Skeletal muscle differentiation: role of dehydroepiandrosterone sulfate

Dehydroepiandrosterone (DHEA) and its sulfonated form dehydroepiandrosterone sulfate (DHEAS) are the main circulating steroid hormones and many epidemiological studies show an inverse relationship between DHEA/DHEAS levels and muscle loss for which the primary cause is the accelerated protein breakdown. The aim of this work was to determine whether DHEA/DHEAS supplementation in differentiating C2C12 skeletal muscle cells might influence the expression of the atrophy-related ubiquitin ligase, MuRF-1, and thereby impact key molecules of the differentiation program. DHEA is the prohormone crucial for sex steroid synthesis, and DHEAS is thought to be its reservoir. However, our preliminary experiments showed that DHEAS, but not DHEA, is able to influence MuRF-1 expression. Therefore, we treated differentiating C2C12 cells with various concentrations of DHEAS and analyzed the expression of MuRF-1, Hsp70, myosin heavy chain (MHC), myogenin, and the activity of creatine kinase. We observed that DHEAS at physiological concentrations downregulates MuRF-1 expression and affects muscle differentiation, as shown by the increased levels of MHC, which is a sarcomeric protein that undergoes MuRF-1-dependent degradation, and also by an increase in creatine kinase activity and myogenin expression, which are two other well-known markers of differentiation. Moreover, we found that DHEAS might have a protective effect on differentiating cells as suggested by the augmented levels of Hsp70, a member of heat shock proteins family that, besides its cytoprotective action, seems to have a regulatory role on key atrophy genes such as MuRF-1. In conclusion, our data shed light on the role of DHEAS at physiologic concentrations in maintaining muscle mass.

Evaluation of genotoxic and cytotoxic properties of pesticides employed in Italian agricultural practices

In a program coordinated by the Italian Ministry of Works, we tested in vitro four pesticides widely employed in a developed agricultural region of central Italy. The four commercial agents were chosen on the basis of their diffusion in agricultural practice, knowledge of their active principle(s), and scant availability of data concerning their toxic and genotoxic activity. The agents were Cirtoxin, Decis, Tramat Combi (TC), and Lasso Micromix (LM). All substances were tested in three in vitro systems: Chinese hamster ovary (CHO) cells, a metabolically competent hamster cell line (Chinese hamster epithelial liver; CHEL), and root tips of Vicia faba (VF). The cytotoxic and genotoxic end points challenged were micronuclei and root tip length (RTL) in VF and mitotic index (MI), proliferation index (PI), cell survival (CS), cell growth (CG), cell cycle length (CCL), sister chromatid exchanges, chromosomal aberrations, and single-cell gel electrophoresis, or comet assay, in CHEL and CHO cells. Tested doses ranged from the field dose up to 200x the field dose to take into account accumulation effects. On the whole, tested agents appear to induce genotoxic damage only at subtoxic or toxic doses, indicating a low clastogenic risk. MI, PI, CS, CG, RTL, and CCL appear to be the less sensitive end points, showing no effects in the presence of a clear positive response in some or all of the other tests. Using cytogenetic tests, we obtained positive results for TC and LM treatments in CHO but not in CHEL cells. These data could be accounted for by postulating a detoxifying activity exerted by this cell line. However, cytogenetic end points appear to be more sensitive than those referring to cytotoxicity.

The National Outcomes Evaluation Programme in Italy: The Impact of Publication of Health Indicators

In Italy the National Outcomes Evaluation Programme, (P.N.E.) is the most comprehensive comparative evaluation of healthcare outcomes at the national level. The aim of this report is to describe the P.N.E. and some of the most relevant results achieved. The P.N.E. analysed 184 indicators on quality of care in 2015-2020 period. The data sources are the Italian Health Information Systems. The indicators reported were: proportion of surgery within 2 days after hip fracture in the elderly (HF), 30-day mortality after hospital admission for acute myocardial infarction (AMI), proportion of reoperations within 90 days of breast-conserving surgery and proportion of primary caesarean deliveries. Risk adjustment methods were used to take into account patients' characteristics. From 2010 to 2020 the proportion of interventions within 2 days after HF increased from 31.3% to 64.6%, the AMI 30-day mortality decreased from 10.4% to 8.3%, the proportion of reinterventions within 90 days of breast-conserving surgery decreased from 12.0% to 5.9% and the proportion of primary caesarean deliveries decreased from 28.4% to 22.7%. Results by area of residence showed heterogeneity of healthcare quality. We observed a general improvement in different clinical areas not always associated with a reduction of heterogeneity among areas of residence.

The interaction of the polyphenylacetylene surface with biological environments studied by XPS, RAIRS and biological tests

A pi-conjugated polymer, polyphenylacetylene or PPA, has been tested for its possible applications as biosensor or biomaterial. Protein adsorption was investigated by incubating PPA films in solutions of bovine serum albumin (BSA) dissolved in phosphate buffer (PBS) having increasing protein concentration. Investigations on the PPA films were carried out by means of two surface analysis techniques, X-ray photoelectron spectroscopy (XPS) and reflection-absorption infrared spectroscopy (RAIRS). Desorption of BSA from the PPA surface was also investigated. Finally, the cytototoxicity of the PPA surface was checked by measuring viability and proliferation of lymphoma macrophages and SAOS osteoblasts grown in the presence of the polymer.

Long-Term Outcomes of Contemporary Surgical Repair for Degenerative Mitral Regurgitation

BACKGROUND

There are limited published reports about the long-term outcomes of contemporary surgical mitral repair series for degenerative mitral regurgitation performed at a high-volume center.

OBJECTIVES

The aim of this study is to report independently adjudicated long-term results of contemporary mitral repair surgery performed at a high-volume center.

METHODS

A retrospective study was conducted on 3,317 patients who underwent surgical mitral repair for degenerative mitral regurgitation at a tertiary care center between January 1, 2008 and December 31, 2017. Follow-up data, focusing on survival, reinterventions, and heart failure rehospitalizations were adjudicated and analyzed by the Italian National Agency for Regional Healthcare Services. Echocardiographic assessments during follow-up were not included. Complete (100%) data linkage was achieved.

RESULTS

The median age of the patients was 57 years, and 68.56% were men. The overall in-hospital mortality was 0.48% (16 of 3,317) for all cases and 0.21% (5 of 2,399) in isolated mitral valve repair. The 10-year survival was 89.65% (95% CI: 88.75%-90.55%), independently associated with preoperative symptoms and anterior leaflet disease. Freedom from reoperation was 96.63% (95% CI: 95.63%-97.63%) at 10 years. Anterior leaflet disease, a second run of cardiopulmonary bypass, and more than mild mitral regurgitation at discharge were associated with increased risk of reoperation. Finally, 10-year freedom from rehospitalization for heart failure was 92.24% (95% CI: 90.62%-93.86%), with age, prior hospitalization for heart failure, preoperative symptoms, and anterior leaflet disease identified as independent risk factors.

CONCLUSIONS

This contemporary series provides further data on the low in-hospital mortality and excellent long-term outcomes of surgical mitral repair when performed in a high-volume center. Preoperative symptoms are associated with worse outcomes. Isolated anterior leaflet disease increases the risk of reoperation, heart failure rehospitalization, and late mortality compared to posterior or bileaflets pathology.

A nationwide participatory programme to measure person-centred hospital care in Italy: Results and implications for continuous improvement

BACKGROUND

Patient-centredness has been targeted by the Italian government as a key theme for the future development of health services.

OBJECTIVE

Measuring patient-centred health services in partnership with citizens, health professionals and decision makers.

DESIGN

National participatory survey in a large test set of hospitals at national level.

SETTING AND PARTICIPANTS

A total of 387 hospital visits conducted in 16 Italian regions by over 1,500 citizens and health professionals during 2017-2018.

MAIN VARIABLES AND OUTCOME MEASURES

An ad hoc checklist was used to assess person-centredness in hospital care through 243 items, grouped in 4 main areas, 12 sub-areas and 29 person-centred criteria (scored 0-10). GEE linear multivariate regression was used to explore the relation between hospital characteristics and person-centredness.

RESULTS

Person-centred scores were moderately high, with substantial variation overall (median score: 7.0, range: 3.2-9.5) and by area (Care Processes: 6.8, 2.0-9.8; Access: 7.4, 2.7-9.7; Transparency: 6.7, 3.4-9.5 and Relationship: 7.3, 0.8-10.0). Multivariate regression found higher scores for increasing volumes of activity (quartile increase: +0.21; 95% CI: 0.13, 0.29) and lower scores in the south and islands (-1.03; -1.62,-0.45).

DISCUSSION

The checklist has been applied successfully by over 1,500 collaborators who assessed hospitals in 16 distinct Regions and Autonomous Provinces of Italy. Despite an overall positive mark, all scores were highly variable by location and hospital characteristics.

CONCLUSION AND PATIENT OR PUBLIC CONTRIBUTION

A national participatory programme to improve patient-centredness in Italian hospitals highlighted critical areas with the direct input of citizens.

[Review and evaluation of waiting time indicators used in Italy]

In this study, a set of 15 indicators that are used to provide information on waiting times for medical services and procedures were evaluated. Each waiting time indicator was evaluated with respect to 14 criteria and given a score. The indicator "waiting time estimated through past performance" reached the highest score with respect to all others. This indicator is calculated by dividing the total number of individuals waiting for a medical procedure by the number of procedures performed in the facility in the previous month. The result is multiplied by thirty and expressed in days. This indicator can be used even in non-computerized facilities. It allows easy data accounting (at all levels, i.e service, facility, healthcare unit, area, regional and national level) and provides useful information for citizens/users.

Strong antioxidant activity of ellagic acid in mammalian cells in vitro revealed by the comet assay

Oxidative stress due to oxygen and various radical species is associated with the induction of DNA single- and double-strand breaks and is considered to be a first step in several human degenerative diseases, cancer and ageing. Naturally occurring antioxidants are being extensively analysed for their ability to protect DNA against such injury. We studied three naturally occuring compounds, Ascorbic Acid, Melatonin and Ellagic acid, for their ability to modulate DNA damage produced by two strong radical oxygen inducers (H2O2 and Bleomycin) in cultured CHO cells. The alkaline Comet assay was used to measure DNA damage and a cytofluorimetric analysis was performed to reveal the intracellular oxidative species. The data showed a marked reduction of H2O2- and Bleomycin-induced DNA damage exerted by Ellagic Acid. On the contrary Ascorbic acid and Melatonin appeared to induce a slight increase in DNA damage per se. In combined treatments, they caused a slight reduction of H2O2-induced damage, but they did not efficiently modulate the Bleomycin-induced one. The Dichlorofluorescein diacetate (DCFH-DA) cytofluorimetric test confirmed the strong scavenging action exerted by Ellagic Acid.

Relative Survival After Adult Cardiac Surgery: Analysis of the Italian Nationwide Registry Data

OBJECTIVE

The authors aimed to investigate life expectancy after adult cardiac surgery.

SETTING

Nationwide study including University and non-University hospitals.

PARTICIPANTS

Consecutive adult patients who underwent heart valve and coronary artery surgery from a nationwide administrative registry.

INTERVENTIONS

Surgical procedures on the heart valves and coronary arteries.

METHODS

The authors estimated the 10-year relative survival of adult patients who underwent surgery for heart valve diseases and coronary artery disease taken from a nationwide administrative registry.

MEASUREMENTS AND RESULTS

Overall, data on 415,472 patients were available for this study. Among them, 394,445 (94.9%) survived 90 days after surgery, and their 10-year survival was 58.0% (95% CI 57.8-58.3); the expected survival was 70.1%, and the relative survival was 0.83 (95% CI 0.82-0.83). Patients who underwent surgical repair of the mitral valve and aortic valve had relative survival of 0.96 and 0.92, respectively. Isolated coronary artery bypass grafting had a relative survival of 0.88. Surgical replacement of the heart valves had a relative survival below 0.80. Poor results with relative survival <0.70 were observed after complex cardiac surgery. Relative survival was <0.60 in patients who underwent double- or triple-valve surgery combined with coronary artery surgery. The authors observed markedly lower relative survival among women (0.77, 95% CI 0.77-0.78) compared with men (0.86, 95% CI 0.85-0.86) at 10 years. Such a difference was observed after almost all different procedures.

CONCLUSIONS

The present findings provided a picture of the real expectation in terms of the late survival of patients after having undergone adult cardiac surgery. This information should be communicated to patients and their relatives before surgery, and it may be relevant in the decision-making process and in planning tertiary prevention.

The effect of diabetes on long-term outcomes in patients following coronary artery bypass grafting

OBJECTIVES

Diabetes mellitus is a risk factor for coronary artery disease, but its role following coronary artery bypass grafting (CABG) is still unclear and few data on long-term outcomes are available. This study aimed to evaluate the impact of diabetes on long-term outcomes after CABG.

METHODS

The PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgerY) project is an observational cohort study merging 2 prospective multicentre studies on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. Baseline differences between patients with and without diabetes were balanced with inverse probability of treatment weighting.

RESULTS

The cohort consisted of 10 989 patients with complete follow-up information who underwent isolated CABG (diabetes 32.3%). Diabetes did not affect short-term mortality [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.73-1.10] and repeat revascularization (OR 0.79, 95% CI 0.42-1.49), while it is related to lower incidence of 30-day major adverse cardiac and cerebrovascular events (OR 0.67, 95% CI 0.60-0.76), acute myocardial infarction (OR 0.60, 95% CI 0.51-0.70) and stroke (OR 0.47, 95% CI 0.28-0.77). Diabetic patients had a higher long-term risk for major adverse cardiac and cerebrovascular event [weighted hazard ratio (HR) 1.31, 95% CI 1.26-1.37], mortality (HR 1.45, 95% CI 1.37-1.53), as well as stroke (HR 1.38, 95% CI 1.25-1.53) and myocardial infarction (HR 1.39, 95% CI 1.26-1. 53). Diabetes had not been associated with an increased incidence of repeated revascularization up to 10 years (HR 1.04, 95% CI 0.96-1.12).

CONCLUSIONS

Diabetic patients had worse long-term outcomes. Diabetes may have a greater negative impact on micro-vasculopathy than grafts, as evidenced by the increased long-term incidence of myocardial infarction without affecting myocardial revascularization.

Effects of chronic Rhodiola Rosea supplementation on sport performance and antioxidant capacity in trained male: preliminary results

AIM

Rhodiola Rosea, is an adaptogen plant which has been reported to promote fatty acids utilisation, to ameliorate antioxidant function, and to improve body resistance to physical strenuous efforts. The purpose of the present study was to investigate the effects on physical performance as well as on the redox status of a chronic Rhodiola Rosea supplementation in a group of competitive athletes during endurance exercise.

METHODS

Following a chronic supplementation with Rhodiola Rosea for 4 weeks, 14 trained male athletes underwent a cardio-pulmonary exhaustion test and blood samples to evaluate their antioxidant status and other biochemical parameters. These data were compared with those coming from the same athletes after an intake of placebo.

RESULTS

The evaluation of physical performance parameters showed that HR Max, Borg Scale level, VO(2) max and duration of the test were essentially unaffected by Rhodiola Rosea assumption. On the contrary, Rhodiola Rosea intake reduced, in a statistically significative manner, plasma free fatty acids levels. No effect on blood glucose was found. Blood antioxidant status and inflammatory parameters resulted unaffected by Rhodiola Rosea supplementation. Blood lactate and plasma creatine kinase levels were found significantly lower (P<0.05) in Rhodiola Rosea treated subjects when compared to the placebo treated group.

CONCLUSION

Chronic Rhodiola Rosea supplementation is able to reduce both lactate levels and parameters of skeletal muscle damage after an exhaustive exercise session. Moreover this supplementation seems to ameliorate fatty acid consumption. Taken together those observation confirm that Rhodiola Rosea may increase the adaptogen ability to physical exercise.

[Performance indicators: INCA (cardiovascular indicators) project]

The objective of INCA project was the development and implementation of Acute Myocardial Infarction (AMI type ST elevation) process and outcome indicators for the regional cardiology units, testing the possibility of using regional healthcare information data to evaluate the quality of provided healthcare within the regional healthcare accreditation process. The project is introduced by an overview of major concepts of evaluating and managing quality of healthcare. We performed a literature review of structure, process and outcome indicators in cardiology and of accreditation standards for cardiology at national and international level. Through consensus procedures and according to international evidence based literature a set of 18 process and outcome indicators for AMI was defined. A specific procedure for data collection has been developed. Education and training of participants on procedures, quality and accreditation was achieved. Expected verifiable end-points have been achieved over a three months period of data collecting throughout 21 cardiology units, differentiated for level of complexity and location, for a total of 409 clinical observed cases of AMI. Analysis of data was followed by the diffusion of results. Successful data collection of clinical performance indicators on a regional basis was achieved. Participants have been trained to quality sciences. Results will be useful to evaluate and design implementation strategies of regional accreditation of health care services within a shared framework. Benchmarking within Regional hospital cardiology care services will be developed following self evaluation and continuous quality improvement cycle activities.

Trends and perioperative mortality in gastric cancer surgery: a nationwide population‑based cohort study

This study aimed to investigate changes and perioperative mortality over a 6-year period within the Italian Hospital Information System among patients with gastric cancer (GC) who underwent gastrectomies and to identify risk factors associated with 90-day mortality. Additionally, nationwide differences between high and low-volume hospitals were evaluated. A nationwide retrospective study was conducted using patient hospital discharge records (HDRs) based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) classification. The HDRs were linked to the National Tax Registry records using deterministic record linkage. The data were obtained from the Italian National Outcomes Evaluation Programme (PNE). Multivariate logistic regression was used to examine risk factors for 90-day mortality among patients with GC who underwent partial or total gastrectomies over the period from 2018 to 2020 with adjustment for comorbidities. Overall, the number of patients with GC who underwent total or partial gastrectomies steadily decreased in Italy from 5765 in 2015 to 4291 in 2020 (p < 0.001). The use of the laparoscopic approach more than doubled from 2015 (10.8%) to 2020 (26.3%), with a concomitant conversion rate from laparoscopy to open surgery decreasing from 7.7 to 5.8%. The 30 and 90-day mortality rates remained stable over time (p > 0.05). Low-volume hospitals had higher inpatient, early, and late mortality compared to high-volume hospitals (5.9% vs 3.8%, 6.3% vs 3.8%, and 11.8% vs 7.9%, respectively; p < 0.001). Multivariate logistic regression analysis showed that an advanced age (adjusted odds ratio: 3.72; 95% [CI]: 3.15-4.39; p < 0.001), an open approach (adjusted-OR: 1.69, 95% CI: 1.43-1.99, p < 0.001) and a total gastrectomy (adjusted-OR: 1.44, 95% CI: 1.27-1.64, p < 0.001) were independent risk factors for 90-day mortality. Additionally, patients with GC who referred to high-volume hospitals were 26% less likely to die within 90 days after a gastrectomy than those who underwent surgery in low-volume hospitals. During the 6-year period, surgeons implemented a minimally invasive approach to reduce the conversion over time. Centralisation was associated with better outcomes while advanced age, an open approach, and total gastrectomy were identified as risk factors for 90-day mortality.