Multicomponent intervention provided by GPs to reduce cardiovascular risk factors: evaluation in an Italian large sample

BACKGROUND

The cardiovascular risk increases in a multiplicative way when patients present more risk factors simultaneously. Moreover, the General Practitioners (GPs) play a crucial role in risk factors prevention and reduction. This work aimed to evaluate a multicomponent intervention in the Primary Care Department in an Italian Local Health Unit.

METHODS

A pre-post study was conducted in Northern Italy (2018). Patients were eligible if: aged between 30 and 60 years, not chronic patients, not affected by hypertension or hypercholesterolaemia. The GPs assessed body mass index, hypertension, abdominal obesity, low-density lipoprotein (LDL) values, glycaemic values, smoking and exercise habit (T0). A counselling by GPs to at-risk patients and a multicomponent health education intervention were performed. Reassessment occurred after at least 3 months (T1). Main analyses were chi-squared tests for gender differences, McNemar or marginal homogeneity tests for changes in paired data (P < 0.05 as significant).

RESULTS

Participants were 5828 at T0 (54.0% females) and 4953 at T1 (53.4% females). At T0, 99.1% presented at least one risk factor. Significant changes in paired data were reported for each risk factor. The greatest improvement frequencies occurred in glycaemia values (51.0%) and hypertension (45.6%), the lowest in abdominal obesity (3.7%). Some differences were recorded between genders, e.g. females reported higher improvement frequencies in hypertension (P = 0.001) and abdominal obesity (P < 0.001), whereas males in physical activity (P = 0.011) and LDL values (P = 0.032).

CONCLUSION

The results showed significant changes for each risk factor, both for men and women. GPs and multicomponent educational interventions could play a key role in reducing cardiovascular risk factors.

Food selection based on high total antioxidant capacity improves endothelial function in a low cardiovascular risk population

BACKGROUND AND AIMS

Oxidative stress has been advocated as a major cause for cardiovascular disease (CVD), and low plasma antioxidant concentrations are associated with endothelial dysfunction, the first step towards atherosclerosis. However, although the antioxidant content in fruits and vegetables may explain at least in part their protective effect against CVD, supplementation with antioxidant vitamins fails to improve endothelial function and reduce CVD risk. The aim of this study was to investigate the impact of a diet rich in antioxidants on endothelial function measured by flow-mediated dilatation (FMD) in volunteers at low cardiovascular risk.

METHODS AND RESULTS

In a crossover trial, 24 subjects (13 women, mean age 61 ± 3 years), received, in a randomised order, a 14-day high (HT) and a 14-day low (LT) antioxidant diets, with a 2-week wash-out (WO) in between. Both diets were comparable in daily portions of fruits and vegetables, and in alcohol, fibre and macronutrient intake, but differed in their total antioxidant capacity. Before and after each diet, anthropometrics, blood pressure, fasting plasma glucose, lipid profile, hepatic enzymes, circulating antioxidant concentrations, high sensitivity C-reactive protein (hs-CRP) and FMD were assessed. FMD increased significantly during the HT diet compared to the LT (p < 0.000). FMD values were 2.3% higher after HT compared with LT (p < 0.001) after adjustment for age, gender and diet order. α-tocopherol increased significantly (p < 0.05) and hs-CRP and of γ-glutamyltranspeptidase decreased significantly (p < 0.05 and p < 0.01, respectively) during the HT diet, compared with the LT diet.

CONCLUSIONS

A short-term HT diet improves endothelial function in volunteers at low cardiovascular risk, which may further reduce their risk of CVD.

Effects of the regular consumption of wholemeal wheat foods on cardiovascular risk factors in healthy people

BACKGROUND AND AIM

The intake of wholemeal foods is consistently associated with reduced risk of type 2 diabetes and cardiovascular diseases in epidemiological studies, although the mechanisms of this association are unclear. Here we aim to compare in healthy subjects the metabolic effects of a diet rich in wholemeal wheat foods versus one based on the same products in refined form.

METHODS AND RESULTS

Fifteen healthy individuals (12 M/3 F), mean age 54.5+/-7.6 years, BMI 27.4+/-3.0 kg/m(2) (mean+/-SD), participated in a randomized sequential crossover study. After 2 weeks run-in, participants were randomly assigned to two isoenergetic diets with similar macronutrient composition, one rich in wholemeal wheat foods and the other with the same foods but in refined form (cereal fibre 23.1 vs. 9.8 g/day). After the two treatment periods (each lasting 3 weeks) plasma glucose and lipid metabolism, antioxidant activity, acetic acid, magnesium, adipokines, incretins and high-sensitivity C-reactive protein (hs-CRP) were measured at fasting and for 4h after a standard test meal (kcal 1103, protein 12%, CHO 53%, fat 35%) based on wholemeal or refined wheat foods, respectively. After the two diets there were no differences in fasting nor in postprandial plasma parameter responses; only glucose was slightly but significantly lower at 240 min after the refined wheat food meal compared to the wholemeal wheat food meal. Conversely, after the wholemeal diet both total (-4.3%; p<0.03) and LDL (-4.9%; p<0.04) cholesterol levels were lower than after the refined wheat diet at fasting.

CONCLUSIONS

Consumption of wholemeal wheat foods for 3 weeks reduces significantly fasting plasma cholesterol as well as LDL cholesterol levels in healthy individuals without major effects on glucose and insulin metabolism, antioxidant status and sub-clinical inflammation markers.

A fluorescence-based method for the detection of adhesive properties of lactic acid bacteria to Caco-2 cells

AIMS

The ability of probiotic micro-organisms to adhere to the intestinal surface is regarded as a substantial advantage in terms of bacteria persistence in the gastrointestinal tract. The aim of the present study was the development of a method based on fluorescent staining of bacteria and subsequent spectrofluorimetric detection to quantify the adhesion of several strains of Lactobacillus and Bifidobacterium to Caco-2 cells.

METHODS AND RESULTS

Lactic acid bacteria strains were subjected to fluorescent staining using the viable probe carboxyfluorescein diacetate and subsequently incubated on Caco-2 monolayers. The adhesion of the micro-organisms was determined by spectrofluorimetry following the lysis of the attached bacterial cells and expressed as adhesion percentage. The values obtained for the micro-organisms tested ranged from 4% for Bifidobacterium infantis Bi1 to 10% for a Bifidobacterium mixture containing three different strains.

CONCLUSIONS

In the present study we successfully applied fluorescent labelling and fluorimetric detection to investigate the adhesive properties of some Lactobacillus and Bifidobacterium strains and a Bifidobacterium mixture to Caco-2 cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results proved that fluorescent labelling is suitable for adhesion studies and provides a reliable and safer alternative to radioactive labelling.

Treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome in children

A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of age, seven with toxic epidermal necrolysis and one with transitional-type Stevens-Johnson syndrome. The body surfaces affected ranged from 40% to 100%. Seven of the patients were taking a sulfonamide or anticonvulsant before the onset of their disease. Complete reepithelialization took an average of 15 days, but newly evolving lesions of the lips and oropharynx continued for approximately 4 more weeks. These lesions took an additional 2 to 4 weeks to heal. Only one of the children died.

Lymphangioma of the tongue and the team approach

Case report of a 9-year-old female with a 7cm (length) x 4cm (width) x 1cm (thick) lymphangioma of the tongue. The tumor caused speech distortion, crowding of the anterior maxillary and mandibular teeth, and a prognathic mandible. The patient was evaluated by the members of the Cleft Lip and Palate Team at St. Christopher's Hospital and underwent a complete resection of the tumor and is continuing follow-up care. This case exemplifies the value in a team approach to a variety of intraoral problems.

Spin-lattice relaxation rates in Fe(III)-doped human serum measured by magnetic resonance imaging

The proton spin-lattice relaxation time T1 in iron-doped serum was measured with a magnetic resonance imager operating at 0.5 T. The T1 in aqueous solutions of iron and iron-doped solutions of albumin and gamma globulin was also measured in order to analyse the paramagnetic contribution in iron-doped serum. The enhancement in serum is not linearly dependent on concentration of iron added. It is known that Fe(III) added to serum is mainly complexed with transferrin, albumin, gamma globulin and water. With serum pH (7.9) Fe(III) in the protein solution results in enhancement. Fe(III) in water does not cause any enhancement. As a result, the 1/T1 enhancement in serum should be caused solely by iron-binding serum proteins.

Development of a heterotrophic bacterial community within a closed prawn aquaculture system

The quantitative and qualitative development of a heterotrophic bacterial community in seawater was studied throughout an experimental rearing of the prawnPenaeus japonicus. The maturation of juvenile prawns had been carried out for 8 months in aerated tanks of seawater without any water renewal. Bacteria (337 strains) were isolated from seawater, which had been sampled at different times. Samples from one of the mussels used to feed the prawns and from the digestive tract of one prawn each supplied 40 more strains. 101 tests were performed on each strain, and cluster analysis showed the existence of 4 different groups containing 95% of the sampled strains. Characteristics of the various samples and groups were described in terms of ecotype diversities, catabolic potentialities, nutritional capacities, and morpho-physiological groups. Until nitrification attained a steady state, the heterotrophic community clearly decreased in number and was composed mostly of auxotrophic bacteria (pseudomonads andMoraxella-Acinetobacter groups). These bacteria needed growth factors and were unable to use amino acids (group B). At the end of the experiment (7 months) the bacteria isolated from the water were vibrios and enterobacteria, as were those isolated from the prawn and the mussel. They clustered together in group A. The number of strains that clustered with those of natural seawater (group E) decreased steadily during the experimental period.

Statistical sampling of bacterial strains and its use in bacterial diversity measurement

The cultural bacterial strains of two sediment samples, i.e., 260 strains, were submitted to numerical taxonomy to determine "ecological profiles." From these profiles several calculations of bacterial diversity were done with increasing number of strains (between 10 and 130). Studying 20-30 strains was sufficient to obtain a diversity of bacterial community.Number of tests could be reduced from 62 to 30 without any influence on bacterial diversity. Similarity between studied tests was shown by using numerical taxonomy.

[Comparison between serum ferritin and induced sideruria in the diagnosis of disorders of iron metabolism]

The A. compare the values of serum ferritin and Desferrioxamine (DFO)-induced sideruria on 73 patients affected by different diseases. The results may be divided into three groups: a first one concerning patients with low serum ferritin and low DFO-induced sideruria, a second one of patients with normal serum ferritin and normal DFO-induced sideruria; in the third group of patients the A. found high values of serum ferritin and high or normal values of DFO-induced sideruria. The different behaviour observed in this III group of patients mostly affected by malignancy may be ascribed, in all those cases with high ferritin and normal sideruria, to a direct production of isoferritins by cancer cells.

Structure, diversity, and catabolic potentialities of aerobic heterotrophic bacterial populations associated with continuous cultures of natural marine phytoplankton

Variations of structure (probable taxonomic generic groups; ecological profiles), diversity (Shannon index, ¯H), and average catabolic potentialities (strain's average exoenzyme equipment, EAI; average carbonaceous compound utilization, UAI) of bacterial populations during two experimental phytoplankton blooms are described and show a certain overall unity. Oligotrophic conditions are characterized by high diversity levels (¯H from 3.60 to 4) and moderate catabolic potentialities (EAI and UAI close to 40%). During phytoplankton exponential growth phase bacteria show an EAI stability, but there is an increase of UAI with maximal values at the beginning of chlorophyll plateau (52-57%) and higher values of diversity (¯H greater than 4). Phytoplankton mortalities appear to cause an EAI increase and a decrease of both UAI and ¯H (1.50 to 2). Vibrio-like organisms seem to be closely related to this period.In spite of these similar patterns, many differences appear between both experiments from a taxonomic point of view, the autumnal population being more diversified than the spring one.The results obtained show the value of simultaneous analysis of these different aspects and of this ecological methodology allowing spatial or temporal comparisons.

[Planktonic and bacterial population dynamics during experimental production of natural marine phytoplankton. II. Structure and physiology of populations and their interactions]

During the spring, an experiment was conducted on the production of natural phytoplankton in a continuous flow layout of large capacity, and an analysis was made of the simultaneous evolution of microplanktonic populations (taxonomic composition, diversity, class ranges, and energetic charge) and of bacterial populations (structure, diversity, dominances, and cetabolic potentialities). Oligotrophic initial conditions were charcterized by a poor (0.22 umg of chlorphyll a/L) and diversified (pigment diversity = 4.5) phytoplankton with nanoplanktonic dominance associated with several benthic type diatoms. Bacterial flora, in which pseudomonads were dominant (54.5%), were also diversified (Shannon index H = 3.57). Metabolic potentialities of these bacterial communities were several. Enrichment of the milieu caused the selection and development of a small number of algal species dominated by the diatoms skeletonema costatum (64 x 106/L) and Chaetoceros (3.2 x 106/L) leading to a paucispecific population with a large biomass, a pigment diversity of 1.97, and a chlorophyll a concentration of 25.08 mu/L. The bacterial community then because diversified (H = 4.12) and, although pseudomonads remained dominant (62%), a larger use of organic micromolecules was noted. The establishment of this phytoplanktonic community was followed by a zooplanktonic development in which larger species succeeded smaller ones (ciliates, tintinnides, rotifers, and copepods) corresponding to the global increase of the phytobiomass. Although this system appeared to be in a phase of relative stability, a decease in the energetic charge showed a disturbance in the physiological state of the planktonic populations. These phenomena led to the vanishing of the diatom's dominance (Chaetoceros, and then S. costatum) and its replacement by nanoplankton (123 x 106 cells/L) and dinoflagellates (300000 cells/L). A modification in the organic wealth of the milieu with the addition of particular complex material that was not or little degraded caused deep disturbances in the bacterial populations. Their diversity reached a very low level (H = 1.56 to 2.25) with a proliferation of vibrions (up to 74%) well equipped with exoenzymes, but more restricted in their nutritional versatility (marked preference for organic macromolecules). During the final phase of experimentation, despite a change in qualitative composition and a more important biomass, microplanktonic and bacterial populations returned to a diversified state nearing that of the initial conditions (pigment diversity = 3.2; H = 3.37).

[Deoxyribonucleic acid hybridizations among some vibrio-like marine bacteria (author's transl)]

The genotypic relationships established by DNA/DNA hybridization in vitro confirm the results obtained by earlier phenotypic analyses of certain vibrio-like marine bacteria. These strains are closely related to the species Photobacterium fischeri, and do not belong to the genus Vibrio. The group of marine, vibrio-like bacteria that require Na+ for growth is genotypically very heterogeneous.