Mediterranean-Oriented Dietary Intervention Is Effective to Reduce Liver Steatosis in Patients with Nonalcoholic Fatty Liver Disease: Results from an Italian Clinical Trial.

Results: One hundred and fifty five subjects aged 20-59 years underwent (i) liver ultrasound (US), (ii) clinical and anthropometric evaluations, (iii) blood tests, and (iv) assessment of dietary habits. According to US evaluation, 73 of them had severe, moderate, or mild liver steatosis (NAFLD patients) and 82 had no liver steatosis (healthy controls). Fifty-eight NAFLD patients and 73 controls completed the study. Among NAFLD patients, 26 (45%) downgraded steatosis severity, 12 of which achieved complete steatosis regression (21%). Three of the healthy controls developed NAFLD. The NAFLD patients improved their dietary habits and reduced BMI and waist circumference, during the study period, more than healthy controls. Liver steatosis remission/regression was independent of changes in BMI or liver enzymes and was more frequent among patients with mild steatosis at baseline. Conclusions: Mediterranean dietary advices, without a personalised meal planning, were efficient in reducing/remitting NAFLD, especially among patients with mild disease, which argues in favour of early identification and lifestyle intervention. This trial is registered with NCT03300661.

Computational Studies of Molecular Permeation through Connexin26 Channels.

A signal property of connexin channels is the ability to mediate selective diffusive movement of molecules through plasma membrane(s), but the energetics and determinants of molecular movement through these channels have yet to be understood. Different connexin channels have distinct molecular selectivities that cannot be explained simply on the basis of size or charge of the permeants. To gain insight into the forces and interactions that underlie selective molecular permeation, we investigated the energetics of two uncharged derivatized sugars, one permeable and one impermeable, through a validated connexin26 (Cx26) channel structural model, using molecular dynamics and associated analytic tools. The system is a Cx26 channel equilibrated in explicit membrane/solvent, shown by Brownian dynamics to reproduce key conductance characteristics of the native channel. The results are consistent with the known difference in permeability to each molecule. The energetic barriers extend through most of the pore length, rather than being highly localized as in ion-specific channels. There is little evidence for binding within the pore. Force decomposition reveals how, for each tested molecule, interactions with water and the Cx26 protein vary over the length of the pore and reveals a significant contribution from hydrogen bonding and interaction with K(+). The flexibility of the pore width varies along its length, and the tested molecules have differential effects on pore width as they pass through. Potential sites of interaction within the pore are defined for each molecule. The results suggest that for the tested molecules, differences in hydrogen bonding and entropic factors arising from permeant flexibility substantially contribute to the energetics of permeation. This work highlights factors involved in selective molecular permeation that differ from those that define selectivity among atomic ions.

Does the intragastric balloon have a predictive role in subsequent LAP-BAND(®) surgery? Italian multicenter study results at 5-year follow-up.

BACKGROUND: The intragastric balloon has been reported to be a safe and effective tool for temporary weight loss. The aim of this study is the evaluation of the possible predictive role of intragastric balloon when used before laparoscopic adjustable gastric banding. METHODS: A longitudinal multicenter study was conducted in patients with body mass index (BMI)>35 kg/m(2) who underwent gastric banding with the BioEnterics Intragastric Balloon (BIB). After balloon removal (6 mo), patients were allocated into 2 group according to their percentage of excess weight loss (%EWL): group>25 (%EWL>25%) and group<25 (%EWL<25%). Patients from both group underwent laparoscopic adjustable gastric banding (LAGB) 1-3 months after BIB removal. The LAP-BAND AP band was placed in all patients via pars flaccida. Weight loss parameters were considered in both groups. RESULTS: From January 2005 to December 2009, 1357 patients were enrolled in this study. Mean BMI at time of BIB positioning was 44.9±8.4 (range 29-82.5). After 6 months, at time of removal, mean BMI was 39.4±7.3. According to the cutoff, patients were allocated into group A (n = 699) and group B (n = 658). At this time the mean BMI was 36.4±6.4 and 42.7±6.9 (P = .001) in groups A and B, respectively. At 1-year follow-up from LAGB, mean BMI was 35.8±6.5 and 40.0±7.4 (P<.001) in groups A and B, respectively. This significant difference was confirmed at 3- and 5-year follow-ups. A similar pattern was observed with the %EWL. CONCLUSION: Satisfactory results with BIB are predictive of a positive outcome of LASB at 1, 3, and 5 years after the procedure, and poor results do not inevitably indicate a negative outcome for gastric banding.

The gender-related differences of nutrient intakes in a group of Italian obese patients display the ongoing transition from Mediterranean to western dietary patterns.

BACKGROUND: The purpose of this study was to compare nutrients and energy intakes between obese women and men and the variation rates over or below the recommended dietary allowances. METHODS: A retrospective survey was conducted on the records of obese patients, categorized into gender-related groups (36 women, 36 men). Total energy and nutrient intakes were determined. RESULTS: The highest variation rates were found for animal protein, averaging 225 % over the recommended dietary allowance, without significant differences between women and men. The simple carbohydrate intake was quite elevated in women with variations almost 80% over the RDA, significantly higher than in men (22%). CONCLUSION: The consumption of high-protein foods in both sexes, and even more the association with high-simple carbohydrate foods in women, display the Westernization of traditional eating habits.

One-step hydrothermal synthesis of manganese-containing MFI-type zeolite, Mn-ZSM-5, characterization, and catalytic oxidation of hydrocarbons.

Manganese-containing MFI-type Mn-ZSM-5 zeolite was synthesized by a facile one-step hydrothermal method using tetrapropylammonium hydroxide (TPAOH) and manganese(III)-acetylacetonate as organic template and manganese salts, respectively. A highly crystalline MFI zeolite structure was formed under pH = 11 in 2 days, without the need for additional alkali metal cations. Direct evidence of the incorporation of Mn in the zeolite framework sites was observed by performing structure parameter refinements, supported by data collected from other characterization techniques such as IR, Raman, UV-vis, TGA, N2-adsorption, SEM, TEM, EDAX, and XPS. UV-vis spectra from the unique optical properties of Mn-ZSM-5 show two absorption peaks at 250 and 500 nm. The absorption varies in different atmospheres accompanied by a color change of the materials due to oxygen evolution. Raman spectra show a significant and gradual red shift from 383 cm(-1) to 372 cm(-1) when the doping amount of Mn is increased from 0 to 2 wt %. This suggests a weakened zeolite structural unit induced by the Mn substitution. The catalytic activity was studied in both gas-phase benzyl alcohol oxidation and toluene oxidation reactions with remarkable oxidative activity presented for the first time. These reactions result in a 55% yield of benzaldehyde, and 65% total conversion of toluene to carbon dioxide for the 2% Mn-ZSM-5. Temperature programmed reduction (TPR) using CO in He demonstrates two reduction peaks: one between 300 and 500 °C and the other between 500 and 800 °C. The first reduction peak, due to manganese-activated oxidation sites shifted from higher temperature to lower temperature, and the peak intensity of CO2 rises when the dopant amount increases. For the first time, calculated photophysical properties of a model Mn(O-SiH3)4(-) compound, an Mn-embedded zeolite cluster, and model Mn oxides help to explain and interpret the diffuse reflectance spectroscopy of Mn-ZSM-5 zeolites.

Molecular dynamics simulations of the Cx26 hemichannel: evaluation of structural models with Brownian dynamics.

The recently published crystal structure of the Cx26 gap junction channel provides a unique opportunity for elucidation of the structure of the conductive connexin pore and the molecular determinants of its ion permeation properties (conductance, current-voltage [I-V] relations, and charge selectivity). However, the crystal structure was incomplete, most notably lacking the coordinates of the N-terminal methionine residue, which resides within the pore, and also lacking two cytosolic domains. To allow computational studies for comparison with the known channel properties, we completed the structure. Grand canonical Monte Carlo Brownian dynamics (GCMC/BD) simulations of the completed and the published Cx26 hemichannel crystal structure indicate that the pore is too narrow to permit significant ion flux. The GCMC/BD simulations predict marked inward current rectification and almost perfect anion selectivity, both inconsistent with known channel properties. The completed structure was refined by all-atom molecular dynamics (MD) simulations (220 ns total) in an explicit solvent and POPC membrane system. These MD simulations produced an equilibrated structure with a larger minimal pore diameter, which decreased the height of the permeation barrier formed by the N terminus. GCMC/BD simulations of the MD-equilibrated structure yielded more appropriate single-channel conductance and less anion/cation selectivity. However, the simulations much more closely matched experimentally determined I-V relations when the charge effects of specific co- and posttranslational modifications of Cx26 previously identified by mass spectrometry were incorporated. We conclude that the average equilibrated structure obtained after MD simulations more closely represents the open Cx26 hemichannel structure than does the crystal structure, and that co- and posttranslational modifications of Cx26 hemichannels are likely to play an important physiological role by defining the conductance and ion selectivity of Cx26 channels. Furthermore, the simulations and data suggest that experimentally observed heterogeneity in Cx26 I-V relations can be accounted for by variation in co- and posttranslational modifications.

Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients.

PURPOSE: This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up. METHODS: An observational study was carried out since 2005 on all children (<15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures. Improvement in nutritional status (ie, gaining weight) and sustained esophageal patency were both considered reference points to successful treatment. RESULTS: In 4 years (2005-2009), 175 children were admitted, 53.7% at more than 1 month after ingestion. Dilatations were carried out in 77.7%, and a gastrostomy was placed in 64%. Perforations and death rate were 4.5% and 2.8%, respectively. Sixty-two patients (35.4%) required more than 7 dilatations, whereas 15 (8.5%) were unable to maintain a satisfactory luminal diameter. Follow-up (range, 1-36 months; median, 7 months) was possible in 52.7%. Long-term success according to the aforementioned criteria was observed in only 16%. CONCLUSIONS: Delayed presentations and complex strictures with repeated postdilatation recurrence are characteristics of children's corrosive ingestion in developing countries. Malnutrition is common, and gastrostomy is frequently compulsory. Esophageal patency with improvement in nutritional state is achieved only in a small percentage of patients.

24-h pH-metry and multichannel intraluminal impedance monitoring in obese patients with and without gastroesophageal reflux disease symptoms.

BACKGROUND: The 24-h ambulatory pH-metry with multichannel intraluminal impedance monitoring (24-h pH-metry+MII) allows the simultaneous assessment of chemical and physical properties of esophageal refluxes and the detection of its proximal migration. METHODS: Gastroesophageal reflux (GER) was investigated in obese symptomatic (obese gastroesophageal reflux disease, GERD) and asymptomatic (obese non-GERD) patients. The data were compared with those obtained from non-obese GERD patients and a control group. Thirty-five (20 non-GERD, 15 GERD) obese patients and 15 non-obese GERD were investigated with 24-h pH-metry+MII. Ten normal weight subjects with normal 24-h pH-metry+MII were used as control group. RESULTS: The percent time acid exposure was significantly higher in obese non-GERD than controls (p = 0.007). Acid reflux episodes were increased vs. controls in obese non-GERD (p = 0.005) and obese GERD (p = 0.034). Upright position showed a significant increase of reflux episodes in non-obese GERD (p = 0.034) and in obese non-GERD (p = 0.027) vs. controls. Recumbent position showed reflux episodes significantly increased vs. controls in obese non-GERD (p = 0.002), obese GERD (p = 0.021), and non-obese GERD (p = 0.033). In obese non-GERD, waist circumference (WC) correlated negatively with upright position episodes (r = -0.53; p = 0.043) and with proximal migration episodes, i.e., total (r = -0.60; p = 0.018), acid (r = -0.55; p = 0.033), and weakly acidic refluxes (r = -0.56; p = 0.031). CONCLUSIONS: Obese patients showed an increased number of refluxes with acid content. Refluxes with proximal extent were significantly higher in obese non-GERD than in controls and non-obese GERD patients. No difference was observed between the two obese patient groups. In asymptomatic obese patients, the WC correlated with proximal extent episodes.

Nutrient intake in Italian obese patients: relationships with insulin resistance and markers of non-alcoholic fatty liver disease.

OBJECTIVE: We investigated the prevalence of insulin resistance, elevated liver enzymes, and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) in obese and severely obese patients. Relations between inadequate nutrient intakes and the markers of metabolic and hepatic disorders were evaluated. METHODS: From January to September 2009, 63 consecutive obese patients (21 men and 42 women, 19-68 y old) were admitted to the study. According to the World Health Organization obesity classification, patients were categorized into three subgroups (classes I, II, and III). NFS scores lower than -1.455 were defined as NFS(-); higher scores were positive (NFS(+)). Insulin resistance (IR) was assessed by the homeostasis model assessment. Nutrient intakes and their potential role as risk factors for IR and liver damage were determined. RESULTS: Body mass index ranged from 30.9 to 73.7 kg/m(2) and most patients (54%) were in class III (body mass index ≥40 kg/m(2)). Homeostasis model assessment of IR (>2.5) was recorded in 63.5%. The prevalence of NFS(+) was significantly higher in class III than in classes II and I. Excessive nutrient and energy intake prevalence showed significant differences for protein, fat, and carbohydrate among the obesity classes. Animal protein (odds ratio 3.43, 95% confidence interval 1.15-10.20) and carbohydrate (odds ratio 3.83, 95% confidence interval 1.33-10.94) intakes were the risk factors for IR and NFS(+). CONCLUSION: Non-normal alanine aminotransferase and γ-glutamyltranspeptidase values were observed in less than one-third of patients, whereas NFS(+) and IR were significantly prevalent, suggesting a close relation between the progression of liver fibrosis and metabolic derangement. An excessive intake of animal protein is associated with an increased risk of IR. Carbohydrate intake, albeit at the highest limit of the recommended dietary allowance range, is associated with an increased risk of liver fibrosis.

Excited states and photochemistry of bicyclo[1.1.0]butane.

Calculations on the excited states of bicyclo[1.1.0]butane in the gas phase by different theoretical methods using several basis sets were performed. In general, the agreement between calculated and experimental excitation energies for bicyclo[1.1.0]butane in the gas phase is very good. Reviews of the solution-phase photochemistry of bicyclo[1.1.0]butane as well as previous calculations on the ground and excited states of bicyclo[1.1.0]butane are given to provide a necessary perspective of the photochemistry of bicyclo[1.1.0]butane in solution. To simulate the solution-phase photochemistry of bicyclo[1.1.0]butane, a well potential is added to the Kirkwood-Onsager model for obtaining solvation energies of molecules in solution. The addition of the well potential gives rise to a blue-shift of all gas-phase excitation energies in solution. However, there is also the very important added effect of providing an increase in Rydberg-valence mixing of solution-phase excited states. It is this mixing of antibonding valence character into the solution-phase excited states that is necessary to explain the solution-phase photochemistry of bicyclo[1.1.0]butane through bond-breaking and the formation of a conical intersection intermediate.

Longitudinal clinical evaluation of bonded composite inlays: a 3-year study.

OBJECTIVE: The aims of this prospective clinical study were (1) to evaluate the clinical performance of Signum composite inlays over a 3-year period; (2) to investigate the clinical efficacy of composite inlays in premolars versus molars; and (3) to evaluate differences between 1- or 2-surface inlays and multisurface inlays. METHOD AND MATERIALS: One hundred thirteen composite inlays were placed in 30 patients by a clinician. All the inlays were made by the same laboratory technician using only one composite material (Signum, Heraeus Kulzer). All the restorations were bonded with a 3-step bonding system and a composite luting cement. The restorations were assessed after placement by a clinician who had not been involved with the placement of the restorations, in accordance with the modified US Public Health Service criteria. RESULTS: Three of the 113 experimental restorations had to be replaced; the total failure rate was 2.6% after 3 years. At baseline, 88.5% to 100% of the inlay restorations were rated as excellent (Alpha). Statistically significant (P < .05) differences were observed during the study for surface roughness, anatomic form at the margin, marginal integrity, and inlay integrity. The comparison of the clinical outcome of inlays in premolars versus molars and with 1 or 2 surfaces versus multisurfaces showed no significant differences, except for the parameters anatomic form at the margin and marginal integrity. CONCLUSION: Composite inlays demonstrated a very high success rate (97.4%) after 3 years. Neither the size of the restorations nor the tooth type significantly affected the clinical outcome of the restorations.

Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients.

BACKGROUND: Obesity is often associated with fatty liver (FL). In most cases, bright liver at ultrasound (US) and increased alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels are considered the hallmarks of nonalcoholic fatty liver disease (NAFLD). Insulin resistance (IR) is the main link between obesity and NAFLD. The use of the Bioenterics intragastric balloon (BIB) is a safe procedure either for inducing a sustained weight loss with diet support or for preparing those patients who are candidates for bariatric surgery. The aim of the study was to investigate whether the weight loss induced by intragastric balloon might improve IR and liver enzymes. The presence or absence of FL at US and the influence of a body mass index (BMI) decrease > or = 10% after BIB (DeltaBMI > or = 10%) were also considered. METHODS: One hundred and three consecutive obese (BMI > 30 kg/m(2)) patients (38 males/65 females; mean age 41.3, range 20-63 years) underwent BIB insertion under endoscopic control. The BIB was removed 6 months later. US, clinical, and routine laboratory investigations were performed before and after BIB. IR was calculated by the homeostasis model assessment (HOMA-IR > 2.5). Exclusion criteria were hepatitis B virus positive, hepatitis C virus positive, alcohol consumption >30 g/day, history of hepato-steatogenic drugs, and type 1 diabetes. RESULTS: Ninety-three patients were eligible for the study. The BMI significantly decreased in all investigated patients, and it was > or = 10% in 59% of the patients. FL was seen at US in 70%, impaired fasting blood glucose was present in 13%, ALT exceeded the normal limit in 30.1%, GGT exceeded the normal limit in 15%, and HOMA-IR was >2.5 in 85%. Median HOMA-IR decreased significantly in FL (4.71 vs 3.10; p < 0.05) and non-FL (3.72 vs 2.81; p < 0.01) groups. Median ALT decreased significantly in the FL group (31.5 vs 24; p < 0.001) and GGT significantly decreased in the FL group (31 vs 23.5; p < 0.05). In the FL group with DeltaBMI > or = 10%, the median values of HOMA-IR (4.95 vs 2.69; p < 0.05), ALT (30 vs 23; p < 0.01), and GGT (28 vs 20; p < 0.001) significantly decreased after BIB. In the non-FL group, HOMA-IR values significantly decreased (4.07 vs 2.36; p < 0.01) in patients with a DeltaBMI > or = 10%; ALT and GGT did not significantly decrease. CONCLUSIONS: Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement in hepatic damage. The benefit depends on the decrease of BMI higher than 10%.

Intragastric balloon insertion increases the frequency of erosive esophagitis in obese patients.

BACKGROUND: The BioEnterics intragrastric balloon (BIB) has been successfully used for treatment with BMI >35 or BMI >40. Gastroesophageal reflux (GER) symptoms are sometimes reported to occur and/or to worsen in patients with BIB, with a variable onset of erosive esophagitis (EE). The aim of this study was to investigate the prevalence and the severity of esophagitis after BIB placement. METHODS: 121 patients (93 F, 28 M, mean age 45 (19-65), mean BMI 41.5 (30-63.5) were studied. Patients with severe esophagitis (grade C-D Los Angeles (LA) classification), gastric or duodenal ulcers were excluded from the BIB treatment. After BIB placement, proton-pump inhibitors (PPI) were administered in the first month to each patient. The BIB was removed after 6 months. The presence of EE and related severity by LA classification were recorded RESULTS: Before BIB insertion, 18 patients (15%) showed mild EE (16 grade A and 2 grade B). After BIB removal, EE was observed in 22 patients (18.2%): 11 grade A, 7 grade B, 4 grade C-D. The difference in the prevalence of EE after BIB was statistically significant (Wilcoxon's test P =0.030). CONCLUSION: EE prevalence was significantly increased after BIB placement. We suggest that EE due to enhanced GER could be considered as an adverse effect of such treatment. We therefore recommend maintaining intragastric acid suppression with PPIs during the 6 months of BIB placement.

Echo-Doppler and clinical evaluations to define hemodynamic profile in patients with chronic heart failure: accuracy and influence on therapeutic management.

BACKGROUND: Correct classification of chronic heart failure (CHF) patients by dual evidence of congestion and adequate perfusion is the primary clinical focus for management. OBJECTIVES: To evaluate the accuracy of echo-Doppler compared with clinical evaluation in determining the hemodynamic profile of patients with CHF; and to compare therapeutic changes based on hemodynamic or echo-Doppler findings. METHODS: Three hundred and sixty-six consecutive CHF patients (ejection fraction 25+/-7%) in sinus rhythm, undergoing evaluation for cardiac transplantation, underwent physical examination prior to right heart catheterization and echo-Doppler studies. Subsequently, patients were randomized to therapeutic optimization using either right heart catheterization or echo-Doppler data. The end-points were: identification of low cardiac output (cardiac index <2.2 l/min/m(2)); high pulmonary wedge pressure (PWP >18 mm Hg); high right atrial pressure (RAP >5 mm Hg) and analysis of therapeutic changes made in response to the right heart catheterization and echo-Doppler studies. RESULTS: Echo-Doppler showed better accuracy in estimating abnormal hemodynamic indices than clinical variables (cardiac index <2.2 l/min/m(2): echo positive predictive accuracy (PPA) 98% vs. clinical PPA 52% p<0.00001; PWP >18 mm Hg: echo PPA 85% vs. clinical PPA 76% p=0.0011; RAP >5 mm Hg: echo PPA 82% vs. clinical PPA 57% p<0.00001). When applied to individual patients, the echo-Doppler assessment was more accurate than clinical evaluation in defining the different hemodynamic profiles: wet/cold (89% vs. 13%, p<0.0001); wet/warm (73% vs. 30%, p<0.0001); dry/cold (68% vs. 12%, p<0.0001); dry/warm (88% vs. 51%, p<0.0001). Therapeutic decision-making based on echo-Doppler findings was similar to that based on hemodynamics. CONCLUSION: Echo-Doppler hemodynamic monitoring proved accurate in estimating hemodynamic profiles and influenced therapeutic management.

Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers.

BACKGROUND: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo-Doppler, and cardiopulmonary exercise testing. OBJECTIVE: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. METHODS: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53 +/- 9.4 years, 85% male, LVEF 25 +/- 8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. RESULTS: Nineteen percent of patients were anemic. These patients had a lower body mass index (24 +/- 3 vs. 25 +/- 4 Kg/m2 p < 0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p < 0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p < 0.0001) and increased right (7 +/- 5 vs. 5 +/- 4 mmHg, p < .0004) and left (21 +/- 9 vs. 19 +/- 10 p < 0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these "hard" cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUC(ROC): 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUC(ROC): 0.719) or invasive variables (AUC(ROC): 0.719). CONCLUSIONS: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation.

Comparison between the two systems to evaluate the appropriateness of endoscopy of the upper digestive tract.

OBJECTIVES: The aim of this study was to compare the diagnostic performance of the two systems for the evaluation of the appropriateness of upper digestive endoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). METHODS: Patients referred for the upper digestive endoscopy (EGD) to a University Outpatients Clinic of Northeastern Italy were consecutively included in this prospective observational study. Before the EGD, the endoscopist assigned the patients to one of the ASGE appropriateness classes; another endoscopist then identified the detailed clinical scenario for the patients, which corresponds to scenarios examined by EPAGE by using a nine-point scale: 1-3 inappropriate; 4-6 uncertain; and 7-9 appropriate. The relationship between the appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, esophagitis, erosive gastritis/duodenitis, stenosis, and varices) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE scores, and plotting them to form a receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from a minimum of 0.5 to a maximum of 1.0. We compared the AUC of the ROC curve derived from the ASGE criteria against that derived from the EPAGE criteria. RESULTS: A total of 2,300 consecutive patients were included in the study (42% men; mean age: 57.3; range: 12-99); comparison of appropriateness criteria according to the ASGE and EPAGE could be made for 2,000 patients. The AUC of the ROC curve derived from the ASGE criteria was 0.553 (95% CI: 0.527-0.579), significantly higher than the AUC of the ROC curve derived from the EPAGE score: 0.523 (95% CI: 0.497-0.549; p < 0.05). CONCLUSIONS: We suggest that the diagnostic yield for relevant endoscopic findings obtained by both the systems (ASGE and EPAGE) is low; slightly better results could be accomplished by the ASGE criteria.

Discriminating the helical forms of peptides by NMR and molecular dynamics simulation.

The HNCO NMR pulse sequence was applied to three selectively labeled (15)N and (13)C isotopic homologues of the peptide Ac-WAAAH(AAARA)(3)A-NH(2) to probe directly for hydrogen bonds between residues 8 and 11 (characteristic of a 3(10)-helix), 8 and 12 (alpha-helix), and 8 and 13 (pi-helix). The experiments demonstrate conclusively, and in agreement with circular dichroism studies, that the center of the peptide is alpha-helical; there is no discernible 3(10)- or pi-helix at these specific positions. Molecular dynamics simulations of the preceding peptide and Ac-(AAAAK)(3)A-NH(2) in water using the potential energy parameter set CHARMM22/CMAP correctly yield an alpha-helix, in contrast to simulations with the set CHARMM22, which result in a pi-helix.

ASGE guidelines for the appropriate use of upper endoscopy: association with endoscopic findings.

BACKGROUND: This prospective study examined the appropriate use of EGD in an open-access system with the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and determined whether the ASGE guidelines were associated with relevant endoscopic findings. METHODS: In a cohort of 1777 consecutive patients referred for open-access EGD, the proportion of patients who underwent EGD for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the likelihood ratio, positive and negative, of the indications; and (2) the change in the probability of relevant endoscopic diagnoses in the presence of the ASGE criteria. RESULTS: The rate for EGDs "generally not indicated" was 15.6%. Relevant endoscopic diagnoses were present in 47.4% of cases with ASGE indications versus 28.8% of patients without appropriate indications as defined by the ASGE criteria (OR: 2.23; 99% CI [1.55, 3.22]; p < 0.01). A similar difference was observed for erosive gastritis (OR: 1.86; 99% CI [1.17, 2.95]; p < 0.01), erosive esophagitis (OR: 1.48; 99% CI [0.87, 2.52]; p < 0.05), and Barrett's esophagus (OR: 9.76; 99% CI [0.72, 132]; p < 0.05). The pretest probability of finding a relevant endoscopic diagnosis was modified slightly when an ASGE indication(s) was present and decreased markedly when ASGE criteria were absent. CONCLUSIONS: The use of the ASGE guideline for appropriate indications for EGD can improve patient selection for the procedure. However, to avoid missed diagnoses of serious disease, use of the guidelines must be tailored to the specific clinical setting.

An organizational model to translate nutritional recommendations into routine clinical practice in secondary prevention of coronary artery disease.

BACKGROUND: We hypothesized that nutritional risk factors can be reduced routinely in all patients with coronary artery disease (CAD) by modifying general hospital catering into "antiatherogenic catering" and providing patients with an education program. METHODS: General nutritional rules were applied to transform the standard alimentary regimen of our catering service (lipids 30% energy) into antiatherogenic catering (lipids 20% energy). The educational program (EP) consisted of a nutritional manual and 4 h/week of lessons. Eighty male patients (pts) with CAD (54 +/- 13 years), 10 +/- 4 days after an acute coronary event, were randomly allocated by cardiologists to a lipids 30% energy (control group = 40 pts) or to a lipids 20% energy diet (previously deposited in our catering service) + EP (treatment group = 40 pts). Serum total cholesterol (T-Chol), HDL- (HDL-Chol), LDL- (LDL-Chol), triglycerides (Trig), and body mass index (BMI) were determined before and after the 21-day treatment. RESULTS: Lipids 20% energy reduced T-Chol (P < 0.001), LDL-Chol (P < 0.001), and Trig (P < 0.05), while lipids 30% worsened T-Chol and LDL-Chol. The changes in the lipid parameters resulted in significant differences between the two groups. CONCLUSIONS: Simple reorganization of hospital catering and an educational program may routinely reduce nutritional risk factors in CAD patients, without individual counseling by the nutrition team.