Persistence of vitamin D deficiency among Italian patients with acute myocardial infarction

BACKGROUND AND AIMS

Vitamin D deficiency is a common cardiovascular risk factor associated with the development of atherosclerosis. We evaluated changes in 25(OH)D concentrations in 1510 patients with acute myocardial infarction (AMI) over a long observation period, including the COVID-19 pandemic.

METHODS AND RESULTS

Patients were separated into four groups according to the year of enrolment, group 1 (2009-2010), group 2 (2014-2016), group 3 (2017-2019), and group 4 (2020-2022). The median 25(OH)D concentration in the overall cohort was 17.15 (10.3-24.7) ng/mL. The median plasma concentrations of 25(OH)D for groups 1, 2, 3, and 4 were 14.45 (7.73-22.58) ng/mL, 17.3 ng/mL (10.33-24.2), 18.95 (11.6-26.73) ng/mL and 19.05 (12.5-27.3) ng/mL, respectively. Although 25(OH)D levels increased over the years, the prevalence of vitamin D deficiency remained high in each group (68.4%, 61.4%, 53.8%, and 52% respectively). Hypovitaminosis D was predicted by the season influence (OR:2.03, p < 0.0001), higher body mass index (OR:1.25; p = 0.001), diabetes mellitus (OR:1.54; p = 0.001), smoking (OR:1.47; p = 0.001), older age (OR:1.07; p = 0.008), higher triglycerides levels (OR:1.02; p = 0.01), and female gender (OR:1.3; p = 0.038). After multivariable adjustment, vitamin D ≤ 20 ng/mL was an independent predictor of mortality.

CONCLUSION

Vitamin D deficiency is highly prevalent and persistent in patients with AMI despite a trend towards increasing 25(OH)D concentrations over the years. The frequent lockdowns did not reduce the levels of 25(OH)D in the fourth group. Low levels of 25(OH)D are an independent predictor of mortality.

Ampullary Cancer: Histological Subtypes, Markers, and Clinical Behaviour-State of the Art and Perspectives

There are different cancers in the peri-ampullary region, including pancreatic ductal adenocarcinoma (PDAC), duodenum cancers (DCs), and ampullary adenocarcinoma (AAC). Here, significant morphological-molecular characterizations should be necessary for the distinction of primary tumours and classifications of their subtypes of cancers. The sub classification of AACs might include up to five different variants, according to different points of view, concerning the prevalence of the two more-cellular components found in the ampulla. In particular, regarding the AACs, the most important subtypes are represented by the intestinal (INT) and the pancreato-biliary (PB) ones. The subtyping of AACs is essential for diagnosis, and their identifications have been impacting clinical management responses to treatments and overall survival (os) after surgery. Pb is associated with a worse clinical outcome. Otherwise, the criteria, through which are possible to attribute its subtype classification, are not well established. A triage of immune markers represented by CK7, CK20, and CDX-2 seem to represent the best compromise in order to split the cohort of AAC patients in the INT and PB groups. The test of choice for the sub-classification of AACs is represented by the immuno-histochemical approach, in which its molecular classification acquires its diagnostic, predictive, and prognostic value for both the INT and PB patients.

Diagnosis of Respiratory Syncytial Virus (RSV) infection in children by Respiratory Panel utilized during the COVID-19 pandemic

BACKGROUND

In the months of October and November 2021, there was throughout Italy and in our specific case in the area of Lucca and Versilia, a disturbing increase of SARS-CoV-2 infections and cases of Respiratory Syncytial Virus (RSV) in new-borns. The aim of this paper is to compare the cases of RSV infection diagnosed in recent years to the cases recorded during the SARS-CoV-2 pandemic to November 2022.

MATERIALS AND METHODS

The study consisted of evaluating the results of requests for RSV diagnosis from 2015 to November 2022, using molecular biology techniques.

RESULTS

The data obtained show that the number of cases of RSV infection in children during the winter season had a constant trend from 2015 to 2019. From November 2020 to February 2021 there were no cases of RSV respiratory infections. Starting from September 2021, on the other hand, there was a resumption of cases of RSV infections in conjunction with an increase in the number of children affected by COVID-19. From January 2022, after a peak in cases of SARS-CoV-2 infection, there has been a decrease in RSV infections. From September 2022 to November 2022, there was no increase of cases of RSV infections in new-borns but on the contrary, there was a trend in respiratory infections comparable to the pre-pandemic period.

CONCLUSION

The data that emerged from the study conducted, show the onset of an outbreak of RSV in new-borns. This incidence is linked to the implementation of rigorous non-pharmacological public health interventions in 2020, aimed at combating COVID-19 infection. The use of the molecular panel made it possible to identifying the responsible agent and highlighting the most suitable clinical and therapeutic path.

338 PREVALENCE AND PERSISTENCE OF HYPOVITAMINOSIS D AMONG ITALIAN PATIENTS WITH MYOCARDIAL INFARCTION

Background

Hypovitaminosis D is common in the Italian population and has a comparable effect to diabetes mellitus on survival after an acute myocardial infarction (AMI). We aimed to evaluate if the prevalence of hypovitaminosis D changed over time, considering also frequent lockdowns in the last years due to COVID-19 pandemic.

Methods

According to the year of enrollment, we divided our cohort of 1042 patients hospitalized for AMI, into three groups (group 1 with 368 patients enrolled from 2014 till 2016, group 2 with 470 patients enrolled in the period from 2017 till 2019, and group 3 including 204 patients enrolled in the last three years, from 2020 till 2022) and evaluate whether the concentration of vitamin D changed in the last decade.

Results

The median concentration of vitamin D in our cohort of patients with AMI was 18.2 (11.48-25.73) ng/ml). Throughout the three groups (2014-2016, 2017-2019, 2020-2022), the median plasma vitamin D showed a trend toward an increase (17.3 (10.33–24.2) ng/ml, 18.95 (11.6–26.73) ng/ml, and 19.05 (12.5–27.3) ng/ml respectively), which was significant between the group 1 vs 2 and 3 (p = 0.033 and p = 0.004, respectively), while between the group 2 and 3 did not. Despite the trend of increase, the percentage of patients with hypovitaminosis D in each group remained high (61.4%, 53.8% and 52.0% respectively). As expected, samples taken between May and September have significantly higher vitamin D values compared to ones taken from October to April for each group (the group 1: 21.80 (15.55–31.23) ng/ml vs 15.8 (9.22–23.98) ng/ml, p &lt; 0.0001; the group 2: 22.05 (14.10–30.98) ng/ml vs 16.50 (11.03–23.90) ng/ml, p &lt; 0.0001); the group 3: 20.00 (11.90–26.90) ng/ml vs 16.30 (9.75–22.30) ng/ml, p = 0.001).

Conclusions

There has been a trend of increasing vitamin D values over the years, but hypovitaminosis D remains frequent. During the pandemic, vitamin D levels did not decrease due to frequent lockdowns, possibly due to media awareness that emphasized the significance of vitamin D administration against viral infection.

Prognostic implications of previously known or newly diagnosed diabetes and hypovitaminosis D in patients with myocardial infarction

Background

Vitamin D deficiency and diabetes mellitus are frequent among patients with acute myocardial infarction. Independently, both were associated with a worse prognosis after myocardial infarction (MI). However, it is unclear whether the risk of worse outcome, associated with diabetes mellitus, may be accentuated in presence of hypovitaminosis D.

Purpose

We assessed if previously known or newly diagnosed diabetes is associated with worse outcome (major cardiovascular events) in combination with hypovitaminosis D in patients with acute MI.

Methods and results

Were enrolled 1004 patients with acute MI; 64.7% of them, had hypovitaminosis D and 37% were diabetic.

We grouped our population by diabetic status: previously known diabetes (diagnosis of diabetes before MI, n=330; 32.9%); newly diagnosed diabetes (during hospitalization for MI, but no known diabetes at presentation, n=47; 4.7%); or no diabetes (n=627; 62.5%).

Hypovitaminosis D was more frequent among patients with previously known (70.2%) and newly diagnosed diabetes (73.3%), when compared to non diabetic patients (61.2%).

During median follow-up of 15.6 months, patients with previously known and newly diagnosed diabetes had increased risks of major cardiovascular events (HR 1.72; 95% CI, 1.26 to 2.36. The risk of major events during the follow-up among diabetic patients, was further increased in presence of hypovitaminosis D (Figure 1).

Conclusions

The presence of both, previously known or newly diagnosed diabetes and hypovitaminosis D, in patients with MI is synergistically associated with a worse outcome.

Funding Acknowledgement

Type of funding source: None

Diabetes Mellitus and Vitamin D Deficiency:Comparable Effect on Survival and a DeadlyAssociation after a Myocardial Infarction

Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.

Sex Differences in Proatherogenic Cytokine Levels

BACKGROUND

It has been shown that sex affects immunity, including cytokine production. Given that atherosclerosis is an inflammatory disease promoted by specific cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, we aimed at evaluating whether sex could affect the levels of these proatherogenic cytokines in a group of healthy adults. In this analysis, we also included other cytokines and peptides that have been implicated in atherosclerosis development and progression.

METHODS

A total of 104 healthy adults were recruited; we measured circulating levels of IL-1β, IL-6, TNF-α, angiotensins and angiotensin-converting enzyme-2 (ACE2), as well as osteoprotegerin and receptor activator of nuclear factor κB ligand (RANKL).

RESULTS

IL-1β, IL-6, and TNF-α were significantly higher in men as compared to women. They were all associated with testosterone and the testosterone/estradiol ratio. They remained significantly associated with sex (but not with hormones) after being tested for potential confounders.

CONCLUSIONS

Sex seems to influence the levels of proatherogenic cytokines. This is consistent not only with sex differences in vulnerability to infections but also with the higher cardiovascular risk exhibited by the male gender as compared to the female gender. Nevertheless, this association is only partly explained by hormone levels.

The Total Testing Process of Intra-Operative Parathyroid Hormone. A Narrative Review

BACKGROUND

Primary hyperparathyroidism (pHPT) is a common endocrine disorder, due to an excessive secretion of parathyroid hormone (PTH) from one or more parathyroid gland(s), where the only cure remains surgery. The surgical approach has become less invasive over the years, thanks to the advances in the preoperative localization of the enlarged parathyroid gland, as well as to the possibility to measure intra-operative parathyroid hormone (IOPTH). After the targeted removal of a parathyroid gland, IOPTH can confirm biochemically the cure of pHPT, such that it helps the surgeon to judge if the parathyroidectomy has been successful and there is no need of additional dissection. As with all laboratory tests, the quality of IOPTH total testing process is essential to the best utilization of patients' results. However, this can be affected by errors occurring in different phases. This review aims to describe the total testing process of IOPTH.

METHODS

We performed a search in Pubmed and a review of the literature on the current management of pHPT and the total testing process of IOPTH measurement.

RESULTS

Compared to previous studies focusing on single aspects of the IOPTH testing process, here we have analyzed all the steps crucial for the quality of IOPTH from the "pre-pre" to the "post-post" analytical phase.

CONCLUSIONS

Clinicians and laboratory scientists should be aware of all the potential sources of errors in IOPTH measurement in order to improve their daily management of pHPT.

Agreement between procalcitonin measurements using the new point-of-care testing ichroma™ reader and the automated Kryptor instrument

Background

To evaluate if procalcitonin (PCT) measurements made using the new point-of-care testing (POCT) ichroma™ are interchangeable with those made using Kryptor.

Methods

Serum samples (n = 117) were processed sequentially on Kryptor and ichroma™. Statistical analysis was performed using Passing-Bablok (PB) regression and the Bland-Altman (BA) test. Cohen’s kappa statistic was used to calculate the concordance at the clinically relevant cutoffs.

Results

PB regression did not show a significant deviation from linearity; proportional and constant differences were observed between ichroma™ and Kryptor. The 95% confidence interval (CI) of the mean bias percentage was very large, exceeding the maximum allowable total error (TE) (approximately 20%) and the clinical reference change value (about 60%). However, the concordance between methods at the clinically relevant cutoffs was strong, with the exception of the 0.25 ng/mL cutoff, which was moderate.

Conclusions

Our data suggest that ichroma™ is not interchangeable with Kryptor, so cannot be mixed; one must choose one instrument only and be consistent. However, while the strong concordance at the clinically relevant cutoffs allows us to consider ichroma™ a suitable option to Kryptor to support clinicians’ decision-making, nevertheless the moderate agreement at the 0.25 ng/mL cutoff recommends caution in interpreting the data around this cutoff.

Interchangeability of Procalcitonin Measurements Using the Point of Care Testing i-CHROMATM Reader and the Automated Liaison XL

BACKGROUND

Our aim was to verify if procalcitonin (PCT) measurements using the new point-of-care testing i-CHROMATM are interchangeable with those of Liaison XL.

METHODS

One hundred seventeen serum samples were processed sequentially on a Liaison XL and i-CHROMATM. Statistical analysis was done using the Passing-Bablok regression, Bland-Altman test, and Cohen's Kappa statistic.

RESULTS

Proportional and constant differences were observed between i-CHROMATM and Liaison XL. The 95% CI of the mean bias% was very large, exceeding the maximum allowable TE% and the clinical reference change value. However, the concordance between methods at the clinical relevant cutoffs was strong, with the exception of the 0.25 ng/mL cutoff which was moderate.

CONCLUSIONS

Our data suggest that i-CHROMATM is not interchangeable with Liaison XL. However, while the strong concordance at the clinical relevant cutoffs allows us to consider i-CHROMATM a suitable option to Liaison XL to support clinicians' decision-making; nevertheless, the moderate agreement at the 0.25 ng/mL cutoff recommends caution in interpreting the data around this cutoff.

Circulating osteoprotegerin is associated with chronic kidney disease in hypertensive patients

Background

Osteoprotegerin (OPG) is a glycoprotein that plays an important regulatory role in the skeletal, vascular, and immune system. It has been shown that OPG predicts chronic kidney disease (CKD) in diabetic patients. We hypothesized that OPG could be a risk marker of CKD development also in non-diabetic hypertensive patients.

Methods

A case-control study was carried out to measure circulating OPG levels in 42 hypertensive patients with CKD and in 141 hypertensive patients without CKD. A potential relationship between OPG and the presence of CKD was investigated and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of OPG that best explained the presence of CKD. Secondly, to evaluate whether OPG increase could affect the kidney, 18 C57BL/6J mice were randomized to be treated with saline or recombinant OPG every 3 weeks for 12 weeks.

Results

Circulating OPG levels were significantly higher in hypertensive patients with CKD, and there was a significant inverse association between OPG and renal function, that was independent from other variables. ROC analysis showed that OPG levels had a high statistically predictive value on CKD in hypertensive patients, which was greater than that of hypertension. The OPG best cut-off value associated with CKD was 1109.19 ng/L. In the experimental study, OPG delivery significantly increased the gene expression of pro-inflammatory and pro-fibrotic mediators, as well as the glomerular nitrosylation of proteins.

Conclusions

This study shows that OPG is associated with CKD in hypertensive patients, where it might have a higher predictive value than that of hypertension for CKD development. Secondly, we found that OPG delivery significantly increased the expression of molecular pathways involved in kidney damage. Further longitudinal studies are needed not only to evaluate whether OPG predicts CKD development but also to clarify whether OPG should be considered a risk factor for CKD.

Electronic supplementary material

The online version of this article (doi:10.1186/s12882-017-0625-3) contains supplementary material, which is available to authorized users.

Association between thyroid hormones and TRAIL

INTRODUCTION

Recent studies suggest that a circulating protein called TRAIL (TNF-related apoptosis-inducing ligand) might have a role in the regulation of body weight and metabolism. Interestingly, thyroid hormones seem to increase TRAIL tissue expression. This study aimed at evaluating whether overt thyroid disorders affected circulating TRAIL levels.

METHODS

TRAIL circulating levels were measured in euthyroid, hyperthyroid, and hypothyroid patients before and after thyroid function normalization. Univariate and multivariate analyses were performed to evaluate the correlation between thyroid hormones and TRAIL. Then, the stimulatory effect of both triiodothyronine (T3) and thyroxine (T4) on TRAIL was evaluated in vitro on peripheral blood mononuclear cells.

RESULTS

Circulating levels of TRAIL significantly increased in hyperthyroid and decreased in hypothyroid patients as compared to controls. Once thyroid function was restored, TRAIL levels normalized. There was an independent association between TRAIL and both fT3 and fT4. Consistent with these findings, T3 and T4 stimulated TRAIL release in vitro.

CONCLUSION

Here we show that thyroid hormones are associated with TRAIL expression in vivo and stimulate TRAIL expression in vitro. Given the overlap between the metabolic effects of thyroid hormones and TRAIL, this work sheds light on the possibility that TRAIL might be one of the molecules mediating thyroid hormones peripheral effects.

The upper reference limit for thyroid peroxidase autoantibodies is method-dependent: A collaborative study with biomedical industries

BACKGROUND

The determination of the upper reference limit (URL) for thyroid peroxidase autoantibodies (TPOAbs) is a contentious issue, because of the difficulty in defining the reference population. The aim of this study was to establish the URL (eURL) for TPOAbs, according to the National Academy of Clinical Biochemistry (NACB) guidelines and to compare them with those obtained in a female counterpart, by the use of six commercial automated platforms.

METHODS

120 healthy males and 120 healthy females with NACB-required characteristics (<30years, TSH between 0.5 and 2.0mIU/L, normal thyroid ultrasound, without personal/family history of thyroid and non-thyroid autoimmune diseases) were studied. Sera were analyzed for TPOAbs concentration using six immunoassay methods applied in automated analyzers: Advia Centaur XP (CEN), Siemens Healthcare Diagnostics; Maglumi 2000 Plus, Shenzen New Industries Biomedical Engineering; Architect ci4100, Abbott; Cobas e411 (COB) Roche Diagnostics; Unicel DxI (UNI) and Lumipulse G1200, Fujirebio.

RESULTS

Within each method, TPOAbs values had a high degree of dispersion and the eURLs were lower than those stated by the manufacturer. A statistically significant difference (p<0.05) between medians of males and females was observed only for COB and for UNI. However, the comparison of the male and female proportions positive for TPOAbs using the eURL of the counterpart, showed the lack of clinical significance of the above differences (Chi-square test, p>0.05).

CONCLUSIONS

Despite the analytical harmonization, the wide dispersion of the results and the differences of the eURLs between methods suggest the need of further studies focusing on TPO antigen preparations as the possible source of variability between different assays. In addition, the lack of clinical significant difference between males and females, in terms of TPOAb eURLs, confirms the suitability of the NACB recommendations.

Whole-body glucose oxidation rate during prolonged exercise in type 1 diabetic patients under usual life conditions

OBJECTIVE

Fuel oxidation during exercise was studied in type 1 insulin-dependent (T1DM) patients mainly under quite constant insulin and glycemia; these protocols, however, likely do not reflect patients' usual metabolic conditions. The glucose oxidation rate (GLUox) in T1DM patients under usual life conditions was thus investigated during prolonged exercise (3-h) and its behavior was described mathematically.

MATERIALS/METHODS

Whole-body GLUox was determined in eight T1DM patients (4/8 M; aged 35-59 years) and eight well-matched healthy subjects. Venous blood was drawn prior to and every 30 min until the end of exercise; glycemia, insulin, cortisol, and growth hormone concentrations were determined. Oxygen consumption, carbon dioxide production, and ventilation were measured at rest and thereafter every 30 min of the exercise. To prevent hypoglycemia, patients were given fruit fudge (93% sucrose) prior to / during exercise.

RESULTS

Insulin concentration and glycemia were significantly higher in patients across the entire exercise period (group effect, p<0.001 for both). GLUox decreased significantly with increasing exercise duration (time effect, p<0.001), but no significant difference was detected between the two groups (group effect, p=NS). GLUox, expressed as the percentage of the starting value, was described by an exponential function showing a time constant of 90 min (n=96; mean corrected R(2)=0.666).

CONCLUSIONS

GLUox in T1DM patients was not significantly different from the rate observed in the control subjects. The function describing the time course of GLUox may be useful to correct an estimated GLUox for the duration of exercise and help T1DM patients avoiding exercise-induced glycemic imbalances.

Comparative evaluation of B-type natriuretic peptide and mid-regional pro-A-type natriuretic peptide changes from admission to discharge in prognosis of acute decompensated heart failure patients

BACKGROUND

Mid-regional pro-A-type natriuretic peptide (MRproANP) seems to be non-inferior compared to B-type natriuretic peptide (BNP) for heart failure diagnosis and prognosis; however, no previous studies have investigated the MRproANP in-hospital changes in prognostic role. This study aimed to compare the prognostic accuracy of BNP and MRproANP in-hospital changes in acute decompensated heart failure (ADHF) patients.

METHODS

37 patients with either admission/pre-discharge BNP and MRproANP data, were investigated. The combined endpoint was cardiovascular death/heart transplantation/readmission for HF.

RESULTS

BNP and MRproANP had a median decrease of 55% [72;45] and 21% [40; 11] respectively in event-free patients; BNP decrease of 34% [48; 29] but MRproANP increase of 4% [-7; 25] in patients with cardiovascular events. Prognostic accuracy of deltaBNP and deltaMRproANP was similar.

CONCLUSIONS

MRproANP basically trends up in patients with worse outcome and decreases in event-free patients, likely leading to a simpler interpretation although the prognostic accuracy is similar for both peptides.

B-type natriuretic peptide as a predictor of outcome in a general intensive care unit

BACKGROUND

B-type natriuretic peptide is a hormone secreted by the heart in response to ventricular wall stress. Increased B-type natriuretic peptide plasma levels are also found as a consequence of noncardiac conditions including sepsis, surgery-induced systemic inflammatory response syndrome and kidney failure. Since these conditions are common in general intensive care unit patients, we hypothesized that B-type natriuretic peptide could be a helpful marker in predicting outcome in this setting.

METHODS

We measured plasma B-type natriuretic peptide concentrations in 228 patients at admission to our general intensive care unit. The primary aim of the study was to investigate the relationship between B-type natriuretic peptide and hospital mortality. The secondary aim of the study was to investigate the association between B-type natriuretic peptide and severity of disease, quantified by the Simplified Acute Physiology Score II.

RESULTS

Logistic regression revealed a positive association between B-type natriuretic peptide level and in-hospital death (OR= 1.59; 95% CI 1.30 to 1.95; p<0.0001) and a Cox proportional hazards regression model showed that B-type natriuretic peptide was significantly associated with the risk of death (HR=1.27; 95% CI 1.11 to 1.46; p=0.0005). B-type natriuretic peptide was higher in patients who died in the hospital than in those who survived (371.20 pg/ml vs. 127.10 pg/ml; p<0.0001). There was a positive correlation between B-type natriuretic peptide and Simplified Acute Physiology Score II (r=0.50; 95% CI 0.40 to 0.59; p<0.0001).

DISCUSSION

B-type natriuretic peptide on admission is an independent prognostic marker of outcome in an unselected cohort of critically ill patients.

[Minimally invasive video-assisted parathyroidectomy and intraoperative parathyroid hormone monitoring]

BACKGROUND

Aim of this study is to analyze our preliminary results from minimally invasive video-assisted parathyroidectomy (MIVAP) and to evaluate the clinical impact of intraoperative measurements of intact parathyroid hormone (PTHIO).

PATIENTS AND METHODS

MIVAP by an anterior approach was proposed for patients with sporadic primary hyperparathyroidism pHPT and one unequivocally enlarged parathyroid gland on preoperative ultrasound and 99mTc-SestaMIBI scintigraphy. We used an operative technique first described by Miccoli in 1997, without carbon dioxide insufflation. Quick parathyroid hormone immunochemiluminometric assay (qPTHa) was performed intraoperatively during all surgical procedures. Age, operative times, pathologic findings, postoperative pain, calcemia, length of hospital stay, cosmetic results, and complications were retrospectively analyzed.

RESULTS

From October 2006 to December 2009, MIVAP was proposed for 28 of 40 (70%). Mean operative time was 65 minutes. Postoperative complications included 4 (12.9%) transient hypocalcemia and one (3.22%) transient nerve palsy with complete recovery. No definitive laryngeal nerve palsies, no definitive hypocalcemias, no persistent pHPT and no recurrent pHPT were observed. The cosmetic result was excellent in all cases.

CONCLUSIONS

Our preliminary results demonstrate that MIVAP for localized single-gland adenoma, after adequate training, seems to be feasible with significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery, if performed by dedicated team, with a sufficient and specific activity volume.

B-type natriuretic peptide after open-water and hyperbaric chamber exposure to 10 msw

INTRODUCTION

Hyperbaric environment exposure in humans has cardiovascular effects mainly characterized by an increase in afterload and a decrease in cardiac output. In a previous study we did not find B-type natriuretic peptide (BNP) changes in healthy volunteers exposed to hyperbaric oxygen while other authors documented a significant increase in N-terminal pro-BNP after scuba diving. On the basis of these data we hypothesized that dry hyperbaric exposure and scuba diving could have different effects on BNP secretion.

METHODS

Nine healthy volunteers performed a 1-h open-sea air dive at 10 m depth (T); a few days later they were compressed in air in a hyperbaric chamber (CT) using the same dive profile. Three venous blood samples were drawn for each session: before starting the dives (T0 and CT0), immediately after exiting the water and the chamber (T1 and CT1), and 5 h later (T2 and CT2).

RESULTS

A significant increase in plasma BNP was found with respect to baseline conditions after scuba diving both at T1 (median increment +32.69% [interquartile range +25.62 to +65.35%]) and at T2 (+28.03% [+23.08 to +38.92%]) while no differences were documented after the same dive in dry conditions either at CT1 (+1.34% [-17.57 to +33.55%]) or at CT2 (0.00% [17,67 to +21.62%]).

DISCUSSION

These preliminary findings show that scuba diving and dry hyperbaric exposure, although at the same environmental pressure, cause different effects on ventricular loads in healthy subjects.

Red cell and core temperature in spelunking

Alpine spelunking is practiced in darkness, isolation, cold and high humidity. In this paper we study the acute haematological effects of prolonged strenuous activity in five spelunkers who spent about 20 hours in a 700-meter deep cave without resting much or sleeping. On four occasions, we measured their red cell counts, haemoglobin, mean corpuscular volume and percentage changes of plasma volume. We also measured their rectal temperature to estimate, in the limits of this parameter, thermoregulatory response. After the spelunkers descended 5 hours to the bottom of the cave, we detected, in all of them, a significant increase in red cell counts and haemoglobin and a drop in mean corpuscular volume and plasma volume. The day after recovery, we found a significant drop in all red cell parameters and a rise in plasma volumes. Rectal temperatures peaked at the exit. These findings suggest that alpine spelunking induces an initial haemoconcentration (bottom of the cave) followed by a haemodilution (the day after recovery). Sport anaemia was not detected. The rise of rectal temperature suggests that spelunking is a very strenuous sport with possible transpiration problems.

Hormonal responses to a long duration exploration in a cave of 700 m depth

We studied the hypothalamus-pituitary adrenocortical, hypothalamus-pituitary and hypothalamus-pituitary thyroid system responses to a long duration activity (about 20 h) practiced in a demanding environment, characterized by darkness, low temperature and high humidity, namely alpine potholing. We performed four blood drawings in five elite potholers: (1) the morning before the performance, (2) at the bottom of the cave (-700 m), (3) at the end of the ascent, and (4) after 24 h of recovery. Two blood drawings as controls were performed on the same potholers, at the same resting time and with the same experimental procedures as the previous ones. Friedman two-way ANOVA test evidenced significant changes through the different time intervals for detrended (i.e., test values minus control values) growth hormone (GH) (P = 0.003), detrended cortisol (P = 0.004) and FT4 (P = 0.002), while this was not true for TSH and FT3. Successively pairwise comparisons were done both through the different time intervals and between test and control values. The rise of GH values during the performance underlines the great intensity and long duration characteristic of potholing as well as the possibility that the climbing sit harness can cause problems due to vascular hypo-perfusion. Cortisol data, peaking before entering the cave, suggest that there was a marked anticipatory stress reaction followed by less stressing phase during the performance. Finally, the rise of FT4 is likely due to the typical increase of free fatty acids that usually occurs during endurance exercise.

Muscular damage and intravascular haemolysis during an 18 hour subterranean exploration in a cave of 700 m depth

OBJECTIVE

To verify presence and severity of muscular and/or intravascular damage during a subterranean exploration of long duration.

METHODS

We measured serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) as markers of muscular damage. We also measured haptoglobin as a marker of intravascular haemolysis, and platelets and leucocytes as markers of inflammation.

RESULTS

We found in all the participants an increase in CK, LDH, and platelets and leucocytes (mainly due to neutrophilia and monocytosis), and a decrease in the level of haptoglobin and circulating lymphocytes.

CONCLUSIONS

The observed data suggest that continuous effort during long alpine subterranean explorations, environmental conditions, sleep deprivation, multiple impacts on rocks, and compression caused by bindings of the caving harness cause muscle damage, intravascular haemolysis, inflammation response, and immunological changes.