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1.
Int J Mol Sci ; 24(12)2023 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-37373341

RESUMO

Several studies have highlighted the ability of snail mucus in maintaining healthy skin conditions due to its emollient, regenerative, and protective properties. In particular, mucus derived from Helix aspersa muller has already been reported to have beneficial properties such as antimicrobial activity and wound repair capacity. In order to enhance the beneficial effects of snail mucus, a formulation enriched with antioxidant compounds derived from edible flower waste (Acmella oleracea L., Centaurea cyanus L., Tagetes erecta L., Calendula officinalis L., and Moringa oleifera Lam.) was obtained. UVB damage was used as a model to investigate in vitro the cytoprotective effects of snail mucus and edible flower extract. Results demonstrated that polyphenols from the flower waste extract boosted the antioxidant activity of snail mucus, providing cytoprotective effects in keratinocytes exposed to UVB radiation. Additionally, glutathione content, reactive oxygen species (ROS), and lipid peroxidation levels were reduced following the combined treatment with snail mucus and edible flower waste extract. We demonstrated that flower waste can be considered a valid candidate for cosmeceutical applications due to its potent antioxidant activity. Thus, a new formulation of snail mucus enriched in extracts of edible flower waste could be useful to design innovative and sustainable broadband natural UV-screen cosmeceutical products.


Assuntos
Antioxidantes , Cosmecêuticos , Antioxidantes/farmacologia , Antioxidantes/análise , Cosmecêuticos/farmacologia , Extratos Vegetais/química , Queratinócitos , Flores/química , Muco/química , Raios Ultravioleta/efeitos adversos
3.
Eur Radiol ; 31(3): 1236-1244, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32886202

RESUMO

OBJECTIVES: The current reference standard for diagnosing LAA thrombi is transesophageal echocardiography (TEE), a semi-invasive technique. We aimed to devise an optimal protocol for cardiac computed tomography (CCT) in diagnosing left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), using TEE as reference standard. METHODS: Two hundred sixty consecutive patients referred for radiofrequency ablation for AF were prospectively enrolled. All patients underwent CCT and TEE within 2 hours. The CCT protocol included one standard angiographic phase and three delayed acquisitions at 1-, 3-, and 6-min after contrast injection. Thrombi were defined as persisting defects at 6-min delayed acquisition. RESULTS: TEE demonstrated spontaneous contrast in 52 (20%) patients and thrombus in 10 (4%). In 63 patients (24%), CCT demonstrated LAA early filling defects at angiographic phase. Among them, 15 (6%) had a persistent defect at 1-min, 12 (5%) at 3-min, and 10 (4%) at 6-min. All 10 thrombi diagnosed on TEE were correctly identified by delayed CCT, without any false positives. For all phases, sensitivity and negative predictive were 100%. Specificity increased from 79% for the angiographic phase to 100% at 6-min. Positive predictive value increased from 16% to 100%. Estimated radiation exposure was 2.08 ± 0.76 mSv (mean ± standard deviation) for the angiographic phase and 0.45 ± 0.23 mSv for each delayed phase. CONCLUSION: A CCT protocol adding a 6-min delayed phase to the angiographic phase can be considered optimized for the diagnosis of LAA thrombi, with a low radiation dose. KEY POINTS: • In patients with persistent atrial fibrillation referred for ablation procedures, a cardiac CT examination comprising an angiographic-phase acquisition and, in case of filling defects, a 6-min delayed phase may help reduce the need for transesophageal echocardiography. • Cardiac CT would provide morphological and volumetric data, along with the potential to exclude the presence of thrombi in the left atrial appendage.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Cardiopatias , Trombose , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Trombose/complicações , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
JACC Case Rep ; 2(11): 1667-1670, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34317030

RESUMO

Mycotic coronary aneurysm and pseudoaneurysm are rare infective complications of percutaneous coronary interventions, associated with poor prognosis. Multimodality imaging is recommended to achieve a correct diagnosis. We present a case of post-stenting mycotic coronary pseudoaneurysm complicated by myocardial abscess in which we used different imaging tools, each carrying additional information. (Level of Difficulty: Advanced.).

5.
Future Cardiol ; 15(5): 333-338, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496269

RESUMO

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome particularly among young women. Although coronary angiogram (CAG) is the gold standard exam for the diagnosis, SCAD may be missed by CAG alone. Our case series illustrates the adjunctive role of cardiac computed tomography angiography (cCTA) to CAG in ascertaining the diagnosis of SCAD. Three young women were admitted with ST-segment elevation myocardial infarction. CAG showed no significant coronary artery stenosis. In two patients, cCTA performed after CAG revealed an intramural hematoma compressing the coronary lumen. In one patient, SCAD was initially misdiagnosed as Takotsubo cardiomyopathy and cCTA performed 1 month later allowed to make the correct diagnosis of SCAD assessing the spontaneous healing of the dissected vessel.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Doenças Vasculares/congênito , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Ultrassonografia de Intervenção/métodos , Doenças Vasculares/diagnóstico
6.
Eur Heart J Cardiovasc Imaging ; 20(1): 45-55, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29420710

RESUMO

Aims: A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones. Methods and results: One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85) (all P < 0.0001) than manual one. Both 3D methods underestimated the MSCT measurements, but semi-automated measurements showed narrower limits of agreement and lesser bias than manual measurements for most of AA parameters. On average, 3D-TOE semi-automated major diameter, area, and perimeter underestimated the respective MSCT measurements by 7.4%, 3.5%, and 4.4%, respectively, whereas minor diameter was overestimated by 0.3%. Moderate agreement for valve sizing for both 3D-TOE techniques was found: Kappa agreement 0.5 for both semi-automated and manual analysis. Interobserver and intraobserver agreements for the AA measurements were excellent for both techniques (intraclass correlation coefficients for all parameters >0.80). Conclusion: The 3D-TOE semi-automated analysis of AA is feasible and reliable and can be used in clinical practice as an alternative to MSCT for AA assessment.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Ecocardiografia Tridimensional , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Interpretação de Imagem Assistida por Computador , Ajuste de Prótese , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Software , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ácidos Tri-Iodobenzoicos
7.
Trials ; 19(1): 492, 2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-30217235

RESUMO

BACKGROUND: Parkinson's disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. METHODS/DESIGN: This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson's disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson's diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. DISCUSSION: Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17396879 . Registered on 15 March 2017.


Assuntos
Atitude do Pessoal de Saúde , Cuidadores/psicologia , Prestação Integrada de Cuidados de Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Doença de Parkinson/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Médicos/psicologia , Telemedicina/métodos , Idoso , Tomada de Decisão Clínica , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Equipe de Assistência ao Paciente , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
JACC Cardiovasc Interv ; 11(15): 1519-1526, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-30093056

RESUMO

OBJECTIVES: This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR). METHODS: Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length. RESULTS: Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 h after TAVR. The final analysis included 611 patients. Fifty-four patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 h following TAVR. Patients who required a late PPM implant had a wider QRS width (113 ± 25 ms vs. 105 ± 23 ms; p = 0.009) and a higher prevalence of baseline right bundle branch block (12.9% vs. 5.3%; p = 0.026) and were more likely to have a self-expandable valve implanted (51.8% vs. 31.9%; p = 0.003). The ΔPR was 40 ± 51 ms (p = 0.0001) and the ΔQRS was 22 ± 61 ms (p = 0.001). Multivariable analysis revealed that baseline right bundle branch block (odds ratio: 3.56; 95% confidence interval: 1.07 to 11.77; p = 0.037) and ΔPR (odds ratio for each 10-ms increase: 1.31; 95% confidence interval: 1.18 to 1.45; p = 0.0001) are independent predictors of delayed advanced conduction disturbances. CONCLUSIONS: This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Sistema de Condução Cardíaco/fisiopatologia , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Itália/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
J Cardiovasc Med (Hagerstown) ; 19(4): 181-182, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29373376

RESUMO

: Ventricular septal defect (VSD) has been reported as a rare complication after transcatheter aortic valve implantation (TAVI), presenting with signs of heart failure. Furthermore, left ventricular outflow tract obstruction (LVOTO) may worsen after TAVI, especially in cases of severe left ventricular hypertrophy and small cavity. However, the simultaneous appearance of VSD and LVOT after TAVI has not been reported before. We report a case of combined VSD and LVOTO after TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Comunicação Interventricular/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Complicações Pós-Operatórias
10.
Am J Cardiol ; 120(12): 2233-2240, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-29106835

RESUMO

A high prevalence of mitral annular calcium (MAC) is expected in patients undergoing transcatheter aortic valve implantation (TAVI); however, data regarding the prevalence of MAC and impact on risk of cardiovascular events are lacking. To determine the prevalence of MAC and its association with clinical outcomes in patients undergoing TAVI, we retrospectively analyzed 424 patients who underwent transfemoral TAVI from 2007 to 2015 and whose preoperative computed tomography images were available for assessment of MAC. Severe circumferential MAC (SC-MAC) was defined as calcification involving at least the whole posterior annulus alone or with the attachment of the anterior leaflet. Clinical outcomes were examined according to Valve Academic Research Consortium-2 criteria up to 2 years. SC-MAC was found in 17.7% of patients. Patients with SC-MAC were more likely to be female, with a higher prevalence of atrial fibrillation and peripheral artery disease. There were no differences between the groups regarding age, functional class, prevalence of diabetes, kidney disease, and operative risk. Female gender and peripheral artery disease were independent predictors of SC-MAC. SC-MAC did not appear to be associated with periprocedural and 30-day outcomes. At 2 years' follow-up, patients with SC-MAC had significantly higher cardiovascular and all-cause mortality rates. SC-MAC was an independent predictor of cardiovascular mortality during follow-up. In conclusion, SC-MAC is a frequent finding in the TAVI population and appears to be an independent predictor of cardiovascular mortality at 2 years' follow-up.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Calcinose/complicações , Cálcio/metabolismo , Valva Mitral/metabolismo , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Calcinose/diagnóstico , Calcinose/metabolismo , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X
14.
Am J Cardiol ; 119(7): 1088-1093, 2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28237287

RESUMO

There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis. A total of 439 patients were included in the final analysis; 108 patients were discharged on SAPT and 331 on DAPT. Reasons for discharge SAPT included high risk of bleeding (n = 33; 31%), postprocedural bleeding (n = 42; 39%), thrombocytopenia (n = 20; 18%), vascular complications (n = 13; 12%). The mean length of DAPT was 5.2 ± 2.7 months. Patients discharged in SAPT had a higher incidence of life-threatening bleeding during the index hospitalization. At follow-up, no differences were observed in the incidence of net adverse clinical event, all-cause or cardiovascular mortality, and cerebrovascular events. A similar rate of valve thrombosis was reported in both groups. In conclusion, prescribing only SAPT after TAVI in selected patients was not associated with an increased risk of events and may be an acceptable alternative to DAPT in elderly patients at high risk of bleeding.


Assuntos
Quimioterapia Combinada , Inibidores da Agregação Plaquetária/uso terapêutico , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Contraindicações , Relação Dose-Resposta a Droga , Ecocardiografia , Feminino , Hemorragia/epidemiologia , Hemorragia/prevenção & controle , Humanos , Incidência , Itália/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombose/epidemiologia , Trombose/prevenção & controle , Resultado do Tratamento
19.
Eur Heart J Cardiovasc Imaging ; 17(1): 24-33, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26160397

RESUMO

AIMS: To investigate the feasibility, image quality, and clinical implications of an ultra-low-dose contrast injection computed tomography angiography (CTA) protocol in patients scheduled for transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: Images obtained with 64-slice CT were retrospectively evaluated in 162 TAVI candidates with a body mass index (BMI) of ≤29 kg/m(2). A multiphasic, low iodine dose and BMI-adapted CM protocol was administered in all patients (BMI <22 kg/m(2): 40 mL; BMI 22-29 kg/m(2): 55 mL). All images were evaluated for image quality, vessel attenuation, and estimated radiation dose. The anatomy, diameters, perimeter, and area of the aortic annulus were assessed. Anatomy and diameters of peripheral vessels were also evaluated. Image quality of the aortic root and ilio-femoral vessels was diagnostic in all patients. Vascular attenuation was >200 HU at any vessel level. The mean diameters of the aortic annulus were 22 ± 3 mm (range: 16-28 mm) × 26 ± 3 mm (range: 20-33 mm); the mean perimeter was 77.0 ± 7.1 mm. After CTA, a total of 137 patients (84.6%) underwent TAVI. Mean estimated radiation dose was 20.2 ± 4.6 mSv. CONCLUSION: With our protocol, we achieved images of the aortic annulus and aorto-iliac anatomy of sufficient quality to allow patient selection and procedural planning for TAVI, with a substantial reduction of the amount of injected CM.


Assuntos
Meios de Contraste/administração & dosagem , Angiografia Coronária/métodos , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Doses de Radiação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2016: 663-666, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28268415

RESUMO

Parkinson's disease (PD) is a complex, chronic disease that many patients live with for many years. In this work we propose a mHealth approach based on a set of unobtrusive, simple-in-use, off-the-self, co-operative, mobile devices that will be used for motor and non-motor symptoms monitoring and evaluation, as well as for the detection of fluctuations along with their duration through a waking day. Ideally, a multidisciplinary and integrated care approach involving several professionals working together (neurologists, physiotherapists, psychologists and nutritionists) could provide a holistic management of the disease increasing the patient's independence and Quality of Life (QoL). To address these needs we describe also an ecosystem for the management of both motor and non-motor symptoms on PD facilitating the collaboration of health professionals and empowering the patients to self-manage their condition. This would allow not only a better monitoring of PD patients but also a better understanding of the disease progression.


Assuntos
Monitorização Fisiológica/métodos , Doença de Parkinson/fisiopatologia , Telemedicina , Ecossistema , Frequência Cardíaca/fisiologia , Humanos , Doença de Parkinson/diagnóstico , Qualidade de Vida , Smartphone
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