischemic stroke. The 109 subjects without a history of stroke were compared with those with such a history for major risk factors for ischemic events. Mean plasma TPA and PAI-1 levels significantly (P < .001) discriminated among subjects younger than 70 years with a history of stroke. The mean plasma Lp(a) level of stroke subjects (21.9 mg/dL) did not differ significantly from that of control subjects (15.2 mg/dL). However, among individuals < 70 years old, Lp(a) plasma levels > 50 mg/dL were more common among stroke patients (8 with versus 1 without, P < .01 by chi 2 test). A molecular variation in the 5' flanking region of the apo(a) gene that has been related to elevated Lp(a) plasma levels (G/A-914) was not strongly correlated with circulating levels of Lp(a), nor did Lp(a) levels correlate with a polymorphism of the apo(a) gene (G/A-21), which is strongly linked (P < .001) to the G/A-914 variation. In this setting, the relation between Lp(a) and cerebral ischemia appears to be limited to individuals below 70 years with elevated (> 50 mg/dL) plasma levels of the lipoprotein.
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Affiliation(s)
- M Margaglione
- Clinical Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Napoli, Italy
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Singh RB, Ghosh S, Niaz MA, Singh R, Beegum R, Chibo H, Shoumin Z, Postiglione A. Dietary intake, plasma levels of antioxidant vitamins, and oxidative stress in relation to coronary artery disease in elderly subjects. Am J Cardiol 1995; 76:1233-8. [PMID: 7503002 DOI: 10.1016/s0002-9149(99)80348-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The prevalence of coronary artery disease (CAD) in the urban population of India is similar to that in developed countries; Indian immigrants in industrialized countries have the highest prevalence of CAD. This is a cross-sectional survey within a random sample of a single urban setting in India. The relation between risk of CAD and plasma levels of vitamins A, C, E, and beta-carotene was examined in 72 of 595 elderly subjects (12.1%) with CAD (aged 50 to 84 years). Plasma levels of vitamins A, C, E, and beta-carotene were significantly related to risk of CAD. Smoking (n = 145) and diabetes (n = 70) were the confounding factors. Lipid peroxides were higher in patients with CAD and diabetes, and in those who smoked. The inverse relation between CAD and low plasma vitamin C was substantially reduced after adjustment for smoking and diabetes. Vitamin A and E levels remained independently and inversely related to the risk of CAD after adjustment for age, smoking, diabetes, blood pressure, blood lipoproteins, and relative weight and body mass index. The adjusted odds ratios for CAD between the lowest and highest quintiles of vitamin E levels were 2.53 (95% confidence interval [CI] 1.11 to 5.31), vitamin C, 2.21 (95% CI 1.12 to 3.15), and beta-carotene, 1.72 (95% CI 0.88 to 3.62). The fatty acid composition of the diet, blood lipid levels, central obesity (waist-hip ratio), smoking habits, blood pressure, and plasma insulin levels do not appear to account for high rates of CAD among elderly Indians.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R B Singh
- Centre of Nutrition, Medical Hospital and Research Centre, Moradabad, India
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Singh RB, Niaz MA, Ghosh S, Beegom R, Chibo H, Agarwal P, Singh R, Srivastav S, Rastogi SS, Postiglione A. Epidemiological study of coronary artery disease and its risk factors in an elderly urban population of north India. J Am Coll Nutr 1995; 14:628-34. [PMID: 8598424 DOI: 10.1080/07315724.1995.10718552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In view of the rapid increase in the prevalence of coronary artery disease (CAD) in developing countries, our aim was to determine the prevalence of CAD and its risk factors and lifestyle factors in an elderly population from north India. METHODS A random sample of 595 elderly subjects between 50 to 84 years of age was obtained from the urban population of Moradabad. The response rate was 90.1%. The survey methods included a questionnaire containing information on 7-day food intake, other lifestyle factors, Rose questionnaire for diagnosis of angina pectoris, a standard 12-lead electrocardiogram, blood pressure measurements and blood examination. RESULTS The total prevalence of CAD based on clinical history and electrocardiogram was 121/1000 (95% CI 72 to 165). The prevalence rate was slightly higher in males (130/1000) than in females (110/1000). The prevalence of CAD based on the Rose questionnaire was 57/1000 and based on electrocardiogram in 561 asymptomatic subjects was 67/1000. CAD was significantly higher in the elderly (65 to 84 years) group than in the middle-aged (50 to 64 years) group (168 vs. 97 per 1000), respectively. While the prevalence of hypertension was significantly higher in the elderly than middle-aged group respectively (214 vs. 168 per 1000), the prevalence of central obesity was significantly higher in the middle-aged than elderly group (674 vs. 632 per 1000). Other risk factors including smoking were comparable in the two subgroups. Prevalence of major risk factors and central obesity were significantly higher among patients with CAD than in the rest of the subjects. Prevalence of CAD was significantly higher in the middle and higher socio-economic groups compared to the lower income group. These higher income groups were also eating significantly higher amounts of visible fat and had a higher prevalence of physical inactivity (93.3%) compared to the lower income group. CONCLUSIONS CAD and its risk factors such as hypertension, hypercholesterolemia, diabetes and central obesity are of sufficient magnitude in the elderly population of India to be a major public health problem. The findings also indicate that CAD is more commonly associated with middle and higher socio-economic status which may be due to greater consumption of dietary fat and more sedentariness compared to lower socioeconomic groups.
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Affiliation(s)
- R B Singh
- Centre of Nutrition and Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India
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Napoli C, Postiglione A, Triggiani M, Corso G, Palumbo G, Carbone V, Ruocco A, Ambrosio G, Montefusco S, Malorni A, Condorelli M, Chiariello M. Oxidative structural modifications of low density lipoprotein in homozygous familial hypercholesterolemia. Atherosclerosis 1995; 118:259-73. [PMID: 8770320 DOI: 10.1016/0021-9150(95)05612-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with homozygous familial hypercholesterolemia (FH), as a result of the increased levels and prolonged residence time of low density lipoprotein (LDL) in plasma, have a strong tendency toward accumulation of LDL-cholesterol in the arterial wall, causing premature atherosclerosis. This phenomenon may enhance per se the physiological degradation of both protein and lipid component of LDL, which be more susceptible to oxidative damage induced by oxygen radicals. It is well known that LDL may undergo oxidative modification before being taken up by macrophages which are then transformed into foam cells. It has been suggested that platelet-activating factor (PAF) may play an important role in atherogenesis and PAF catabolism is known to be mediated by serum acetylhydrolase, an enzyme that is normally associated with LDL. Thus, the present study was designed to investigate the structural properties of LDL, including acetylhydrolase activity, in homozygous FH as compared to normolipidemic subjects before and after xanthine/xanthine oxidase-mediated oxidation. We studied 8 homozygous FH patients matched with 8 normolipidemic volunteers. Lipids of LDL fraction were extracted and verified by thin layer chromatography (TLC) analysis. Fatty acids were methylated and injected into a gas chromatograph/mass spectrometer. Vitamin E in LDL was determined by high performance liquid chromatography (HPLC). As an index of susceptibility of LDL to oxidative modifications, the formation of lipid-conjugated dienes was continuously monitored at 234 nm. Lipid peroxidation was also evaluated from the amount of both lipid peroxides (LPO) and malonyldialdehyde (MDA) content. Apolipoprotein (apo) B-100 on LDL was carried on polyacrylamide and agarose gel electrophoresis. In the homozygous FH patients, the relative content of cholesteryl ester was slightly increased. Interestingly, the relative amount of arachidonic acid (20:4) was constantly increased in each lipid fraction in homozygous FH patients. The amount of vitamin E was not significantly different in the patient group from that in the control group. However, LDL from patients carried lower levels of vitamin E (nmol/mg LDL) than controls (2.7 +/- 0.4 vs. 2.9 +/- 0.3 P = NS). The results shows that lag time (min) was decreased (82 +/- 19 vs. 111 +/- 21; P < 0.05) and the maximal rate of diene production and total diene production was increased in homozygous FH patients. Mean levels of MDA were similar in both groups before oxidation, but levels after initiation of oxidation were significantly higher in the patient group. In contrast, mean levels of LPO were already higher in patients before oxidation (58 vs. 27 nmol/mg of protein; P < 0.05), and after initiation of oxidation were also significantly higher at each time points. When oxidized LDL was run on a polyacrylamide gel, an extensive apo B-100 fragmentation replaced by lower molecular mass fragments ranging from 45,000 to 205,000 m.wt., was observed only in LDL from homozygotes. Relative LDL agarose gel mobility shows that LDL from patients migrated higher than LDL of controls. Finally acetylhydrolase activity associated with LDL in patients was significantly reduced as compared to controls. Thus, in homozygous FH patients, LDL appeared more susceptible to oxidation in vitro; the indices for LDL oxidizability were all significantly different from those of controls. This phenomenon might be due to prolonged residence time of LDL in these patients, as suggested from high basal LPO levels and lower vitamin E levels carried by LDL. This hypothesis may explain together with the high content of arachidonic acid, the enhanced susceptibility of LDL from homozygous FH patients to oxidative damage.
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Affiliation(s)
- C Napoli
- Department of Medicine, Federico II, School of Medicine, University of Naples, Italy
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Soricelli A, Postiglione A, Cuocolo A, De Chiara S, Ruocco A, Brunetti A, Salvatore M, Ell PJ. Effect of adenosine on cerebral blood flow as evaluated by single-photon emission computed tomography in normal subjects and in patients with occlusive carotid disease. A comparison with acetazolamide. Stroke 1995; 26:1572-6. [PMID: 7660400 DOI: 10.1161/01.str.26.9.1572] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Acetazolamide is commonly used with single-photon CT to assess the cerebrovascular reserve in patients with internal carotid artery stenosis or occlusion. In this study we wanted to evaluate the effects of adenosine, a well-known vasodilatatory compound with a short biological half-life, on brain circulation in humans and compare the results with those of acetazolamide. METHODS Acetazolamide (1 g) and adenosine (140 micrograms/kg per minute) were injected intravenously on different days in 6 normal subjects and 6 patients: 4 with unilateral stenosis, 1 with bilateral stenosis, and 1 with complete occlusion of the internal carotid artery. Changes in regional cerebral blood flow relative to that of the cerebellum (cortico/cerebellar ratios) from resting conditions were evaluated by 99mTc-hexamethylpropyleneamine oxime and single-photon emission CT. RESULTS The measured blood flow ratios increased significantly in the normal group 20 minutes after acetazolamide injection in several cortical and subcortical regions, as well as at the 4th minute of a 6-minute adenosine infusion. Regional cerebral blood flow ratio values were higher after adenosine than after acetazolamide in both cortical (frontal and parietal) and subcortical (thalamus and basal ganglia) regions. In 4 of the 6 patients the side-to-side asymmetry increased from the basal resting condition after the injection of acetazolamide and even more so after the injection of adenosine. CONCLUSIONS Adenosine infusion causes vasodilation of cerebral arteries and can be used for the investigation of cerebrovascular perfusion capacity in patients with carotid occlusive disease. One advantage in the use of adenosine over acetazolamide is the possibility of interrupting the test with reversal of clinical symptoms or patient discomfort within a few minutes.
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Affiliation(s)
- A Soricelli
- Nuclear Medicine Unit, Medical School, Federico II University, Naples, Italy
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Abstract
Controversies exist concerning the role of hypercholesterolaemia as a risk factor for nonhaemorrhagic stroke because intracranial arteries seem to be more resistant than coronary arteries to cholesterol-induced endothelial damage. Only very high levels of serum cholesterol seem to be a significant risk factor. It is possible that coronary heart disease may occur earlier in life than cerebrovascular atherosclerosis, and it could then become the cause of stroke. In our view, the causal relationship between very low levels of serum cholesterol and haemorrhagic stroke is unlikely, and cholesterol-lowering treatment appears to be safe. New studies should consider the particular metabolic aspects of intracranial arteries and the independent role of lipoprotein (a), apolipoprotein E phenotypes and other molecular and genetic mechanisms involved in atherosclerotic cerebrovascular disease.
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Affiliation(s)
- A Postiglione
- Institute of Internal Medicine and Metabolic Diseases, Medical School, University of Naples Federico II, Italy
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50
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Ferrara LA, Mancini M, Iannuzzi R, Marotta T, Gaeta I, Pasanisi F, Postiglione A, Guida L. Carotid diameter and blood flow velocities in cerebral circulation in hypertensive patients. Stroke 1995; 26:418-21. [PMID: 7886717 DOI: 10.1161/01.str.26.3.418] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The recent development of noninvasive techniques for the evaluation of the carotid arteries has focused attention on the study of arterial wall thickness to identify early lesions of vessels in patients at high risk for atherosclerosis, such as those with hypercholesterolemia, diabetes mellitus, and hypertension. METHODS In a sample of 70 hypertensive patients without clinical evidence of target organ damage, we showed a thickening of the intimal plus medial layers compared with age- and sex-matched normotensive control subjects. In this sample we also studied the diameter of the carotid arteries by ultrasound imaging, and we studied flow velocities in common carotid, internal carotid, and middle cerebral arteries by Doppler technique. Pulsatility and resistance indexes were calculated. RESULTS Absolute values of the carotid diameter were similar in the two groups (6.3 +/- 0.7 versus 6.0 +/- 0.8 mm); however, the ratio of diameter to blood pressure was significantly reduced in hypertensive compared with normotensive subjects (5.3 +/- 0.7 versus 6.5 +/- 0.8; P < .001 for mean blood pressure). Parietal stress was increased in the hypertensive subgroup and significantly correlated with arterial diameter in the normotensive group but not in the hypertensive group. No significant differences between the two groups were observed in blood flow velocities, with the exception of a slight significant increase of mean velocity in the internal carotid artery in hypertensive patients (37.5 +/- 9.1 versus 32.7 +/- 3.0 cm/s; P < .02). CONCLUSIONS These results indicate that in addition to the degenerative changes of the common carotid wall, the diameter of the carotid artery and the relation to parietal stress show an early impairment in patients with uncomplicated hypertension.
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Affiliation(s)
- L A Ferrara
- Institute of Internal Medicine and Metabolic Diseases, Medical School, Federico II University, Naples, Italy
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