C57 DUAL ANTIPLATELET THERAPY DID NOT PREDICT ALL–CAUSE BLEEDING AT LONG–TERM FOLLOW–UP AFTER ACS: A SUBANALYSIS FROM THE APULIA PONTE ACS STUDY

Background

Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS.

Methods

This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up.

Results

We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up.

Conclusions

Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.

P254 THE ROLE OF GENDER IN CONGESTION STATUS EVALUATION IN PATIENTS WITH ACUTE HEART FAILURE

Background

The evaluation of congestion play a central role in the management of patients with acute heart failure (AHF).The impact of gender on congestion in patients with HF is still a matter of debate. The objective of this analysis was to evaluate the impact of gender on congestion status at admission of patients hospitalized for AHF.

Methods

We consecutively enrolled 487 patients with AHF (50% female). We assessed peripheral edema, jugular venous distention (>10 cm), B–type natriuretic peptide (BNP), hydration status (by means of bioimpedance analysis), and estimated plasma volume (by means of the Duarte’s formula [D–ePVS] and Kaplan–Hakim formula [KH–ePVS]).

Results

Home medications and body mass index were not different between women and men. Women were older (79 yrs vs 77 yrs, P = 0.005), showed better left ventricular ejection fraction (mean 50% vs 38%, P < 0.001), and increased plasma concentrations in blood urea nitrogen (40 mg/dL vs 25 mg/dL, P = 0.02) and serum creatinine (1.5 mg/dL vs 1.5 mg/dL, P = 0.8). At physical examination, the number of patients with peripheral edema and jugular venous distention was not significantly different between women and men (53% vs 45% and 60% vs 55%, respectively). BNP levels (median 1100 pg/mL vs 994 pg/mL) and hydration status (78% vs 79%) were similar in women and men, while ePVS was higher in women (D–ePVS 6.0 ± 1.6 dL/gr vs 5.1 ± 1.5 dL/gr, P < 0.001; KH–ePVS 7.9% ± 13% vs –7.3 ±12%, P < 0.001).

Conclusions

The evaluation of congestion in AHF using physical examination and multiparametric approaches was similar between women and gender. Women rather showed higher plasma volume as compared to male individuals.

P225 RESPIRATORY FAILURE AND BIOELECTRICAL PHASE ANGLE ARE INDEPENDENT PREDICTORS FOR LONG–TERM SURVIVAL IN ACUTE HEART FAILURE

Background

The assessment of long term mortality in acute decompensated heart failure (ADHF) is challenging. Respiratory failure and congestion play a fundamental role in risk stratification of ADHF patients. The aim of this study was to investigate the impact of arterial blood gases (ABG) and congestion on long–term mortality in patients with ADHF.

Methods and Results

We enrolled 252 patients with ADHF. Brain natriuretic peptide (BNP), blood urea nitrogen (BUN), phase angle as assessed by means of bioimpedance vector analysis (BIVA), and ABG analysis were collected at admission. The endpoint was all–cause mortality. At a median follow–up of 447 days, (IQR: 248–667), 72 patients died 1–840 days (median 106, IQR: 29–233) after discharge. Respiratory failure types I and II was observed in 78 (19%) and 53 (20%) patients, respectively. The ROC analyses revealed that the cut–off points for predicting death were: >441 pg/mL for BNP, >30 mg/dL for BUN, ≤ 69.7 mmHg for partial pressure in Oxygen (PaO2), and ≤4.9° for Phase Angle. Taken together, these four variables proved to be good predictors for long–term mortality in ADHF (AUC 0.78, 95% CI 0.72–0.78), thus explaining 60% of all deaths. A multiparametric score based on these variables was determined: each single–unit increase promoted a 2.2–fold augmentation of the risk for death (HR 2.2, 95% CI 1.8–2.8, P < 0.0001).

Conclusions

A multiparametric approach based on measurements of BNP, BUN, PaO2, and phase angle is a reliable approach for long–term prediction of mortality risk in patients with ADHF.

Acute Myocarditis After Black Widow Spider Bite: A Case Report

The black widow spider (BWS) is a venomous spider whose bite can cause various clinical conditions that range from local damage to serious systemic complications, including death. Cases of myocarditis following a BWS bite are rare but they can be fatal on occasion. However, the prognostic significance of the bite and presentation of myocarditis is unknown. Our case involved a 50-year-old man who presented with myocarditis after being bitten by a BWS and subsequently admitted to the intensive care unit for cardiac monitoring. During the hospital stay, he showed worsening signs on both the electrocardiographic and echocardiographic evaluations despite therapeutic success. Subsequent cardiac magnetic resonance and coronary angiography investigations showed no significant alterations; blood and instrumental test results slowly improved, and the patient was discharged home after 12 days of hospitalization without complications. This case illustrates that acute myocarditis, although an infrequent complication of BWS bite, has the potential to be lethal. The correct diagnosis, which is not always easy to formulate, is important to identify those patients who can benefit from careful monitoring and specific therapies aimed at reducing the risk of life.

P4547Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure

Background

The pathophysiology of peripheral congestion is poorly investigated in patients with acute heart failure (AHF).

Purpose

This study evaluated the relative contribution of serum colloid osmotic pressure (COP), relative plasma volume status (PVS), biomarkers of renal function, electrolytes, haemoglobin, and brain natriuretic peptide (BNP) in peripheral fluid overload using bioimpedance vector analysis (BIVA).

Methods

We retrospectively analysed data from 485 patients with AHF. Hydration status was evaluated by semiquantitative and quantitative approach using BIVA (R/Xc graph) and Hydration Index (HI), respectively. COP was calculated from albumin and total protein concentration, while relative PVS was calculated from validated equations.

Results

Congestion assessed by BIVA was observed in 304 (63%) patients and classified as mild (30%), moderate (42%), and severe (28%). On univariate analysis, HI was inversely correlated with COP (P<0.01), glomerular filtration rate (P<0.01), and haemoglobin (P<0.01), while positive correlations were found for relative PVS (P<0.05), BNP (P<0.01), and blood urea nitrogen (BUN; P<0.01). On stepwise multivariate analysis, COP explained 12% of the total variability, while BUN, PVS, haemoglobin, and BNP added a further 6%, 4%, 2%, and 1%, respectively, to the final explanatory model.

Conclusions

COP was the major determinant of the presence and entity of peripheral congestion assessed by BIVA. BUN, PVS, haemoglobin, and BNP revealed reduced influence on congestion as compared with COP. Routine laboratory testing could be useful in peripheral fluid accumulation. Future studies should evaluate the relationship between COP and pharmacological target therapies for the fluid management of AHF patients.

Acknowledgement/Funding

None

Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery

PURPOSE

Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures.

METHOD

We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months.

RESULT

Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points.

CONCLUSION

Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

Shelf-life of Almond Pastry Cookies with Different Types of Packaging and Levels of Temperature

Almond pastries are typical cookies of the south of Italy. Introduction of new packaging for this kind of cookies requires shelf-life assessments. This study, related to different types of packaging under various storage conditions of time and temperature, identifies critical parameters, as color and texture, to track during storage studies and to extend the shelf-life. The cookies were packed in three different ways and stored at two different temperatures. The pastries were separately stored: (1) in polyvinylchloride film; (2) in aluminum foil (ALL); (3) with modified atmosphere (MAP) in plastic vessels sealed into a polyamide/ polyethylene film; and (4) in vessels without any polymeric film. The storage temperatures were 20 and 30 °C. Evolution of texture, water activity, dry matter and color was assessed. Texture was evaluated by a texture analyzer with a puncturing test. Indices for hardening were the area under the curve (N × mm) up to 10 mm of distance, and the maximum force (N) corresponding to the crust fracture. The best results were obtained with ALL packaging and MAP condition, and above all, in all the trials a temperature of 30 °C reduced the crust hardness.

Treatment of Urolithiasis with Ureterocele: 5 Years of Experience (1998–2003)

To assess efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) about treatment of urolithiasis with ureterocele.

Materials and Methods

From January 1998 to July 2003, we have treated 6 adult patients (4 women and 2 men) with urolithiasis linked to ureterocele with mean age 35.8 years (range between 24–49 years). The patients showed dysuria, and pain during advanced stage of miction. The diagnosis of ureterocele was based by ultrasound and intravenous urography. The ureterocele appeared monolateral in 5 patients and bilateral in 1 patient. The stone is been treated with Extracorporeal Shock Wave Lithotripsy (4000 shocks; 9Kj), in mean 2 applications for patient.

Results

In 4 patients we have assessed breaking stone with expulsion of chips. In 2 patients, after treatment with ESWL, we have proceeded to extract the stone by endoscopic view, by small cut (“smile cut”) on ureterocele wall. Reflux was not present in these 2 patients after smile cut.

Conclusions

In patients with urolithiasis and ureterocele is recommended to perform a treatment of ESWL, that proved to be effectiveness, allowed by patients and without collateral effects.

Methylation profile of P. lividus sea urchin genes during development

Methylation pattern has been studied in two genes of sea urchin Paracentrotus lividus using sodium bisulfite method to understand the possible role of DNA methylation during invertebrate development. Three regions of the gene for the hatching enzyme have been analyzed and all of them resulted unmethylated in embryos at different stages of development. Four CpG rich regions have been studied in the gene for DNA methyltransferase: upstream, upstream-exon1, intron 1 and exon 20. The upstream-exon 1 region is always unmethylated, while intron 1 and exon 20 are heavy methylated. Only the upstream fragment changed its pattern of methylation during development. For none of the studied regions the reported data show a general direct correlation between gene expression and methylation process during development.

[Urodynamic evaluation in children with enuresis]

We performed an urodynamic study in enuretic children to evaluate the relationship between urodinamic findings and symptoms. We studied 175 patients, with age from 5 to 12 years, who presented with nocturnal enuresis: 45 monosymptomatic and 130 polysymptomatic (in association with urinary urgency, urge incontinence, etc.). Despite differences in symptoms, in 151 patients (86%) abnormal urodynamic findings were identified. Bladder instability was the most common disorder. However, mild abnormalities were found in the monosymptomatic patients. In treated patients urodinamic findings and clinical improvement were correlated. This study confirmed that most patients with nocturnal enuresis have cystometric abnormalities. Although possible etiologies of nocturnal enuresis are various, bladder dysfunction may be an underlying cause.

Ovarian cysts in newborns

Before the introduction of ultrasonography (US), ovarian cysts in newborns were thought to be rare. With the extended use of real-time US, prenatal detection has increased. There is still considerable controversy regarding the best treatment of these neonatal findings. A total of 27 instances in 24 consecutive newborns of antenatally-diagnosed ovarian cysts were reviewed for US data, management, and outcome to assess the ante- and postnatal evolution of the cyst and establish appropriate therapy. The cysts detected during pregnancy were studied by repeated postnatal US studies. In 10 children (2 with bilateral cysts) the cyst evolved spontaneously toward regression. Fourteen patients were operated upon; 10 had complex and 4 (in 1 bilateral) had simple cysts. Cystectomy was employed when possible to preserve the ovarian parenchyma (3 cases); in the remaining cases oophorectomy was performed. Histologically, the cysts were of follicular origin or necrosis made a diagnosis impossible. US was found to be a helpful diagnostic tool for simple ovarian cysts, but could not reliably distinguish between benign and malignant tumors if a sonographically complex lesion was present. Based on our experience, surgical management of ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes symptomatic.

[Ultrasound-guided ESWT in Peyronie's disease plaques]

The aim of the study was to check the efficiency of shock waves in the treatment of Peyronie's disease. The instrument, because of its lithotriptic power, already used in the treatment of orthopedic disease and salivary stones, can be used to break plaques in induratio penis plastica. A total of 481 patients affected with Peyronie's disease were entered into a prospective trial. Patients with big plaques or with an initial stage of degeneration were excluded. We divided the patients into three treatment groups: a) shock waves alone in 56 patients; b) a combination of shock waves and calcioantagonist (perilesional injection) in 324 patients; c) calcioantagonist alone in 101 patients. The group of 101 patients (group C) treated during the previous 2 years with a medical therapy based only on the injection of calcioantagonist, was used as a control group. Ultrasound evaluation of the treated plaques showed a reduction of size in 27/56 patients of the group A, in 159/324 patients of the group B and in 39/101 patients of group C. Painful erection improved in the 91.5% of group B, against the 45.7% of group C. Furthermore, we pointed out, with interviews to the patients, a considerable improvement of the pain and of the sexual performances. The therapeutic association of shock waves with calcioantagonist injections is an effective non-operative treatment for the stabilization of Peyronie's disease.

Isolation and characterization of the cDNA for a Ciona intestinalis RNA binding protein: spatial and temporal expression during development

A cDNA encoding an RNA binding protein has been isolated from a cDNA library prepared from larvae of the ascidian Ciona intestinalis. The putative protein of 162 amino acids contained in the N-terminal region one copy of the consensus sequence RNA binding domain and in the C-terminal region a glycine-rich domain. The in vitro translated protein bound various RNA homopolymers, preferentially polyU, polyA, and polyG, and the binding was affected by increasing ionic strength. Northern blot analysis revealed a single transcript of about 0.7 kb in length that was present during embryonic development with two major peaks of accumulation at gastrula and larval stages. Whole-mount in situ hybridization experiments on embryos at different stages of development showed gene expression mainly in mesenchymal cells and in neural tissue.

Cloning and characterization of a developmentally regulated sea urchin cDNA encoding glutamine synthetase

A 2935-bp cDNA clone encoding glutamine synthetase (GS) was isolated from a cDNA library prepared from four-blastomere Paracentrotus lividus sea urchin embryos. The sequence consists of a 75-bp 5' untranslated region (5'-UTR) followed by a 1095-bp coding region corresponding to a 365-amino-acid (aa) protein, a 1747-bp 3'-UTR and a terminal 18-bp poly(A) tail. The encoded protein shows about 66% identical residues, as compared with human and lobster class-II GS. The sequence contains the Mn(2+)-binding aa and the highly conserved aa regions observed in other GS. Northern blot analyses show that the GS mRNA is present in the sea urchin egg and is developmentally regulated in the embryo.