Exercise ventilation inefficiency and dynamic tricuspid regurgitation in heart failure

Background

Exercise ventilation inefficiency, i.e. increase slope of the relationship of ventilation (VE) vs carbon dioxide (VCO2) slope is a key prognostic indicator in heart failure (HF). Many determinants have been identified primarily related to the left heart and impaired reflexogenic control of VE. In parallel, the severity of tricuspid regurgitation (TR) at rest is increasingly recognized as an important determinant of functional status and prognosis. It is undefined whether VE inefficiency may be related to the dynamic TR during exercise.

Purpose

We tested the role of dynamic TR and its correlates to exercise VE inefficiency by combining cardiopulmonary exercise test (CPET) with echocardiography.

Methods

We prospectively studied stable HF patients with both reduced and preserved left ventricular ejection fraction (LVEF). Patients with severe pulmonary disease and those who underwent valve replacement or cardiac surgery were excluded. Mitral and tricuspid regurgitation degree were adjudicated accordingly to ESC Guidelines criteria.

Demographics and clinical characteristics along with laboratory parameters including electrolytes, biomarkers of congestion (NT-proBNP), renal and liver function, were collected at the time of CPET. Dynamic TR was defined as worsening of TR grade from rest to stress detected by Doppler analysis. VE/VCO2 slope and peak oxygen consumption (pVO2) were compared between patients with dynamic TR (Group 1) vs non-dynamic TR (Group 2).

Results

Among 56 patients (66±13 years, 64% men, mean LVEF of 50±14%, 35% ischemic) 12% showed at least moderate mitral regurgitation and 16% patients had at least moderate TR at rest.

TR jet velocity at rest and at peak exercise were associated with VE/VCO2 slope (r=0.36 and r=0.3 respectively, p value <0.05, Figure 1). A dynamic TR pattern (Group 1) appeared in 28 (50%) patients. No differences in clinical characteristics, laboratory parameters, LV ejection fraction, prevalence and degree of mitral regurgitation at rest and at peak were found between the two groups.

Group 1 compared to Group 2 exhibited a lower right ventricular fractional area change at peak exercise (45% [41–50] vs 52% [44–62] p=0.03), lower median pVO2 (13.3 [10.4–17.5] vs 16.3 [13.9–21.8], respectively (p=0.04)) and higher VE/VCO2 slope (40.3 [33.1–44] vs 34.1 [29.2–38.8], p=0.01; Figure 2A and B).

Conclusions

Patients with a dynamic TR pattern during CPET imaging exhibit a worse VE efficiency that correlates with TR extent. These data prospect, for the first time, an interaction between dynamic TR and ventilatory pattern during exercise in HF whose relevance may translate in targeting the right heart appropriately.

Funding Acknowledgement

Type of funding sources: None.

AMF communities associated to Vitis vinifera in an Italian vineyard subjected to integrated pest management at two different phenological stages

Vitis vinifera L. is an economically important crop that can be influenced by soil microorganisms, including arbuscular mycorrhizal fungi (AMF), that establish symbiotic associations with its roots. AMF have beneficial effects on grapevine performance improving water use efficiency and replant success. Most grapevine varieties are susceptible to various diseases, and integrated pest management (IPM) is one of the emerging approaches to perform pest control. In the present study, we examined the AMF communities present in the soil associated to the roots of V. vinifera cv. Pinot Noir (comparing them to those present in a soil not affected by grapevine roots), in a vineyard subjected to IPM at two different phenological stages, using 454 Roche sequencing technology. We proposed a new approach to analyze sequencing data. Most of the taxa were included in the family Glomeraceae. In particular, Glomus sp. Rhizophagus sp. and Septoglomus viscosum were present. The family Archeosporaceae was represented only by the genus Archeospora sp. Different AMF communities were found in the two soils and the importance of the phenological stage in regulating AMF biodiversity was assessed.

Metaproteomic characterization of theVitis vinifera rhizosphere

The rhizosphere is a hotspot of microbial activity where the release of root exudates stimulates bacterial density and diversity. The majority of the bacterial cells in soil are viable, unculturable, but active. Proteomic tools could be useful in gaining information about microbial community activity and to better understand the real interactions between roots and soil. The aim of this work was to characterize the bacterial community associated with Vitis vinifera cv. Pinot Noir roots using a metaproteome approach. Our results confirmed the large potential of proteomics in describing the environmental microbial communities and their activities: in particular, we showed that bacteria belonging to Streptomyces, Bacillus, Bradyrhizobium, Burkholderia and Pseudomonas genera are the most active in protein expression. Concerning the biological activity of these genera in the rhizosphere, we observed the exclusive presence of the phosphorus metabolic process and the regulation of primary metabolic processes. To our knowledge, this is the first study reporting the rhizosphere proteome of V. vinifera, describing the bacterial community structure and activity of an important ecosystem for the Italian landscape, agriculture and economy.

Antifungal activity of essential oils against azole-resistant and azole-susceptible vaginal Candida glabrata strains

Candida glabrata is an opportunistic pathogen, associated with endocarditis, meningitis, and disseminated disease, and also with complicated vaginitis. Essential oils derived from aromatic plants are known in traditional medicine as antimicrobial agents and have antifungal properties. The aim of this work was to evaluate whether 12 tested essential oils (tea tree, laurel, anise, basil, bergamot, lavender, mint, oregano, grapefruit, rosemary, winter savory, and ginger) could have a transverse effect on C. glabrata sensitive strains but above all on strains resistant to the three main azole antifungals used (clotrimazole, fluconazole, itraconazole). For this reason, different strains of C. glabrata, vaginal isolated, were characterized (disk diffusion assay, minimal inhibitory concentration) with respect to their response to such antifungals. Electron microscopy analyses were performed to examine cellular damages in depth. Subsequently, we wanted to evaluate the effect of the oils on human cells to estimate their potential cytotoxicity. Oregano and winter savory were the two most effective essential oils, inducing growth inhibition, cell damage of C. glabrata strains (both sensitive and resistant to azole antifungal drugs), and medium–high level of toxicity against human keratinocytes. The results of this work support the research for new alternatives or complementary therapies against vaginal candidiasis.

Sensitivity of Candida albicans to essential oils: are they an alternative to antifungal agents?

AIMS

Candida albicans is an important opportunistic pathogen, responsible for the majority of yeast infections in humans. Essential oils, extracted from aromatic plants, are well-known antimicrobial agents, characterized by a broad spectrum of activities, including antifungal properties. The aim of this work was to assess the sensitivity of 30 different vaginal isolated strains of C. albicans to 12 essential oils, compared to the three main used drugs (clotrimazole, fluconazole and itraconazole).

METHODS AND RESULTS

Thirty strains of C. albicans were isolated from vaginal swab on CHROMagar^™ Candida. The agar disc diffusion method was employed to determine the sensitivity to the essential oils. The antifungal activity of the essential oils and antifungal drugs (clotrimazole, itraconazole and fluconazole) were investigated using a microdilution method. Transmission and scanning electron microscopy analyses were performed to get a deep inside on cellular damages. Mint, basil, lavender, tea tree oil, winter savory and oregano essential oils inhibited both the growth and the activity of C. albicans more efficiently than clotrimazole. Damages induced by essential oils at the cellular level were stronger than those caused by clotrimazole.

CONCLUSIONS

Candida albicans is more sensitive to different essential oils compared to the main used drugs. Moreover, the essential oil affected mainly the cell wall and the membranes of the yeast.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of this work support the research for new alternatives or complementary therapies against vaginal candidiasis.

Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer: results of a randomized phase II study

BACKGROUND

To determine the efficacy and tolerability of capecitabine combined with oxaliplatin (CAPOX) or irinotecan (CAPIRI) as first-line treatment in patients with advanced/metastatic colorectal cancer aged > or =70 years.

PATIENTS AND METHODS

Patients aged > or =70 years were randomly assigned to receive CAPOX [oxaliplatin 65 mg/m(2) intravenously (i.v.) days 1 and 8 and capecitabine 1000 mg/m(2) orally b.i.d. days 1-14; q21d] or CAPIRI (irinotecan 80 mg/m(2) i.v. days 1 and 8 and capecitabine 1000 mg/m(2) orally b.i.d. days 1-14; q21d). The primary study end point was overall response rate (ORR).

RESULTS

Ninety-four patients were enrolled. In an intent-to-treat analysis, 2 complete responses (CRs) and 16 partial responses (PRs) were reported with CAPOX (ORR 38%), and 2 CRs and 15 PRs with CAPIRI (ORR 36%; P = 0.831). Median time to progression was 8 months for CAPOX and 7 months for CAPIRI (P = 0.195), with median survival times of 19.3 months and 14.0 months (P = 0.165), respectively. Global health status was improved in 45% and in 21% of patients in the CAPOX and CAPIRI arms, respectively. The most common treatment-related grade 3-4 adverse events in CAPIRI versus CAPOX patients were diarrhea (32% versus 15%; P = 0.052) and neutropenia (23% versus 6%; P = 0.021).

CONCLUSION

CAPOX and CAPIRI had similar efficacy in elderly patients, although CAPOX seemed to be better tolerated.

Psychopathology and clinical features in an Italian sample of patients with myofascial and temporomandibular joint pain: preliminary data

OBJECTIVE

Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures.

METHODS

Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS).

RESULTS

--Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. --HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. --SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales.

CONCLUSIONS

TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.

[Role of echoencephalography in myelomeningocele]

Infants with myelomeningocele very often present cranio-cerebral anomalies such as Arnold Chiari malformation. Cranial ultrasonography allows early evaluation of these malformations and helps to detect complications in surgically treated children.