Conflicting effects of nitric oxide and oxidative stress in chronic heart failure: potential therapeutic strategies.

Chronic heart failure (CHF) is characterized by decreased nitric oxide (NO) bioavailability. In addition, the beneficial NO turns to be deleterious when it reacts with superoxide anion, leading to peroxynitrite formation. Numerous experimental and clinical studies have reported increased production of reactive oxygen species (superoxide, hydrogen peroxide, hydroxyl radical) both in animals and patients with CHF. Moreover, there are indicative data suggesting mechanisms associated with endothelial dysfunction in states of CHF, mainly attributed to decreased NO bioavailability and enhanced inactivation of the latter. Thus, such molecules appear to be potential targets in patients with CHF. These patients are strong candidates to receive a variety of therapeutic agents, some of which have known antioxidant effects. Classic treatment with statins or angiotensin converting enzyme inhibitors has been found to be beneficial in restoring NO and improving myocardial function and structure. Other agents such as sildenafil and b-blockers along with novel agents such as NO synthase transcription enhancers have been proved to be also beneficial, but their use for such a purpose is still controversial. Approaches using more-effective antioxidants or targeting myocardial oxidant-producing enzymes and oxidative or nitrosative stress might be promising strategies in the future.

Hepatitis B vaccination coverage levels among nurses in Greece: need for improvement.

OBJECTIVES: : The aims of this study were to estimate the hepatitis B vaccination coverage levels among nurses and understand the reasons for receiving or not receiving the preventive vaccination. METHODS: : This cross-sectional study was based on a self-reported questionnaire, which was administered to 788 nurses working in 17 hospitals in Greece. RESULTS: : Overall, 606 out of 784 participants (77.3%) completed the survey. Of these, 63.2% nurses reported that they were fully vaccinated. The majority of immunized nurses (66%) were female (P = 0.008), and 72.6% of the fully-vaccinated nurses were working in Intensive Care Units (ICUs). CONCLUSIONS: : This study showed that almost 40% of nurses are not protected against hepatitis B infection. There is a need for a more aggressive approach to increase the vaccination coverage among nurses.

From atherosclerosis to acute coronary syndromes: the role of soluble CD40 ligand.

The binding of CD40 ligand (CD40L) to CD40 stimulates inflammatory processes including the release of proinflammatory cytokines and the expression of adhesion molecules implying a role in atherosclerosis. Patients exhibiting hypercholesterolemia, unstable angina, or acute myocardial infarction present with increased CD40L levels. Novel data suggest that elevated soluble CD40L levels not only represent a risk factor for cardiovascular disease but also predict future adverse events, especially in patients with acute coronary syndromes (ACS). Examination of the potential role of the genetic variability on CD40/CD40L genes in ACS, as regards the regulation of CD40L, appears to be of great interest. Moreover, several therapeutic approaches such as statins, antihypertensive agents, and antiplatelet agents have been suggested as potential modulators of CD40L levels anticipating a positive impact on the outcomes of patients with ACS. Whether specific agents target the CD40/CD40L system as well as its pathogenic role in ACS remains to be elucidated by large-scale studies in the future.