Myocardial blood flow in patients with hypertrophic cardiomyopathy receiving perindopril (CARAPaCE): a pilot study.

AIMS: Coronary microvascular dysfunction (CMD) represents a powerful independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). No treatment for CMD exists. The angiotensin-converting enzyme (ACE)-inhibitor perindopril improves myocardial blood flow (MBF) in animal models of cardiac hypertrophy and in hypertensive patients. Whether HCM patients with CMD may benefit is unknown. METHODS: Fourteen HCM patients aged 18-60 years with CMD [MBF post 0.56 mg/kg dipyridamole (Dip) infusion <2.1 ml/min∗g] were included. Presence of left ventricular outflow obstruction, hypertension and coronary artery disease were exclusion criteria. Perindopril was administered after the initial Dip 13N-NH3 PET study at 10 mg for 6 months. After wash-out, a second PET was performed. MBF before and after treatment was compared. RESULTS: No relevant associations were found between baseline MBF values and sex, genetics, history of angina, type of HCM (apical/classic), maximum left ventricular thickness and left ventricular mass. No significant improvement in Dip-MBF was observed with treatment (1.79 ±â€Š0.30 vs.1.76 ±â€Š0.26 ml/min∗g at baseline; P = 0.59). A limited but significant improvement in Dip-MBF was seen only in the subset without evidence of fibrosis at cardiac MRI (n = 4; 28%; 2.03 ±â€Š0.13 vs.1.77 ±â€Š0.26 ml/min∗g at baseline; P = 0.014). The drug was generally well tolerated: only one patient temporarily stopped the drug, because of cough. CONCLUSION: A 6-month perindopril treatment course in HCM patients with CMD was not associated with significant improvement in Dip-MBF. A limited but significant improvement was observed only in the subset of patients without myocardial fibrosis, suggesting potential utility in early disease stages.

Salud mental, procesos de crianza e infancias / Mental health, parenting processes and childhoods

INTRODUCCIÓN estudio que aborda nueves experiencias comunitarias vinculadas a la salud mental y los procesos de crianza de las infancias en las provincias de Neuquén, Río Negro y mLa Pampa. OBJETIVO comprender experiencias comunitarias vinculadas a la salud mental y los crianza de las infancias en las provincias de Neuquén, Río Negro y La Pampa durante el período 2020-2022; las transformaciones por ellas vivenciadas en el contexto de la pandemia y las medidas de distanciamiento y aislamiento social implementadas; y los conocimientos que surgen de ellas en términos del diseño y revisión de las políticas públicas vinculadas a la salud mental y los procesos de crianza de las infancias. METODOLOGÍA estudio descriptivo transversal con un enfoque eminentemente cualitativo que incluyó los aportes de la etnografía y la etnografía virtual siendo que los instrumentos de recolección de datos utilizados fueron múltiples. El análisis de datos se basó en el concepto de triangulación metodológica y estará inspirado en la teoría fundamentada y en el método de comparación constante. RESULTADOS en ellos se presenta la caracterización de cada una de las nueve experiencias comunitarias estudiadas desde las dimensiones de análisis propuestas en el marco teórico objetivos, acciones, sentidos, emocionalidades, enseñanzas para las políticas públicas; transformaciones vivenciadas durante el tiempo de pandemia; etc. DISCUSIÓN si bien las experiencias investigadas son muy diferentes entre sí, todas coinciden en haber partido de la escucha de las necesidades y las voces de las infancias y adolescencias orientando sus acciones a dar visibilidad y a validar otras maneras de ser, conocer y sentir este mundo al tiempo que todas han generado un tipo de politicidad en clave femenina que sigue un camino anfibio planteando luchas tanto desde fuera del Estado como desde él.

Polyanilines as New Sorbents for Hydrocarbons Removal from Aqueous Solutions.

Water remediation from hydrocarbons is crucial to reduce health risks. Numerous costly and, sometimes, sophisticated methods were proposed over the years. Herein, an innovative green procedure for porous polyanilines preparation is reported. Polyaniline (PANI) was synthesized by three different approaches ranging from traditional to more eco-friendly ones. Thermal, optical and morphological features of the resulting materials were investigated along with their surface properties. Finally, PANIs were tested as sorbents for hydrocarbons removal from waterbodies. Although an overall fast and high sorption efficiency is always observed, the effective hydrocarbons abatement performed by 'green' PANIs is particularly welcome in the context of environmental protection. Moreover, the sorption efficiency retention after five-run recycling tests suggests potential applications in wastewater remediation.

Clinical Implications of "Tailored" Antiplatelet Therapy in Patients With Chronic Total Occlusion.

Background Clopidogrel nonresponsiveness is a prognostic marker after percutaneous coronary intervention. Prasugrel and ticagrelor provide a better platelet inhibition and represent the first-line antiplatelet treatment in acute coronary syndrome. We sought to assess the prognostic impact of high platelet reactivity (HPR) and the potential clinical benefit of a "tailored" escalated or changed antiplatelet therapy in patients with chronic total occlusion. Methods and Results From Florence CTO-PCI (chronic total occlusion-percutaneous coronary intervention) registry, platelet function assessed by light transmission aggregometry, was available for 1101 patients. HPR was defined by adenosine diphosphate test ≥70% and optimal platelet reactivity by adenosine diphosphate test <70%. The endpoint of the study was long-term cardiac survival. Patients were stratified according to light transmission aggregometry results: optimal platelet reactivity (82%) and HPR (18%). Means for the adenosine diphosphate test were 44±16% versus 77±6%, respectively. Three-year survival was significantly higher in the optimal platelet reactivity group compared with HPR patients (95.3±0.8% versus 86.2±2.8%; P<0.001). With the availability of new P2Y12 inhibitors, a deeper platelet inhibition (46±17%) and similar survival to the optimal platelet reactivity group were achieved in patients with HPR on clopidogrel therapy after escalation. Conversely, HPR on clopidogrel therapy "not switched" was associated with cardiac mortality (hazard ratio 2.37; P=0.003) after multivariable adjustment. Conclusions HPR on treatment could be a modifiable prognostic marker by new antiaggregants providing a deeper platelet inhibition associated with clinical outcome improvement in complex chronic total occlusion patients. A "tailored" antiplatelet therapy, also driven by the entity of platelet inhibition, could be useful in these high risk setting patients.

Targeted Medical Therapies for Hypertrophic Cardiomyopathy.

PURPOSE OF REVIEW: The management of hypertrophic cardiomyopathy (HCM) has changed considerably over the years, although molecular therapies targeting core mechanisms of the disease are still lacking. This review provides an overview of the contemporary medical approach to patients with HCM, and of promising novel developments hopefully soon to enter the clinical arena. RECENT FINDINGS: Our perception of therapeutic targets for medical therapy in HCM is rapidly evolving. Novel approaches include myocardial metabolic modulation, late sodium current inhibition, and allosteric myosin inhibition, actively pursued to reduce and hopefully prevent the development of severe HCM phenotypes, improve symptom control, and preserve patients from disease-related complications. Clinical management of patients with HCM should be guided by in-depth knowledge of the complex mechanisms at the energetic, metabolic, and electrophysiologic level. Until new experimental therapies become available, tailored management of modifiable disease manifestations should be pursued, including lifestyle counseling and prevention of comorbidities.

Comprehensive Risk Management in Arrhythmogenic Cardiomyopathy Associated With Autosomal Dominant Carvajal Syndrome: Protecting Families.

In a 37-year-old cardiac arrest survivor with autosomal dominant Carvajal syndrome and arrhythmogenic cardiomyopathy, a desmoplakin mutation was identified. Cascade screening identified 2 affected family members and 2 healthy children carrying the mutation. Strategies for primary and secondary risk prevention emphasize the role of genetic testing in rare cardiomyopathies. (Level of Difficulty: Advanced.).

Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion.

OBJECTIVE: The aim of the study was to assess the prognostic impact of successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and completeness of revascularization in the elderly. BACKGROUND: Successful CTO-PCI is associated with clinical benefit. Notwithstanding elderly patients are currently underrepresented in CTO-PCI randomized controlled trials and registries. METHODS: From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI between 2004 and 2015; out of these, 460 consecutive patients were ≥75 years. End point of the study was long-term cardiac survival. The prognostic impact of successful CTO-PCI and complete revascularization on survival was assessed by Kaplan-Meier estimation and by Cox multivariable regression analysis. RESULTS: Patients were stratified according to success (72%) or failure of CTO-PCI. Completeness of revascularization was achieved in 57% of patients. Five-year cardiac survival was significantly higher in the successful CTO-PCI group (84 ± 3% vs. 72 ± 6%; p = .006) and it was further improved if complete coronary revascularization was achieved (90 ± 3% vs. 68 ± 5%; p < .001). At multivariable analysis, increasing age (hazard ratio [HR] 1.08; p = .001), diabetes (HR 1.55; p = .033), chronic kidney disease (HR 1.96, p = .002), left ventricular ejection fraction <0.40 (HR 2.10; p < .001), and completeness of revascularization (HR 0.58; p < .005) resulted independently associated with long-term cardiac survival. CONCLUSIONS: In the elderly successful CTO-PCI is associated with a long-term survival benefit. The results of this study suggest that, even in the elderly, a CTO-PCI attempt should be considered to achieve complete coronary revascularization.

Life-Threatening Acute Pulmonary Thromboembolism Following Severe Carbon Monoxide Poisoning: A Plausible Association.

A 57-year-old man admitted with severe carbon monoxide (CO) poisoning suffered life-threatening pulmonary embolism (PE) after hyperbaric oxygen therapy, in the absence of other risk factors for thromboembolism, and was successfully treated with thrombolysis. CO is a thrombophilic condition predisposing to PE and active surveillance is advisable. (Level of Difficulty: Advanced.).

Pre-vascularized dermis model for fast and functional anastomosis with host vasculature.

Skin engineering for clinical applications has gained numerous advances, however, most of the available dermis substitutes are exogenous matrices acting for a limited time. Indeed, after implantation these matrices need to be colonized by host cells such as fibroblast and endothelial cells which respectively produce their own extracellular matrix and set a vascular network within the construct. These steps are essential to guarantee implant efficacy, but they may require a long time depending on tissue dimension and lesion severity. Here we show the pre-vascularization process of a dermis equivalent featured by an endogenous matrix produced by human dermal fibroblasts. In this environment, endothelial cells were able to develop mature capillary-like-structures (CLS) as demonstrated by both the inner lumen and the positivity for alpha-SMA, laminin and collagen. The pre-vascularized dermis model (PVD) so obtained had a human matrix populated by fibroblasts as well as a complex capillary network making the construct ready to be implanted. These features make the graft very easy to handle during the surgery. In vivo results showed that 7 days after implantation CLS effectively anastomosed with host vessels. Therefore we argue that the proposed PVD may represent a new class of dermis substitute of strong clinical interest.

Clinical and Angiographic Outcomes Comparison of Patients With Left Main Vs Non-Left Main Bifurcation Lesions Treated With Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents.

INTRODUCTION: It is not clear if differences exist about treating left main bifurcation (LMB) and non-left main bifurcation (non-LMB) lesions by means of percutaneous coronary intervention (PCI). METHODS: We prospectively analyzed all consecutive patients treated at our center for bifurcation lesions from January 1, 2011 to December 31, 2015, including acute myocardial infarction (MI) and cardiogenic shock, and compared the angiographic and clinical outcomes of patients with LMB and non-LMB lesions treated with PCI and second-generation drug-eluting stent (2G-DES) implantation. The primary endpoint was the major adverse cardiac event (MACE) composite, including MI, clinically indicated target-vessel revascularization (TVR), and cardiac death (CD) at 2-year follow-up. We also compared the angiographic patency of the vessel, which was a composite of the restenosis-reocclusion (RR) rate. RESULTS: Out of 1081 patients (1368 bifurcations), a total of 320 patients had LMB (29%). Overall, procedural success was 98.4%. Clinical follow-up rate was 100%. Angiographic follow-up rate was 83.7%. No differences were seen regarding the primary endpoint of all MACE (17.8% in LMB vs 18.0% in non-LMB; P>.99), MI rate (4.3% in LMB vs 2.9% in non-LMB; P=.20), and CD (8.7% in LMB vs 5.8% in non-LMB; P=.08). The overall RR rate was 11.8%, with 5% RR rate in the LMB group (16/320 lesions) and 9.7% RR rate in the non-LMB group (102/1048 lesions); P<.01. The LMB group had a better TVR rate (5.0% vs 9.4% in the non-LMB group; P=.01). CONCLUSION: PCI with 2G-DES for LMB has better target-vessel patency and TVR rates when compared with non-LMB lesions, without clinical differences in terms of 2-year clinical outcomes.

Polyaniline (PANI): an innovative support for sampling and removal of VOCs in air matrices.

Polyaniline (PANI)-based materials for both removal and sampling of volatile organic compounds (VOCs) from air by rapid adsorption/desorption processes have been developed. The polymer was synthesized in form of emeraldine as both salt and base using different synthetic approaches, a traditional one and a "green" one. VOCs adsorption/desorption efficiency was evaluated for all the materials analyzing the desorbed VOCs fractions by GC/MS technique and obtaining results similar to the presently adopted method employing commercial activated carbon. Most important, in this work it has been demonstrated for the first time that the use of PANI-based sorbents allowed the substitution of the toxic CS2, recommended in official methods, with the less hazardous CH3OH as the VOCs extraction solvent. Moreover, a complete regeneration of the polymers could be realized by a few rapid washing steps. Finally, the best PANI-based material was subjected to recycling tests thereby showing a high adsorption/desorption efficiency retention up to four runs.

Azopolymer photopatterning for directional control of angiogenesis.

Understanding cellular behavior in response to microenvironmental stimuli is central to tissue engineering. An increasing number of reports emphasize the high sensitivity of cells to the physical characteristics of the surrounding milieu and in particular, topographical cues. In this work, we investigated the influence of dynamic topographic signal presentation on sprout formation and the possibility to obtain a space-time control over sprouting directionality without growth factors, in order to investigate the contribution of just topography in the angiogenic process. To test our hypothesis, we employed a 3D angiogenesis assay based on the use of spheroids derived from human umbilical vein endothelial cells (HUVECs). We then modulated the in situ presentation of topographical cues during early-stage angiogenesis through real-time photopatterning of an azobenzene-containing polymer, poly (Disperse Red 1 methacrylate) (pDR1m). Pattern inscription on the polymer surface was made using the focused laser of a confocal microscope. We demonstrate that during early-stage angiogenesis, sprouts followed the pattern direction, while spheroid cores acquired a polarized shape. These findings confirmed that sprout directionality was influenced by the photo-inscribed pattern, probably through contact guidance of leader cells, thus validating the proposed platform as a valuable tool for understanding complex processes involved in cell-topography interactions in multicellular systems. STATEMENT OF SIGNIFICANCE: The complex relationship between endothelial cells and the surrounding environment that leads to formation of a newly formed vascular network during tissue repair is currently unknown. We have developed an innovative in vitro platform to study these mechanisms in a space and time controlled fashion simulating what happens during regeneration. In particular, we combine a "smart" surface, namely a polymer film, with a three-dimensional living cell aggregate. The polymer is activated by light through which we can design a path to guide cells toward the formation of a new vessel. Our work lies at the intersection of stimuli-responsive biointerfaces and cell biology and may be particularly inspiring for those interested in designing biomaterial surface related to angiogenesis.

Enhanced Drug Delivery into Cell Cytosol via Glycoprotein H-Derived Peptide Conjugated Nanoemulsions.

The key role of nanocarriers in improving the pharmacological properties of commonly used drugs is recognized worldwide. It is also known that in the development of new effective nanocarriers the use of targeting moieties integrated on their surface is essential. Herein, we propose a nanocarrier based on an oil in water nanoemulsion coated with a membranotropic peptide derived from the glycoprotein H of Herpes simplex virus 1, known as gH625, in order to reduce endolysosomal accumulation and to enhance cytosolic localization. In addition, we show an enhanced anti-inflammatory activity of curcumin, a bioactive compound isolated from the Curcuma longa plant, when loaded into our engineered nanocarriers. This effect is a consequence of a higher uptake combined with a high curcumin preservation exerted by the active nanocapsules compared to control ones. When loaded into our nanocapsules, indeed, curcumin molecules are directly internalized into the cytosol rather than into lysosomes. Further, in order to extend the in vitro experimental setting with a more complex model and to explore the possibility to use our nanocarriers for further biological applications, we tested their performance in a 3D sprouting angiogenesis model. Finally, we show promising preliminary in vivo results by assessing the anti-inflammatory properties of the proposed nanocarrier.

Angiographic and clinical outcome after crush of everolimus-eluting stent for distal unprotected left main disease.

Obiectives: Angiographic and clinical outcomes after crushing of everolimus-eluting stent (EES) for distal unprotected left main disease (ULMD). BACKGROUND: Few data exist about crushing of EES for distal ULMD. METHODS: From the Florence ULMD Percutaneous Coronary Interevention Registry consecutive patients with distal ULMD treated with EES were included in the analysis. Patients treated with provisional stenting were compared with patients treated with crush stenting. ENDPOINTS: angiographic in-segment restenosis rate, and 1-year clinical outcome. RESULTS: From 2008 to 2015, 405 patients with distal ULMD were treated with EES: 278 (69%) were treated with provisional stenting while 127 (31%) with crush stenting. Provisional stenting group compared to crush stenting group had higher incidence of acute coronary syndrome on admission (63% vs. 52%; P = 0.033) and of left ventricular ejection fraction ≤ 40% (36% vs. 23%; p= 0.008), while patients treated with crush stenting had more frequently diabetes mellitus (35% vs. 21%; P = 0.003) and 3-vessel coronary artery disease (46% vs. 29%; P < 0.001). Angiographic follow rate was 95%. Restenosis rates were similar: 7.1% in the crush stenting group and 5.8% in the provisional stenting group. There were no differences in 1-year clinical outcome between crush stenting group and provisional stenting group: major adverse cardiac events 11.1% and 11.2%, stent thrombosis 0.8% and 1.4%, respectively. CONCLUSION: Crush stenting using EES in patients with complex distal ULMD is associated with low rates of restenosis and adverse clinical events and could be considered as a valid double stenting technique in all patients with complex ULMD bifurcation lesions. © 2017 Wiley Periodicals, Inc.

Study Protocol of MINI SALTEN: a technology-based multi-component intervention in the school environment targeting healthy habits of first grade children and their parents.

BACKGROUND: MINI SALTEN is a program developed to increase moderate to vigorous physical activity (PA) and improve eating habits at home and school in first grade children. It aims to assess the effects of a technology family-based and PA school-based intervention. The purpose of this manuscript is to describe the protocol design and the MINISALTEN intervention. METHODS: This is cluster-randomized controlled trial designed to run from July 2015 to November 2016 in 12 public schools of the city of Buenos Aires, matched for socio-demographic characteristics. The intervention is based on two main components: (a) "active breaks" (AB): implemented during school breaks by a PA instructor; (b) "virtual" (V): web-based contents delivered to the families via a multiplatform application. Using a computer generated random sequence participants are allocated to one of four intervention conditions: (AB), (V), (AB + V), and control (C). Outcomes are measured at baseline and 12 months post intervention, and will include data collected from the child and her/his mother/father or guardian. Primary outcome measures are: PA and sedentary behaviour (measured with accelerometers). Secondary outcome measures related are: percentage of kilocalories (kcal) from added sugars, and from total and saturated fats; grams of fruits and vegetables; and number of snacks and kcal coming from their added sugars and total and saturated fats. Family socio-economic level, home environment, and school environment will also be assessed. Statistical analysis is on an intention-to-treat principle. Baseline characteristics are described using summary measures and mixed models (with school as random effect). The effect of the two interventions will be estimated using a generalized mixed linear model with link and distribution selected according to the type of outcome. Included random effects are: child (or mother/father or guardian) accounting for repeated measures; school accounting for cluster induced by school. The most parsimonious model for each outcome will be reported. The False Discovery Rate criterion will be used to correct for multiple testing in non-planned analyses. DISCUSSION: It is a pioneer assessment of the impact of a technology-based virtual intervention and a school-based PA program, designed to prevent obesity, and involving the parents at public schools of Buenos Aires. TRIAL REGISTRATION: Current Controlled Trials ISRCTN58093412 . Registered March 14th, 2016 (retrospectively registered).

Buenas prácticas en salud mental infantil / Good practices in child mental health

INTRODUCCIÓN Estudio cualitativo multicéntrico acerca de las modalidades de atención y actividades de salud mental orientadas a niñ@s desarrolladas en los Sistemas Públicos de Salud de las Provincias de Río Negro y Neuquén, período 2016-2017. OBJETIVO Caracterizar en profundidad un conjunto específico de dispositivos de salud mental/psicosocial orientados a niñ@s seleccionados siguiendo criterios de buenas prácticas en salud. MÉTODO Los instrumentos de recolección de datos fueron; la revisión de documentación sanitaria existente; la realización de entrevistas en profundidad a los equipos profesionales responsables de los dispositivos y a los beneficiarios de los mismos; y la realización de observaciones de las distintas experiencias con apoyatura de registro fotográfico y videos; el análisis de datos se basó en el concepto de triangulación metodológica y estuvo inspirado en la teoría fundamentada y en el método de comparación constante. RESULTADOS Se caracterizaron un total de catorce dispositivos; en Río Negro; Admisión e Interconsultas, Hospital Cipolletti; Taller de Niños Divertidos, ADANIL, Hospital General Roca; Consejo de Niños, Salud Mental, Hospital General Roca; La Huerta para Compartir, Hospital Villa Regina; Futbol Callejero, El Bolsón; en Neuquén: Grupo de Padres de Bebés Prematuros Internados, Hospital Castro Rendón; Murguita Trapitos de Colores, CAPS Confluencia; Taller de Crianza, Hospital Bouquet Roldán; La Casita Itinerante, CAPS Parque Industrial; Red Interinstitucional, CAPS Don Bosco; Actividad Sala de Espera y Taller de Salud Sexual y Afectiva, Hospital Mariano Moreno; Grupo Psicoterapéutico de Niños, Hospital Horacio Heller. DISCUSIÓN A partir de la caracterización realizada, se re-conceptualizaron los criterios de buenas prácticas en salud mental infantil adquiriendo especial énfasis la consideración de l@s niñ@s como sujet@s y la necesidad del abordaje del entorno inmediato en el que el niñ@ vive como criterios de buenas prácticas

A method to tune the shape of protein-encapsulated polymeric microspheres.

Protein encapsulation technologies of polymeric microspheres currently in use have been optimized to effectively protect their "protein cargo" from inactivation occurring in biological environments, preserving its bioactivity during release up to several weeks. The scenario of protein delivery would greatly benefit by strategies enabling the production of non-spherical particles. Herein we report an easy and effective stamp-based method to produce poly-lactic-glycolic-acid (PLGA) microparticles encapsulating Vascular Endothelial Growth Factor (VEGF) of different shapes. We demonstrate that PLGA microspheres can be deformed at room temperature exploiting solvent/non-solvent plasticization in order to preserve the properties of the starting microspheres. This gentle method allows the production of shaped particles that provide a prolonged release of VEGF in active form, as verified by an angiogenic assay. The retention of the biological activity of an extremely labile molecule, i.e. VEGF, lets us hypothesize that a wide variety of drug and protein encapsulated polymeric microspheres can be processed using this method.

Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease.

BACKGROUND: Parathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we evaluated the association between PTH and hemoglobin in CKD-patients without severe secondary hyperparathyroidism. METHODS: Hospitalized patients and outpatients (N = 979) were retrospectively evaluated and categorized according to PTH quartile and serum hemoglobin (<12.0, <11.0, <10.0 g/dl). Gender, diabetes, glomerular filtration rate (GFR), hemoglobin, PTH, markers of mineral metabolism, inflammation, iron status and nutrition were variables of adjustment in univariate and multivariate analysis. RESULTS: An inverse association (p = 0.001) was observed between PTH and hemoglobin in patients as a whole, in diabetics, and in patients with GFR ≤60 ml/min. PTH was the single predictor of low hemoglobin in patients as a whole (unstandardized beta -2.12; p = 0.005), in diabetics (unstandardized beta -8.86; p = 0.007) and in patients with GFR ≤60 ml/min (unstandardized beta -2.52; p = 0.006). For each increase of quartile of PTH the risk of having hemoglobin level <10.0 mg/dl was more than doubled [hazard ratio (HR) 2.79, 95% confidence interval (CI) 2.00-3.88; p = 0.001]. The receiver operating characteristic curve showed that PTH ≥122 pg/ml had 67% sensitivity and 75% specificity in predicting hemoglobin level <10.0 g/dl with area under the curve of 0.758 (95% CI 0.73-0.78). CONCLUSIONS: This study shows a significant inverse association between PTH and hemoglobin levels across the whole spectrum of non-dialysis CKD and a doubled risk of having serum hemoglobin <10.0 mg/dl in the absence of severely deranged PTH concentration. These findings may have clinical relevance in ascertaining the cause of unexplained low hemoglobin levels in CKD-patients.