Outcome trial data on sodium glucose cotransporter-2 inhibitors: Putting clinical benefits and risks in perspective.

BACKGROUND: Sodium glucose cotransporter-2 (SGLT2) inhibitors have significant heart failure and renoprotective benefits with a wide spectrum of unfamiliar and potentially serious adverse effects. Limited understanding of the risk-benefit profile of SGLT2 inhibitor treatment may result in under utilisation by prescribers and patients. METHODS: Data from recent seminal randomized, placebo-controlled, outcome trials for multiple SGLT2 inhibitors were incorporated. Trial populations were sub-classified into high cardiovascular risk T2DM, HFrEF, and CKD. Efficacy outcomes of heart failure hospitalisation (HFH), cardiovascular (CV) mortality, total mortality, and prevention of renal deterioration were examined. Safety outcomes included were major hypoglycaemia, diabetic ketoacidosis (DKA), urinary tract infections (UTI), mycotic genital infections (MGI), hypotension, amputations and fractures. Absolute risk reduction/increase were used to calculate number needed to treat/harm. RESULTS: Trial data comprised 71,545 patients, of which 53,144 were high risk T2DM, 9696 HFrEF and 8705 CKD. For HFrEF, NNT for HFH was 18, CV mortality 93, total mortality 76, prevention of renal deterioration 143 and prevention of DKA 6224. NNH for UTI was 557, MGI 356, hypotension 120, hypoglycaemia 574, amputations 707 and fractures 858. For CKD, NNT for HFH was 116, CV mortality 245, total mortality 138, and prevention of renal deterioration was 63. NNH for DKA was 1458, UTI 309, MGI 291, hypotension 165, hypoglycaemia 374, amputations 4450 and fractures 696. In the T2DM cohort, NNT for HFH was 139, CV mortality 851, total mortality 601 and prevention of renal deterioration 558. NNH DKA was 1525, UTI 239, MGI 69, hypotension 325, hypoglycaemia 472, amputations 1578 and fractures 9569. CONCLUSIONS AND RELEVANCE: The cardiovascular and renal protective benefits of SGLT2 inhibitors far outweigh the risks. This paper puts into perspective the benefits and risks of treatment with SGLT2 inhibitors for clinicians and patients.

Lower gray matter volumes of frontal lobes and insula in adolescents with anorexia nervosa restricting type: Findings from a Brain Morphometry Study.

BACKGROUND: Brain atrophy in anorexia nervosa (AN) is one of the most marked structural brain changes observed in mental disorders. In this study, we propose a whole brain analysis approach to characterize global and regional cerebral volumes in adolescents with restricting-type anorexia nervosa (AN-r). METHODS: A total of 48 adolescent females (age range 13-18 years) were enrolled in the study (24 right-handed AN-r in the early stages of the illness and treated in the same clinical setting and 24 age-matched healthy controls [HC]). High-resolution T1-weighted magnetic resonance images were acquired. Cerebral volumes, including the total amounts of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were obtained with the Statistical Parametric Mapping software (SPM8); specific cortical regional volumes were computed by applying an atlas-based cortical parcellation to the SPM8 GM segments. Analysis of variance (ANOVA) was performed to identify any significant between-group differences in global and regional brain volumes. RESULTS: The analyses revealed reduced total GM volumes (p = 0.02) and increased CSF (p = 0.05) in AN-r, compared with HC. No significant between-group difference was found in WM volumes. At the regional level, significantly lower GM volumes in both frontal lobes (p = 0.006) and in the left insula (p = 0.016) were detected. No significant relationships were found between cerebral volumes and duration of illness, psychiatric comorbidities, psychopharmacological treatment, prepubertal phase, or presence of amenorrhea. CONCLUSIONS: The topographic distribution of GM reduction in a homogenous group of AN-r involves regions responsible for the emotional and cognitive deficits associated with the illness. These findings are discussed in relation to the roles of the insular cortex and the frontal lobes.

Psychological and Emotional Aspects in Living Donor Kidney Transplantation.

BACKGROUND: The decision to resort to living donor transplantation determines a particular condition characterized by a strong mental and emotional anguish, both for the patients and their families. The purpose of the study was to correlate the relational dynamics between donor-recipient, donor/recipient couple with the health team, and the family support perceived by the couple with the quality of life 6 months before transplant and 12 months after transplant and compare the data between the 2 time points after participating in the psychotherapy program of counseling about behavioral change. PATIENTS AND METHODS: Twenty-seven donor and recipient pairs consented to participate. The quality of life was studied through the Complete Form Health Survey (SF-36). All subjects completed a questionnaire that investigated the 3 types of fundamental relationships (donor-recipient, donor/recipient with the health team, and family support perceived by the couple). All participants were involved in an 18-month psychotherapy program in the pre- and post-transplant phase. RESULTS: The quality of the donor-recipient relationship significantly positively influences the subjective perception of psychophysical well-being before and after transplant. Post-transplant family support is crucial in ensuring a good perception of psychological and emotional health in donors and recipients. The relationship with the health team is important in ensuring a good perception of psychophysical health only in recipients after transplant. CONCLUSIONS: This study suggests that patients should be assisted by a multidisciplinary health care team and receive continuous support from relatives during the post-transplant adaptation process. This facilitates the donor and recipient postoperative quality of life.

Return to Work and Quality of Life: A Psychosocial Survey After Kidney Transplant.

BACKGROUND: The main goals of kidney transplantation are to recreate a condition of psychophysical well-being and to improve the quality of life of the patient, including going back to work after transplant. Returning to work after a kidney transplant is an important health care indicator. The aim of the study was to assess the psychophysical well-being and work condition in kidney transplant recipients and to identify possible predictors of return to work. PATIENTS AND METHODS: A total of 81 patients (mean age, 46.3; SD, 11.47) were selected among patients undergoing 1 or more kidney transplants during follow-up 12 months after transplant. Pre- and post-transplant employment were evaluated using a sociodemographic schedule. Short Form Health Survey 36 was used for the quality of life study. RESULTS: Only 38.3% of patients were back to work 12 months after transplant compared with 67.90% of pretransplant patients (P = .004). The unemployment rate increased from 32.1% to 61.7% (P = .005) after kidney transplant. The reasons for not returning to work included the type of work (eg, factory) and the disability pension. The sociodemographic characteristics of the study population was significantly correlated with the dimensions of the Short Form Health Survey 36. CONCLUSIONS: Kidney transplant recipients should be encouraged to go back to work until it is a risk to physical health. In this regard, there is a need for multidisciplinary collaboration with the psychologist and the psychiatrist on the team, which provides psychological support and cures any psychological fragility in the post-transplant condition.

Alexithymia in Kidney Transplantation Patients.

Alexithymia is a marked difficulty in recognizing, exploring, and expressing inner feelings. Studies have proven the presence of a significant proportion of patients with alexithymia in samples from the transplantation population. This study aims to analyze the presence of alexithymia in a sample of 32 kidney transplantation patients from a deceased donor and to compare this construct with the presence of psychological symptoms and the physical and mental state of health perceived by the patients. Alexithymia assessment was analyzed using the Toronto Alexithymia Scale. The psychological symptoms were studied through the Symptom Checklist-90-R. The quality of life was studied through The Complete Form Health Survey. The study showed a high percentage of the presence of alexithymia in the examined transplant recipients. The construct is more present where the perception of their quality of life is low and where there is a greater presence of psychosomatic symptoms.

Effects of ewes grazing sulla or ryegrass pasture for different daily durations on forage intake, milk production and fatty acid composition of cheese.

Sulla (Sulla coronarium L.) forage is valued for its positive impact on ruminant production, in part due to its moderate content of condensed tannin (CT). The duration of daily grazing is a factor affecting the feed intake and milk production of ewes. In this study, the effects of grazing sulla pasture compared with annual ryegrass, and the extension of grazing from 8 to 22 h/day, were evaluated with regard to ewe forage intake and milk production, as well as the physicochemical properties and fatty acid (FA) composition of cheese. During 42 days in the spring, 28 ewes of the Comisana breed were divided into four groups (S8, S22, R8 and R22) that grazed sulla (S) or ryegrass (R) for 8 (0800 to 1600 h) or 22 h/day, and received no feeding supplement. In six cheese-making sessions, cheeses were manufactured from the 48 h bulk milk of each group. Compared with ewes grazing ryegrass, those grazing sulla had higher dry matter (DM) intake, intake rate and milk yield, and produced milk that was lower in fat and higher in casein. Ewes grazing for 22 h spent more time eating, which reduced the intake rate, increased DM and nutrient intake and milk yield, and reduced milk fat. Due to the ability of CT to inhibit the complete ruminal biohydrogenation of polyunsaturated fatty acids (PUFA), the FA composition of sulla cheese was more beneficial for consumer health compared with ryegrass cheese, having lower levels of saturated fatty acids and higher levels of PUFA and n-3 FA. The FA profile of S8 cheese was better than that of S22 cheese, as it was higher in branched-chain FA, monounsaturated FA, PUFA, rumenic acid (c9,t11-C18:2), and had a greater health-promoting index. The effect of short grazing time on sulla was attributed to major inhibition of PUFA biohydrogenating ruminal bacteria, presumably stimulated by the higher accumulation of sulla CT in the rumen, which is related to a higher intake rate over a shorter eating time. Thus, grazing sulla improved the performance of ewes, thereby increasing, especially with short grazing time, the nutritional properties of cheese fat.

Patterns of Personality in Living Kidney Donors.

BACKGROUND: The decision to undergo living donor transplantation determines a particular condition characterized by strong mental and emotional anguish, both for the patient and his family. Many recent studies showed the concern of living donors who, rather than being driven by altruistic reasons, meet the decision to donate with ambivalence, liabilities, and/or in response to family pressures. The aim of this study was to analyze the more frequently encountered personality variables in a sample of potential kidney living donors, together with any psychological variables that can express possible risks of an impulsive decision and/or poorly processed from a cognitive and emotional point of view. METHODS: We examined 32 potential kidney donors. The personality study was performed using The Millon Clinical Multiaxial Inventory-III. The psychic symptoms were studied through the Symptom Checklist-90-R. The quality of life was studied through the Complete Form Health Survey (SF-36). RESULTS: The study showed that the ability to express free and therefore invalid consent, in the role of donor, is an expression of specific personality patterns, cognitive, emotional aspects and interpersonal experiences. CONCLUSIONS: The psychological-psychiatric evaluation of potential donors is fundamental to certify the state of mental health and psychological well-being, an indispensable prerequisite for the donation.

Subspecialisation in cardiology care and outcome: should clinical services be redesigned, again?

BACKGROUND: Inpatient management of cardiac patients by cardiologists results in reduced mortality and hospitalisation. With increasing subspecialisation of the field because of growing management complexity and use of technological innovations, the impact of sub-specialisation on patient outcomes is unclear. AIM: To investigate whether management by subspecialty cardiologists impacts the outcomes of patients with subspecialty-specific diseases. METHODS: All patients admitted to a tertiary centre over nine years with a diagnosis of heart failure, acute coronary syndrome (ACS) or primary arrhythmia were reviewed. The outcomes of these patients managed by cardiologists subspecialised in their admission diagnosis (heart failure specialists, interventionalists and electrophysiologists) were compared with those treated by general cardiologists. RESULTS: Heart failure was diagnosed in 1704 patients, ACS in 7763 and arrhythmia in 4398. There was no difference in length of stay (LOS) (P = 0.26), mortality (P = 0.57) or cardiovascular readmissions (P = 0.50) in heart failure patients treated by general cardiologists compared with subspecialists. In ACS patients, subspecialty management was associated with reduced LOS, cardiovascular readmissions and mortality (all P < 0.05). This reduction in mortality was seen mainly in lower risk patients (P < 0.05). There was a reduction in LOS and cardiovascular readmissions in arrhythmia patients receiving subspecialty management (both P < 0.05) but no difference in mortality (P = 0.14). ACS patients managed by interventionalists were more likely to undergo coronary intervention (P < 0.05). Electrophysiologists more frequently referred patients for catheter ablation and pacemaker implantation than general cardiologists (P < 0.05). CONCLUSIONS: The benefits of subspecialty care seem attributable to the appropriate selection of patients who would benefit from technological innovations in care. These results suggest that the development of healthcare systems which align cardiovascular disease with the subspecialist may be more effective.

A Study on Emotional-Affective Aspects and the Perception of General Health in Kidney Transplant Subjects.

BACKGROUND: Transplantation has profound psychological implications. Psychodiagnostic assessments with structured instruments (scales, questionnaires) may be insufficient for bringing out the deeper aspects of the personality. PATIENTS AND METHODS: Thirty kidney transplant recipients underwent the Thematic Apperception Test to detect significant variables hypothetically related to characteristics of the study sample and the SF-36 to assess quality of life. RESULTS: The variable of Thematic Apperception Test (TAT) "communication difficulties" was significantly correlated with the dimensions of the SF-36 "emotional role functioning," "social activities," and "mental health." The dimension of SF-36 "general health" did not interfere with the variable of TAT "constricted effect." CONCLUSIONS: This study is considered to be particularly useful in detecting the emergence of "removed difficulties" that transplanted subjects are not inclined to recognize. The analysis of these aspects is necessary to plan individualized psychotherapy pathways.

Sex hormonal regulation and hormesis in aging and longevity: role of vitagenes.

Aging process is accompanied by hormonal changes characterized by an imbalance between catabolic hormones, such as cortisol and thyroid hormones which remain stable and hormones with anabolic effects (testosterone, insulin like growth factor-1 (IGF-1) and dehydroepiandrosterone sulphate (DHEAS), that decrease with age. Deficiencies in multiple anabolic hormones have been shown to predict health status and longevity in older persons.Unlike female menopause, which is accompanied by an abrupt and permanent cessation of ovarian function (both folliculogenesis and estradiol production), male aging does not result in either cessation of testosterone production nor infertility. Although the circulating serum testosterone concentration does decline with aging, in most men this decrease is small, resulting in levels that are generally within the normal range. Hormone therapy (HT) trials have caused both apprehension and confusion about the overall risks and benefits associated with HT treatment. Stress-response hormesis from a molecular genetic perspective corresponds to the induction by stressors of an adaptive, defensive response, particularly through alteration of gene expression. Increased longevity can be associated with greater resistance to a range of stressors. During aging, a gradual decline in potency of the heat shock response occur and this may prevent repair of protein damage. Conversely, thermal stress or pharmacological agents capable of inducing stress responses, by promoting increased expression of heat-shock proteins, confer protection against denaturation of proteins and restoration of proteome function. If induction of stress resistance increases life span and hormesis induces stress resistance, hormesis most likely result in increased life span. Hormesis describes an adaptive response to continuous cellular stresses, representing a phenomenon where exposure to a mild stressor confers resistance to subsequent, otherwise harmful, conditions of increased stress. This biphasic dose-response relationship, displaying low-dose stimulation and a high-dose inhibition, as adaptive response to detrimental lifestyle factors determines the extent of protection from progression to metabolic diseases such as diabetes and more in general to hormonal dysregulation and age-related pathologies. Integrated responses exist to detect and control diverse forms of stress. This is accomplished by a complex network of the so-called longevity assurance processes, which are composed of several genes termed vitagenes. Vitagenes encode for heat shock proteins (Hsps), thioredoxin and sirtuin protein systems. Nutritional antioxidants, have recently been demonstrated to be neuroprotective through the activation of hormetic pathways under control of Vitagene protein network. Here we focus on possible signaling mechanisms involved in the activation of vitagenes resulting in enhanced defense against functional defects leading to degeneration and cell death with consequent impact on longevity processes.

Somatopsychic correlates and quality of life of the dialyzed patient: a cross-sectional study.

BACKGROUND: The dialysis delivered after a chronic kidney disease (CDK) or any otherwise severe end-stage renal failure is a complex medical task, leading to major medical and psychopathological distress for the patient. The aim of the present study was to analyze the impact of the dialysis experience on the nephrologic patient's global quality of life. METHODS: In the present cross-sectional study, involving 96 patients with end-stage renal disease receiving hemodialysis, demographic, medical, and psychological differential features across different CDK diagnoses were accounted and were then correlated each other. RESULTS: Among other differential features, the "acknowledgement of dependence" (from the medical device delivering the dialysis) emerged as a factor correlated to "self-sufficiency" in CDK patients receiving hemodialysis. CONCLUSIONS: Although further, larger-sampled studies on the topic are needed, medical and psychological interventions are useful to ensure a better global quality of life and good therapeutic adherence in dialysis patients.

Role of "self-efficacy" in the process of long-term care in kidney transplant recipients.

OBJECTIVE: This study investigated the relationship between self-efficacy, quality of life, and psychic dimensions of patients with kidney transplants. Given the considerable emotional implications and the risk of psychopathology after transplantation, a protective role is assumed of the sense of self-efficacy, both from any psychopathologic disorders and from a precarious quality of life. METHODS: One hundred twenty recipients of kidney transplants from deceased donors were included in the study. The self-efficacy study was performed with the use of the General Self-Efficacy Scale. The quality of life of the subjects was studied with the use of the Short-Form Health Survey; The psychic symptoms of patients were performed using the Revised Symptom Checklist 90 (SCL-90R). RESULTS: Self-efficacy is positively correlated with both physical role limitations and mental health. With increasing self-efficacy there was a decrease of psychic symptoms as investigated with the use of the SCL-90R test. CONCLUSIONS: This study demonstrated the "protective" function of the sense of self-efficacy in the psychic sphere and its positive effect on quality of life, in the sense that an appropriate problem-solving strategy helps the transplant patient to maintain good mental and physical health.

The concept of self and emotional involvement in living kidney donation: a psychometric investigation.

OBJECTIVE: The aim of our study was to analyze, from a psychological point of view, living kidney donor personality, examining a sample of 18 living kidney donors. PATIENTS AND METHODS: The personality study was performed using The Millon Clinical Multiaxial Inventory-III in 18 potential kidney donors, 6 of whom were genetically and 12 emotionally related individuals. RESULTS: Our study showed the presence of narcissistic, histrionic, and obsessive-compulsive personality traits in living kidney donors. CONCLUSIONS: It is necessary to explore the development of motivation for living donation in order to achieve and maintain a harmonious relationship with the recipient while respecting their individuality.

The study of personality in renal transplant patients: possible predictor of an adequate social adaptation?

BACKGROUND: This study explored the personality characteristic traits within a sample of renal transplant patients, seeking to obtain predictive index for likely clinical impacts. PATIENTS AND METHODS: The personality study was performed using the Structured Clinical Interview Axis II Personality Disorders for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision in 60 recipients of kidney transplantations from deceased donors. RESULTS: The personality trait that prevailed in the female gender was borderline, while in the male gender it appeared to be predominantly obsessive-compulsive personality trait. CONCLUSIONS: The personality study proved to be a good index to predict effects on the level of social adjustment. In this way, patients who have shown pathologic personality traits can be identified early to provide adequate psychologic-psychiatric support and follow-up.

Effect of farming system and cheesemaking technology on the physicochemical characteristics, fatty acid profile, and sensory properties of Caciocavallo Palermitano cheese.

Caciocavallo Palermitano is a typical stretched-curd cheese that has been produced over the centuries in Sicily according to traditional cheesemaking technology and using raw milk from autochthonous cow breeds reared at pasture. The objective of this experiment was to evaluate the effects of the farming system and processing technology on the characteristics of Caciocavallo Palermitano cheese, with particular regard to the fatty acid profile. The farming system was either extensive, using autochthonous cows fed a pasture-based diet, or intensive, with specialized dairy cow breeds fed mainly hay and concentrate. The cheese-processing technology was either artisanal, using traditional wooden tools and endemic lactic bacteria, or advanced, using modern steel equipment and selected lactic bacteria. Twelve Caciocavallo Palermitano cheeses, 3 from each of the 4 experimental theses (2 farming systems × 2 cheesemaking technologies), were obtained and aged for 1, 30, 60, and 120 d. Milk of origin and cheeses were analyzed for the main chemical and rheological parameters. Fatty acids were methylated in lyophilized cheese and analyzed by gas chromatography. Sensory analysis was carried out by trained panelists. The PROC GLM of SAS 9.1.2 (SAS Institute Inc., Cary, NY) was used for the statistical analysis. The physical, chemical, and sensory characteristics of Caciocavallo Palermitano cheese were influenced more by the farming system than by the cheesemaking technology. Compared with cheese produced through intensive farming, cheese from extensive farming was richer in polyunsaturated, n-3, and odd- and branched-chain fatty acids, as well as in conjugated linoleic acid (cis-9,trans-11 C18:2), with accompanying improved human health benefits. The cheesemaking technology produced variation in the evolution of proteolysis during aging, due presumably to the different active microflora, which influenced the sensory profile of the resulting cheese. Indeed, cheese produced by artisanal manufacturing was described as less "bitter" and more "piquant" than cheese produced through the advanced process.

Correlational study between psychic symptoms and quality of life among hemodialysis patients older than 55 years of age.

BACKGROUND: The loss of renal function and urination with dialysis can produce a strong emotional crisis in a patient. This study explored the correlation between psychic symptoms and quality of life among hemodialysis patients who were older than 55 years of age in relation to demographic characteristics of age, time on dialysis, and education. PATIENTS AND METHODS: Twenty patients undergoing hemodialysis were included in the study. The psychic symptoms were studied using the Symptom Checklist-90. Revised (SCL-90 R) and the quality of life was studied using the Complete Form Health Survey (SF 36). RESULTS: The high correlation between psychological sizes investigated through the SCL-90 R test and those for the SF-36 test confirmed the close relationship between physical disorders and mental suffering, and reduced vitality, and lack of socialization. CONCLUSION: The psychiatrist and psychologist may help hemodialysis patients to improve their quality of life by providing new coping strategies for each of the family, occupational, and social network.

Quality of life in kidney transplantation from marginal donors.

OBJECTIVE: Enhancement of the subjective components, recognition of overall needs, and careful consideration of subjectively perceived quality of life among dialysis and/or transplanted patients appear to be key objectives to promote optimized adherence to treatment and active cooperation of the patient. This study explores the relationship between self-rated health among recipients of kidney transplantations from deceased marginal donors (age older than 55 years) in relation to gender, age, time on dialysis, years after transplantation, and donor age. PATIENTS AND METHODS: Posttransplant quality of life was assessed with the Complete Form Health Survey (SF-36) in 70 recipients of kidney transplantations from marginal deceased donors. RESULTS: Donor age did not negatively influence health status perceived by the subjects. The vitality and mental health seemed to increase with greater donor ages, but the status of perceived health, vitality, social activities, and mental health were negatively influenced by the age of the transplant. CONCLUSIONS: Our study shows that good general health and social well-functioning can be achieved also among recipients of organs from older donors. Thus, age alone should not be a barrier to organ donation, providing that the organ function is normal and that specific disease is absent in the organ.

Body image in kidney transplantation.

INTRODUCTION: Psychologic disturbances are becoming more common in kidney transplantation, owing to effects of immunosuppressive therapy. In this study, we explored the incidence and specifity of psychopathology among kidney transplant patients. Twenty kidney transplant recipients underwent the Machover Draw-A-person test to detect significant variables (V1=V6) hypothetically related to chronologic age, education, years from transplantation, and gender differences. Emotional coarctation (V1) in the sense of "mental rigidity," "egocentrism," and "hypercontrol" were present in all transplant recipients (100%), followed by difficulty in interpersonal relationships (V3; 70%) and anxiety (V5; 70%). This research confirmed the hypothesis that transplantation can display a potential risk to the psychologic balance of the patient. Psychologic evaluation may be a fundamental step together with surgical aspects and management of immunosuppression to achieve well-being of kidney transplant recipients.

Acute effects of 5-methyltetrahydrofolate on endothelial function and asymmetric dimethylarginine in patients with chronic heart failure.

BACKGROUND AND AIMS: Folic acid enhances endothelial function in vascular disease states but its effects in chronic heart failure (CHF) are largely unknown. We studied the acute effects of i.v. methyltetrahydrofolate (5MTHF), the active metabolite of folic acid, on endothelial function and asymmetric dimethylarginine (ADMA) in CHF patients. METHODS AND RESULTS: Twenty two CHF patients and 22 controls received one of the following three-step infusions (1h per each step) in a randomized, parallel group, placebo-control study: (1) active treatment (saline, 5MTHF, and 5MTHF+the endothelial nitric oxide inhibitor N(G)-monomethyl l-arginine, LNMMA); or (2) placebo (salinex3). Endothelium-dependent vasodilatation was assessed by pulse-wave analysis (salbutamol-mediated changes in augmentation index, AIx). 5MTHF did not exert any significant effects on endothelium-dependent vasodilatation both in controls [DeltaAIx post-salbutamol baseline -7.6% (-24.8/-4.1) vs. 5MTHF -5.5% (-16.7/-3.6), medians and interquartile range, and CHF patients [-1.8% (-17.3/+1.3) vs. -2.4% (-3.8/-1.2)]. However, a significant reduction in ADMA concentrations was observed in both groups [controls baseline 0.68micromol/L (0.64/0.77) vs. 5MTHF 0.65 (0.57/0.74); CHF baseline 0.76 (0.63/0.82) vs. 5MTHF 0.69 (0.66/0.71), P=0.05 for both vs. baseline and placebo. These effects persisted during co-infusion with LNMMA. CONCLUSION: 5MTHF did not affect endothelial function but significantly reduced serum ADMA concentrations both in CHF patients and controls. This suggests a direct effect of 5MTHF on ADMA metabolism.

A finely tuned strategy adopted by an egg parasitoid to exploit chemical traces from host adults.

Scelionid egg parasitoids can obtain reliable information on the presence of host eggs by discriminating host gender on the basis of chemical footprints of their co-evolved hosts, with a strong preference for the footprint left by host females. Based on the concept of dietary specialization and infochemical use in natural enemies, it could be predicted that host gender discrimination in specialist species belonging to the genus Trissolcus is further tuned to specific cues from distinctive chemical traces left by host females as a consequence of copulation and/or oviposition. To test this hypothesis we used the system Murgantia histrionica - Trissolcus brochymenae. Our results showed that the females of the egg parasitoid search intensely on chemical traces left on the substrate by host females that had mated but had not yet laid host eggs compared with the chemical traces left by virgin or parous host females. This preference for mated females that had not yet laid host eggs was strictly related to the transfer of sperm and associated substances from males to females during copulation. The compounds that mediated the arrestment response of T. brochymenae females are part of the host cuticle, and those that play a role as gender-specific cues seemed to be present in the legs of the host adult. This result represents an interesting new piece of information regarding the exploitation of indirect host-related cues by egg parasitoids. It reveals the existence of a finely tuned strategy that allows the parasitoid to find newly laid host eggs, as chemical traces left by mated host females that have not yet laid eggs are strongly correlated with the moment of oviposition.