P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM

Background

Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS

Methods

39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training

Conclusions - Results

of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS

P368 PHYSICAL AND PSYCHOLOGICAL RECONDITIONING IN LONG COVID SYNDROME: RESULTS OF AN OUT–OF–HOSPITAL EXERCISED–BASED CARDIOVASCULAR REHABILITATION PROGRAM

Background

Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID–19 infection. Natural history and treatments of this syndrome are still poorly understood, even if evidence suggests the potential role of physical rehabilitation in improving symptoms in these subjects.

Aim

The aim of the present study was to evaluate safety, effectiveness and feasibility of a multidisciplinary, out–of–hospital, exercise–based cardiac rehabilitation (EBCR) program, of two months duration, in improving symptoms and physical and psychological parameters in patients with LCS Methods Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test (CPET), quality of life (QoL) and psychological appraisal before and after an EBCR program.

Results

At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the EBCR program, COVID–19 residual symptoms significantly decreased and significant improvements in upper and lower limb muscular strength, CPET parameters, perceived physical and mental health, depression and anxiety were observed.

Conclusions

The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a multidisciplinary EBCR program could promote their physical and psychological recovery

Patients with Minor Non-Disabling Stroke (MiNDS): results of a structured cardiovascular rehabilitation program

Funding Acknowledgements

Type of funding sources: None.

Background

Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non-Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases.

Purpose

To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS.

Methods

39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12-sessions in-hospital SPE program, and after 6- and 12-months follow-up during which they could continue their training schedule on their own.

Results

After in-hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6- and 12- months follow-up training, while regressed in the 7 patients who stopped training.

Conclusions

Results of the present study show that a SPE-based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS.

Physical and psychological reconditioning in long covid syndrome patients: results of a structured physical exercise program

Funding Acknowledgements

Type of funding sources: None.

Background

Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatments of this syndrome is still poorly understood. In literature there is currently a lack of data on the real effectiveness of a multidisciplinary rehabilitation program based on structured physical exercise (SPE) in these patients.

Purpose

To evaluate safety, effectiveness and feasibility of a structured individualized rehabilitation program in improving physical and psychological parameters in patients with LCS.

Methods

Twenty-eight patients with LCS (19 males, mean age 57 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET), muscular strength assessment, quality of life (QoL), psychological assessment and counselling, before and after a 12-sessions SPE program.

Results

At baseline, all LCS patients showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during training session. After the rehabilitation program, significant improvement in CPET parameters, upper and lower limb muscular strength, perceived physical and mental health, body composition, depression and anxiety and Covid residual symptoms was observed.

Conclusions

The present study confirms severe impairment of patients with LCS and suggest that a multidisciplinary rehabilitation program based on SPE could promote their physical and psychological recovery.

RP11-362K2.2:RP11-767I20.1 Genetic Variation Is Associated with Post-Reperfusion Therapy Parenchymal Hematoma. A GWAS Meta-Analysis

Stroke is one of the most common causes of death and disability. Reperfusion therapies are the only treatment available during the acute phase of stroke. Due to recent clinical trials, these therapies may increase their frequency of use by extending the time-window administration, which may lead to an increase in complications such as hemorrhagic transformation, with parenchymal hematoma (PH) being the more severe subtype, associated with higher mortality and disability rates. Our aim was to find genetic risk factors associated with PH, as that could provide molecular targets/pathways for their prevention/treatment and study its genetic correlations to find traits sharing genetic background. We performed a GWAS and meta-analysis, following standard quality controls and association analysis (fastGWAS), adjusting age, NIHSS, and principal components. FUMA was used to annotate, prioritize, visualize, and interpret the meta-analysis results. The total number of patients in the meta-analysis was 2034 (216 cases and 1818 controls). We found rs79770152 having a genome-wide significant association (beta 0.09, p-value 3.90 × 10⁻⁸) located in the RP11-362K2.2:RP11-767I20.1 gene and a suggestive variant (rs13297983: beta 0.07, p-value 6.10 × 10⁻⁸) located in PCSK5 associated with PH occurrence. The genetic correlation showed a shared genetic background of PH with Alzheimer’s disease and white matter hyperintensities. In addition, genes containing the ten most significant associations have been related to aggregated amyloid-β, tau protein, white matter microstructure, inflammation, and matrix metalloproteinases.

Double check discharge planning to improve the results of a heart failure programme

Background

Reduction of readmissions in heart failure (HF) patients is a main goal of HF programmes. Establishing a discharge planning for the patient and coordinating it with primary care teams are key aspects for their success.

Purpose

Evaluate whether a double check discharge planning based on adding face-to-face joint weekly sessions with primary care managers to the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.

Methods

We evaluated all patients discharged from hospital with HF as primary diagnosis between September 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (single check; September 2017 - April 2018) and those discharged during Period #2 (double check; May 2018 - January 2019).

Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 6 months after discharge from the index hospitalization.

Results

The study enrolled 317 patients: 182 in Period #1 and 135 in Period #2.

Mean age was 76±9 years. There was a higher proportion of patients with diabetes and COPD in Period #1, with no differences in other baseline characteristics.

The combined endpoint of all cause-death and all-cause hospitalization at 6 months was significantly reduced in patients in the double check discharge planning group (27% vs. 16%, p 0.021).

Conclusions

In a HF programme, the addition of a double check discharge planning based on having joint weekly sessions with primary care managers on top of the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge

Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?

Background

Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored.

Methods

We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization.

Results

The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011).

Conclusions

Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients.

Event-free survival cumulative curves.

Funding Acknowledgement

Type of funding source: None

Epidemiology of potassium derangements among chronic cardiovascular, metabolic and renal conditions: a population-based analysis data from more than 375,000 individuals

Introduction

In patients with chronic cardiovascular, metabolic and renal disorders, potassium (K)+ homeostasis is often delicate, especially in the presence of renin-angiotensin-aldosterone system inhibition (RAASI) and/or diuretic therapies. In this context, current clinical practical guidelines for the management of these patients recommend close monitoring of renal function and K+ levels, particularly in the presence of drug titration. Nevertheless, very limited epidemiological data on their importance at a population level is available.

Purpose

The objectives of the present analysis are to estimate the prevalence of potassium (K+) derangements in five key chronic cardiovascular, metabolic and renal conditions at the population level, its use of RAASI medication and describe potassium derangements among RAASI users.

Methods

We used data from more than 375,000 individuals 55 years of age or older included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD), and hypertension (HTN). RAASI medications included angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and rennin inhibitors. Hyperkalemia was defined as K+ levels >5.0 mEq/L and hypokalemia as K+ <3.5 mEq /L

Results

The prevalence of chronic cardiovascular, metabolic and renal conditions was high, particularly of HTN (48.2–48.9%). The prevalence of hyperkalemia was ranging between 10% and 25% depending of the condition, more frequent in CKD and less frequent in HTN patients. In figure, we display the prevalence of hyperkalemia among individuals with each of the relevant chronic conditions, January 1st, 2016 and January 1st, 2017. Use of at least one RAASI medication was very prevalent in HTN patients (75.2–77.3%). Among RAASI users, the frequency of K+ derangements and mainly of hyperkalemia was very noticeable (12% overall), especially in patients with CKD, CHF, elderly individuals, and users of MRAs. Hypokalemia was less frequent (1%).

Conclusion

The high prevalence of K+ derangements and predominantly hyperkalemia among RAASI users highlights the real-world relevance of K+ derangements and the importance of close monitoring and management of K+ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk.

Figure 1. Prevalence of hyperkalemia

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet and Miguel Cainzos-Achirica have participated in other research projects funded by unrestricted grants from Vifor Pharma

Association between self-care and prognosis in 1123 patients with chronic heart failure

Background

Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF.

Aims and methods

The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF.

We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline.

Results

We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour.

Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception.

Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028]

Conclusion

Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure.

These results highlight the importance of assessing self-care and provide measures to improve them.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

Background

Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts.

Purpose

To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions.

Methods

In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN).

Results

The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase).

Conclusion

In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

Long-term effectiveness of a nurse-led 7-step transitional intervention programme in heart failure

Background

Reduction of 30-day readmission in heart failure (HF) patients is a main goal of health-care systems. Programmes to decrease 30-day readmission have successfully reduced it but have failed to neither maintain benefit afterwards nor decrease mortality. Moreover, in many cases the price of reducing 30-day readmission is a mortality increase.

Purpose

Evaluate whether the impact of a fully nurse-led HF programme directed to reduce 30-day readmission and mortality extends to longer periods of time, including 90 days and 180 days after discharge.

Methods

We evaluated all patients discharged from hospital with HF as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (pre-programme; Jan 2017 - Aug 2017) and those discharged during Period #2 (HF programme; Sept 2017 - Jan 2019).

Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 90 days and 180 days after discharge from the index hospitalization.

Results

The study enrolled 440 patients: 123 in Period #1 and 317 in Period #2.

Mean age was 75±9 years. There was a higher proportion of female patients in Period #2 (38.2% vs 26.8%, p=0.025), with no differences in other baseline characteristics.

The combined endpoint of all cause-death and all-cause hospitalization was significantly reduced in patients in the HF programme group, both at 90 days [OR 0.37 (0.22–0.63), p<0.001] and at 180 days [OR 0.27 (CI 0.17–0.43), p<0.001]. Such a decrease was at expense of a reduction in cardiovascular (CV) hospitalization and HF hospitalization.

There were no differences between groups in mortality [OR 0.96 (0.18–5.00), p=0.293].

Conclusions

A fully nurse-led HF programme reduces the combined endpoint of all-cause death and all-cause hospitalization both at 90 days and 180 days after an index discharge for HF.

Such a decrease is driven by a reduction of CV and HF hospitalization, which are maintained over time. There were no differences between groups in mortality.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge

A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: The Healing Seasons protocol

Native Americans (NA) experience interrelated risks of trauma exposure, substance use, and HIV risk behaviors that put them at increased risk for HIV infection. Despite these known risk factors, there are very few published randomized trials testing interventions to reduce trauma-related symptoms and substance misuse among NA.

METHODS

The Healing Seasons study is a randomized comparsion trial of two counseling strategies, Narrative Exposure Therapy (NET) addressing PTSD or Motivational interviewing with cognitive behavioral therapy skills training (MIST) addressing substance misuse as a means to prevent HIV among NA. Using a community-based participatory research approach, we adapted both evidence-based interventions to be specific to the risk contexts and realities of NA and to include psychoeducational and skill-building components that include cultural-specific stories, virtues, and traditional treatment strategies. Participants, 16 years and older, were recruited from a Pacific Northwest tribal community, screened over the phone, enrolled in person, and randomized in equal numbers to NET or MIST. We stratified by age (16-29 years and 30 or older) and gender (male or female identified) to ensure balance between treatment arms. The primary outcomes were number of sex partners and frequency of sexual acts (with and without condoms), sex under the influence of substances, frequency of substance use, and PTSD severity.

DISCUSSION

Behavioral interventions for NA are needed to prevent HIV risk behaviors when faced with trauma symptoms and substance misuse. This study will provide evidence to determine feasibility and efficacy of addressing related risk factors as part of counseling-based HIV prevention intervention to reduce sexual risk among this population.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT03112369, registered April 12, 2017.

Double rare-earth nanothermometer in aqueous media: opening the third optical transparency window to temperature sensing

Owing to the alluring possibility of contactless temperature probing with microscopic spatial resolution, photoluminescence nanothermometry at the nanoscale is rapidly advancing towards its successful application in biomedical sciences. The emergence of near-infrared nanothermometers has paved the way for temperature sensing at the deep tissue level. However, water dispersibility, adequate size at the nanoscale, and the capability to efficiently operate in the second and third biological optical transparency windows are the requirements that still have to be fulfilled in a single nanoprobe. In this work, these requirements are addressed by rare-earth doped nanoparticles with core/shell-architecture, dispersed in water, whose excitation and emission wavelengths conveniently fall within the biological optical transparency windows. Under heating-free 800 nm excitation, double nanothermometry is realized either with Ho³⁺-Nd³⁺ (1.18-1.34 μm) or Er³⁺-Nd³⁺ (1.55-1.34 μm) NIR emission band ratios, both displaying equal thermal sensitivities around 1.1% °C^-1. It is further demonstrated that, along with the interionic energy transfer processes, the thermometric properties of these nanoparticles are also governed by the temperature dependent energy transfer to the surrounding solvent (water) molecules. Overall, this work presents a novel water dispersible double ratiometric nanothermometer operating in the second and third biological optical transparency windows. The temperature dependent particle-solvent interaction is also presented, which is critical for e.g. future in vivo applications.

Covering the optical spectrum through collective rare-earth doping of NaGdF4 nanoparticles: 806 and 980 nm excitation routes

Sensitization of numerous emission bands (from ultraviolet to near-infrared) in rare-earth doped multilayered nanoparticles: 806 versus 980 nm excitation.

Plasma phospholipid fatty acid composition and desaturase activity in women with gestational diabetes mellitus before and after delivery

AIMS

Analyze plasma phospholipid fatty acids (PPFA) composition and desaturase activity in women with gestational diabetes (GDM) and in women with a normal glucose tolerance (NGT) before and after delivery, and to evaluate the possible relationship between desaturase activity and inflammatory parameters.

METHODS

PPFA composition was analyzed by gas chromatography in 21 women with GDM and from 21 with NGT, during the third trimester of pregnancy and 6 months after delivery. We used fatty acid product-to-precursor ratios to estimate desaturase activity, and we also measured in all women interleukins six and ten, tumor necrosis factor alpha and C-reactive protein.

RESULTS

No significant differences were observed between NGT and GDM women in terms of PPFA composition, both in pregnancy and after pregnancy. Estimated desaturase Δ9-18 activity was significantly higher, and estimated desaturase Δ5 activity was significantly lower during pregnancy in all women. We observed no correlations between inflammatory markers and desaturases activity, during or after pregnancy, in both groups.

CONCLUSIONS

Our data suggest that GDM does not influence PPFA composition and desaturase activity during pregnancy. In addition, late pregnancy characterized by hyperinsulinemia appears to upregulate desaturase Δ9-18 activity in NGT and GDM women.

High-density lipoprotein oxidation in type 2 diabetic patients and young patients with premature myocardial infarction

BACKGROUND AND AIMS

ApoA-I can undergo oxidative changes that reduce anti-atherogenic role of HDL. The aim of this study was to seek any significant differences in methionine sulfoxide (MetO) content in the ApoA-I of HDL isolated from young patients with coronary heart disease (CHD), type 2 diabetics and healthy subjects.

METHODS AND RESULTS

We evaluated the lipid profile of 21 type 2 diabetic patients, 23 young patients with premature MI and 21 healthy volunteers; we determined in all patients the MetO content of ApoA-I in by MALDI/TOF/TOF technique. The typical MALDI spectra of the tryptic digest obtained from HDL plasma fractions all patients showed a relative abundance of peptides containing Met(112)O in ApoA-I in type 2 diabetic and CHD patients. This relative abundance is given as percentages of oxidized ApoA-I (OxApoA-I). OxApoA-I showed no significant correlations with lipoproteins in all patients studied, while a strong correlation emerged between the duration of diabetic disease and OxApoA-I levels in type 2 diabetic patients.

CONCLUSIONS

The most remarkable finding of our study lies in the evidence it produced of an increased HDL oxidation in patients highly susceptible to CHD. Levels of MetO residues in plasma ApoA-I, measured using an accurate, specific method, should be investigated and considered in prospective future studies to assess their role in CHD.

Advancing methods for reliably assessing motivational interviewing fidelity using the motivational interviewing skills code

The current paper presents novel methods for collecting MISC data and accurately assessing reliability of behavior codes at the level of the utterance. The MISC 2.1 was used to rate MI interviews from five randomized trials targeting alcohol and drug use. Sessions were coded at the utterance-level. Utterance-based coding reliability was estimated using three methods and compared to traditional reliability estimates of session tallies. Session-level reliability was generally higher compared to reliability using utterance-based codes, suggesting that typical methods for MISC reliability may be biased. These novel methods in MI fidelity data collection and reliability assessment provided rich data for therapist feedback and further analyses. Beyond implications for fidelity coding, utterance-level coding schemes may elucidate important elements in the counselor-client interaction that could inform theories of change and the practice of MI.

Aβ promotes VDAC1 channel dephosphorylation in neuronal lipid rafts. Relevance to the mechanisms of neurotoxicity in Alzheimer's disease

Voltage-dependent anion channel (VDAC) is a mitochondrial protein abundantly found in neuronal lipid rafts. In these membrane domains, VDAC is associated with a complex of signaling proteins that trigger neuroprotective responses. Loss of lipid raft integrity may result in disruption of multicomplex association and alteration of signaling responses that may ultimately promote VDAC activation. Some data have demonstrated that VDAC at the neuronal membrane may be involved in the mechanisms of amyloid beta (Aβ)-induced neurotoxicity, through yet unknown mechanisms. Aβ is generated from amyloid precursor protein (APP), and is released to the extracellular space where it may undergo self-aggregation. Aβ aggregate deposition in the form of senile plaques may lead to Alzheimer's disease (AD) neuropathology, although other pathological hallmarks (such as hyper-phosphorylated Tau deposition) also participate in this neurodegenerative process. The present study demonstrates that VDAC1 associates with APP and Aβ in lipid rafts of neurons. Interaction of VDAC1 with APP was observed in lipid rafts from the frontal and entorhinal cortex of human brains affected by AD at early stages (I-IV/0-B of Braak and Braak). Furthermore, Aβ exposure enhanced the dephosphorylation of VDAC1 that correlated with cell death. Both effects were reverted in the presence of tyrosine phosphatase inhibitors. VDAC1 dephosphorylation was corroborated in lipid rafts of AD brains. These results demonstrate that Aβ is involved in alterations of the phosphorylation state of VDAC in neuronal lipid rafts. Modulation of this channel may contribute to the development and progression of AD pathology.

Oestrogens as modulators of neuronal signalosomes and brain lipid homeostasis related to protection against neurodegeneration

Oestrogens trigger several pathways at the plasma membrane that exert beneficial actions against neurodegenerative diseases, such as Alzheimer's disease and Parkinson's disease. Part of these actions takes place in lipid rafts, which are membrane domains with a singular protein and lipid composition. These microdomains also represent a preferential site for signalling protein complexes, or signalosomes. A plausible hypothesis is that the dynamic interaction of signalosomes with different extracellular ligands may be at the basis of neuronal maintenance against different neuropathologies. Oestrogen receptors are localised in neuronal lipid rafts, taking part of macromolecular complexes together with a voltage-dependent anion channel (VDAC), and other molecules. Oestradiol binding to its receptor at this level enhances neuroprotection against amyloid-β degeneration through the activation of different signal transduction pathways, including VDAC gating modulation. Moreover, part of the stability and functionality of signalling platforms lays on the distribution of lipid hallmarks in these microstructures, which modulate membrane physicochemical properties, thus favouring molecular interactions. Interestingly, recent findings indicate a potential role of oestrogens in the preservation of neuronal membrane physiology related to lipid homeostasis. Thus, oestrogens and docosahexaenoic acid may act synergistically to stabilise brain lipid structure by regulating neuronal lipid biosynthetic pathways, suggesting that part of the neuroprotective effects elicited by oestrogens occur through mechanisms aimed at preserving lipid homeostasis. Overall, oestrogen mechanisms of neuroprotection may occur not only by its interaction with neuronal protein targets through nongenomic and genomic mechanisms, but also through its participation in membrane architecture stabilisation via 'lipostatic' mechanisms.

Plasma lipids and inflammation in active inflammatory bowel diseases

BACKGROUND

Ulcerative colitis (UC) and Crohn's disease (CD) can cause metabolic and inflammatory alterations.

AIM

To evaluate the relationships between inflammatory parameters, plasma lipids and phospholipid fatty acid (FA) composition in patients with active UC and CD.

METHODS

Diet, the Harvey-Bradshaw Activity Index (HBAI), inflammatory parameters, lipoproteins and FA composition were assessed in 60 CD and 34 UC.

RESULTS

No differences in clinical parameters were observed in the two groups. Total cholesterol correlated inversely with the number of bowel movements in both groups and directly with BMI in UC. Arachidonic acid correlated inversely with HBAI in UC and total and HDL cholesterol were inversely related to C-reactive protein (CRP) in CD while HDL correlated with CRP in UC. Docosapentaenoic acid was the only polyunsaturated n-3 FA that was correlated to CRP in both groups. Total cholesterol was independently associated in the multiple regression analysis with the number of bowel movements and systemic inflammation.

CONCLUSIONS

Total and LDL cholesterol were lower in the active UC and CD than in the healthy subjects and were correlated with the systemic inflammatory status. Phospholipid FA composition was correlated to the systemic inflammatory status, but was unrelated to dietary intake and intestinal disease activity.

Depression in War-related Post Traumatic Stress Disorder and the Enduring Personality Change After Catastrophic Experience (F62.0) a 15-year Follow-up

Objective:

This study was a 15-year follow-up examination. Many patients with F 62.0 and post traumatic stress disorder (PTSD) have symptoms of depression. The authors’ objective is to analyze symptoms of depression in F 62.0 and PTSD.

Method:

The subjects were 200 male psychiatric patients at a Clinic of psychiatry medical center Banjaluka and psychiatry department of with war-related PTSD. Post traumatic stress syndrom-PTSS scale and 21-item Hamilton Rating Scale for Depression-HAMD was used to assess state measures of symptom severity; from 3 months to 15 years after returning from the war.

Results:

The symptoms of prolonged PTSS (with duration between six moths and two years) had been founded at 54%, and 32% of patients had no diagnosis PTSD. The enduring personality change after catastrophic experience (F 62.0) had been found at 14% patients (with duration more than two years), 19% met HAMD Diagnostic Criteria for major depressive disorder.

The enduring personality exchange F 62.0 had been found at 8% patients and 16% met HAMD Diagnostic Criteria for major depressive disorder 15 years after returning from the war.

Conclusions:

The statistical relationship between level of combat exposure and PTSD symptoms at 15 years, suggests that it may take time for the consequences of traumatic exposure to become apparent. Moreover, degree of exposure may be important in predicting the eventual development of symptoms and precipitation of F 62.0 enduring personality exchange. Continued follow-up will address the evolution of PTSD symptoms in war related PTSD.

Desaturase activities and metabolic control in type 2 diabetes

The aim of this study was to elucidate the effects of a poor glycemic control on fatty acid composition and desaturase activities in type 2 diabetic patients. Plasma phospholipid fatty acid composition and desaturase activities (estimated from fatty acid product to precursor ratios) were measured in 30 type 2 diabetic patients during poor metabolic control and after achieving a good metabolic control. Significant changes were recorded in the percentages of palmitic, stearic, dihomo-gamma-linolenic, docosatetraenoic and docosapentaenoic acid. The delta-5 desaturase activity was significantly higher with poor than with good metabolic control. The changes identified in plasma phospholipid fatty acid composition and the desaturase activity in type 2 diabetic patients go in the opposite direction to those described in similar conditions in type 1 diabetic patients and may be relevant to a better understanding of the role of metabolic control in the progression of chronic complications in type 2 diabetic patients.

Ambulatory Physical Activity during United States Army Basic Combat Training

Electronic pedometers were used to quantify locomotor physical activity during an entire 9-week United States Army Basic Combat Training (BCT) cycle. Pedometers were worn on the hips of 4 trainees in each of 10 BCT companies during all BCT activities. Investigators obtained pedometer readings (steps) on a daily basis, and estimated travel distances were obtained by multiplying steps by the average individual step length. A short questionnaire was administered daily to assure trainees wore the pedometers and trained with their companies all day. Trainees performed an average +/- SD of 16 311 +/- 5826 steps/day and traveled an estimated 11.7 +/- 4.4 kilometers/day. The highest daily locomotor activity was during the field training exercise in which trainees took an average +/- SD of 22 372 +/- 12 517 steps/day traveling an estimated 16.2 +/- 9.7 kilometers/day. Differences among the 10 companies ranged from 14 720 +/- 6649 steps/day to 18 729 +/- 6328 steps/day. This survey provided the first examination of locomotor physical activity during an entire BCT cycle.

Bovine lactoferrin for Helicobacter pylori eradication: an open, randomized, multicentre study

BACKGROUND

Cure rates for eradication of Helicobacter pylori appear to be decreasing, thus more effective therapies must be identified.

AIM

To evaluate the efficacy of bovine lactoferrin in the treatment of H. pylori infection.

METHODS

In a multicentered prospective study, 402 (mean age 52.4, range 19-84 years) H. pylori-positive patients were assigned to one of three regimens: group A - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. for 7 days; group B - lactoferrin 200 mg b.d. for 7 days followed by the same schedule of group A; group C - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. plus lactoferrin 200 mg b.d. for 7 days.

RESULTS

Of the 402 patients, 389 completed the study. Six patients were discontinued due to side effects, one patient in group B died and six patients were lost to follow up. The eradication rate (intention-to-treat analysis) was 77% in group A (105/136), 73% in group B (97/132) and 90% in group C (120/134) (chi(2)-test P < 0.01). The incidence of side effects was 9.5% in group A, 9% in group B and 8.2% in group C (chi(2)-test P = 0.1).

CONCLUSION

This study demonstrates that bovine lactoferrin is an effective adjuvant to 7-day triple therapy for eradication of H. pylori infection.

Trabéculo-sclérectomie non perforante avec mitomycine C, sans implant

PURPOSE

Since 1998 we have been conducting a prospective study of nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate the efficiency of the technique.

MATERIAL AND METHODS

The study was carried out in 55 eyes of 41 patients who suffered from open-angle glaucoma. After performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3 minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds deepness until reaching the cornea. The Schlemm canal and the external trabecula were surgically removed and the two points of the Schlemm canal were catheterized with a trabeculotome to ensure that the ablation was well done. If it was not, it was completed by using a trabeculotome as a guide. Postoperatively, if the filtering bleb tended to decrease or ocular pressure began to increase, the operated trabecular region was reopened with Yag laser. The filtering bleb characteristics were correlated with the normalization of intraocular pressure in the first 30 cases.

RESULTS

Preoperative pressure without treatment was 32 mmHg. Postoperative intraocular pressure without treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6 months, 75% after 8 months and 61% after 12 months. By adding a local hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained in 79% of the cases after 12 months. No severe complications were observed. The presence of a filtering bleb is an important factor in the normalization of postoperative pressure (p=0.0048).

CONCLUSIONS

This surgical technique provides a substantial decrease in intraocular pressure and very few complications after 12 months of follow-up.

An ICI 182,780-sensitive, membrane-related estrogen receptor contributes to estrogenic neuroprotective actions against amyloid-beta toxicity

Although estrogen (E2)-related neuroprotection has been repeatedly demonstrated in different models, the involvement of non-classical estrogen receptors (ERs) in this activity remains unclear. Using SN56 murine cholinergic cell line from the basal forebrain, we present evidence indicating that an ER associated with the plasma membrane participates in estrogen-dependent reduction of neuronal death induced by amyloid-beta peptide (Abeta) toxicity. Exposure to either E2 or estradiol-horseradish peroxidase (E-HRP) for 15 min significantly reduced Abeta-induced cell death. This effect was decreased by the ER antagonist ICI 182,780 as well as by MC-20 antibody directed to a region neighboring the ligand-binding domain of ERa. Using MC-20 antibody in unpermeabilized SN56 cells, we detected a protein at the plasma membrane region. The binding of impermeant forms of E2, E-HRP, and E-BSA-FITC to specific sites of SN56 plasma membrane was blocked by pre-incubation with E2, ICI 182,780, and MC-20 antibody in a concentration-dependent manner. Thus, a membrane-related ER that shares some structural homologies with ERalpha may participate in estrogen-mediated neuroprotection.

Estradiol prevents amyloid-beta peptide-induced cell death in a cholinergic cell line via modulation of a classical estrogen receptor

The pathology of Alzheimer's disease includes amyloid-beta peptide aggregation that contributes to degeneration of cholinergic neurons. Even though the underlying molecular mechanisms remain unclear, recent in vitro evidence supports a protective role for estrogens against several neurotoxic agents. Here we report that, in a murine cholinergic cell line (SN56), the massive cell death induced by 1-40 fragment of amyloid-beta peptide was prevented by 17beta-estradiol through a mechanism that may involve estrogen receptor activation. The protective effect of estradiol was observed in a dose-dependent manner, and was completely blocked by the pure antiestrogen ICI 182,780. In contrast, the inactive isomer 17alpha-estradiol consistently showed weaker neuroprotection than the native hormone that was unaffected by ICI 182,780 treatment. In addition, equivalent concentrations of 17beta-estradiol enhanced luciferase activity in cells transfected with a luciferase reporter gene driven by tandem estrogen response elements. Estrogen-induced luciferase activity was blocked by ICI 182,780, indicating estrogen receptor-dependent transcriptional activity. We also observed by reverse transcription-polymerase chain reaction, Western blot and immunocytochemistry that increasing concentrations of 17beta-estradiol enhanced the expression of estrogen receptor alpha mRNA and protein during amyloid-beta-induced toxicity. Under these conditions, it was found by confocal microscopy that the localization of estrogen receptor alpha in the absence of hormone was mainly extranuclear. However, the receptor was consistently observed also at the nuclear region after estrogen exposure. Overall, these data suggest that estrogen may exert neuroprotective effects against amyloid-beta-induced toxicity by activation of estrogen receptor-mediated pathways. In addition, intracellular estrogen receptors are up-regulated by their cognate hormone even during exposure to neurotoxic agents.

The amount of estrogen receptor alpha increases after heat shock in a cholinergic cell line from the basal forebrain

Estrogen exerts a neuroprotective action in response to a variety of cell stresses. However, to what extent intracellular estrogen receptors are involved in these functions remains to be determined. We have found that SN56 cells, a neuronal-derived cholinergic cell line which produces luteinizing hormone-releasing hormone and contains the mRNAs encoding estrogen and progesterone receptors, also express estrogen receptor alpha, as well as the heat shock protein 90. Exposure of these cells to drastic temperature elevation for 1 h immediately increased the intracellular levels of these two proteins, whereas it rapidly reduced the content of estrogen receptor alpha mRNA. In addition, the amount of estrogen receptor alpha-heat shock protein 90 complexes was increased in response to thermal stress. Pre-treatment with geldanamycin, a potent inhibitor of heat shock protein 90, decreased the amount of estrogen receptor alpha, suggesting that its elevation after the heat insult may be related to its association with heat shock protein 90. In contrast, exposure of heat-shocked cells to 17beta-estradiol reduced the number of estrogen receptor alpha-heat shock protein 90 complexes, suggesting that the receptor conserves the affinity for its cognate ligand under these conditions. Therefore, the interaction of the estrogen receptor with heat shock protein 90 may serve to prevent its degradation during the thermal insult, as well as to maintain it in a high-affinity hormone-binding conformation. Since neuroprotective estrogen effects have been described in a variety of cytotoxic situations, these findings may be suggestive of an integrated neuronal response to injury, which includes the protection of available estrogen receptors through their association with heat shock protein 90.

A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease

OBJECTIVE

To investigate in a random comparison the capacity of an angiotensin converting enzyme inhibitor (fosinopril), and that of a long-acting dihydropiridine (nifedipine GITS) to modify the decay in renal function in patients with primary renal disease, exhibiting a progressive increase in serum creatinine during the previous 2 years.

METHODS

A randomized, open-label, multicenter study with a minimum follow-up of 3 years. A total of 241 patients were included in the study. All of them were hypertensive and had a 25% or at least 0.5 mg/dl increase in the value of serum creatinine during the 24 months prior to entering the study. Initial doses of fosinopril and nifedipine GITS were 10 and 30 mg respectively, and titration to 30 and 60 mg was performed if needed to obtain the expected blood pressure goal (< 140/90 mmHg). Furosemide, atenolol, and doxazosin were added as second, third, and fourth drugs if necessary, for blood pressure control. The primary end-point of the study was the appearance of double the serum creatinine values and/or the need to enter a dialysis programme. Secondary end-points were cardiovascular events, death, changes in 24 h proteinuria, and the evolution of serum creatinine. Data reflect the analysis performed by intention to treat.

RESULTS

Mean age of the group was 54 +/- 14, and 59% were males. Primary glomerulonephritis (31%), nephrosclerosis (26%) and polycystic kidney disease (19%) were the three most frequent diagnostic findings. After 3 years of follow-up, 21% (27/127) of patients treated with fosinopril, and 36% (40/112) of those receiving nifedipine GITS presented a primary end-point, (OR 0.47, 95% confidence intervals 0.26-0.84, P = 0.01). Renal survival was significantly better when fosinopril constituted the first step therapy (P = 0.002). These results did not seem to be influenced by the type of primary renal disease. Proteinuria decreased at the end of the study by a mean of 57% in the fosinopril group and increased by 7% in the group receiving dihydropiridine. Blood pressure control did not differ among groups for diastolic values. During follow-up, however, the patients receiving ACEi showed systolic blood pressure values 4-6 mmHg lower.

CONCLUSION

In patients with chronic renal failure and hypertension due to primary renal disease, fosinopril significantly differed from nifedipine GITS by its capacity to slow the progressive decay in renal function. The drugs also differed by their capacity to lower blood pressure. The better control, in particular of systolic blood pressure, in the fosinopril arm could have contributed in a relevant manner to the attainment of a better outcome when the ACEi was employed.

Characterization of basal nitric oxide production in living cells

Nitric oxide (NO) is an important modulator of immune, endocrine and neuronal functions; however, measuring physiological levels of NO in cell cultures is generally difficult because of the lack of suitable methodologies. We have selected three cell lines from different origins: the neuroblastoma-derived Neuro2A (N2A), the cholinergic SN56 and the non-neuronal COS-1. We first demonstrated the presence of NADPH-diaphoretic activity, a potential marker of the NO-synthesizing (NOS) enzyme. By immunocytochemistry, using specific antibodies for each NOS subtype, we observed that subtype I was present in all cell lines and that subtype II was present in COS-1 and N2A cell lines. The presence of these NOS subtypes was further verified by Western blot analysis. Control cells treated with DAF-2 DA exhibited significant fluorescent levels corresponding to basal NO production. The subcellular distribution of the synthesizing enzyme was consistent with the NO-fluorescence signal; whereas, fixation affected the subcellular pattern of NO fluorescence signal. Addition of NOS inhibitors or NO scavengers to the incubation medium reduced the intensity of the NO fluorescence signal in a concentration-dependent manner. Conversely, increasing concentrations of a NO donor, or incident light, increased the fluorescence intensity. Our observation of NO production and distribution using the DAF-2 method has a direct impact on studies using these cell lines.

Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU"

BACKGROUND

Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly.

AIMS

To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres.

PATIENTS

Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms.

METHODS

Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection.

RESULTS

A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction.

CONCLUSIONS

Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C: influence of HCV genotype

OBJECTIVE

To assess the influence of hepatitis C virus (HCV) genotypes on the clinical outcome of liver disease, we analysed 2,307 patients.

RESULTS

The most frequently represented genotypes were 1b (40%) and 2 (28.1%). Patients with these genotypes had a median age higher than patients with other genotypes (P< 0.01). The overall survival of subjects with genotype 1b was poorer than the survival of patients with other genotypes (P< 0.01). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P< 0.01). Sixty-two patients (22%) developed hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulative years (estimated crude incidence rate, 4.1 cases per 100 person-years for all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; and 2.8 cases for genotypes non-1). Considering the whole population of 2,307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients underwent treatment with interferon in uncontrolled studies. Interferon therapy was associated with both better survival (P< 0.01) and a lower cumulative hazard for HCC (P< 0.01).

CONCLUSIONS

Genotype 1b was associated with a poorer prognosis, probably because it leads to cirrhosis and consequently to HCC development. However, our data did not confirm genotype 1b as an independent risk factor for HCC in liver cirrhosis, which plays a major role in carcinogenesis. Interferon should be considered as a useful strategy in cirrhosis for improvement of survival and reduction of HCC risk.

Physical medicine and rehabilitation in the military: the Bosnian mass casualty experience

On February 5, 1994, a 120-mm mortar shell crashed into the main Market Square of Sarajevo, Bosnia. The explosion killed 66 and injured 206. The United States evacuated 71 of the injured to Landstuhl Regional Medical Center, where the Physical Medicine and Rehabilitation Service evaluated 28 victims. This mass casualty evacuation underscores the role of Army physiatrists in humanitarian assistance and wartime casualty management. The author collected data regarding demographic factors, injury types, complications, and functional limitations. Seventeen of the 28 patients evaluated were injured during the market bombing, with the rest being injured before the bombing. Of 132 diagnoses in these 28 patients, 31 were fractures, 14 were amputations, 8 were peripheral neuropathies, 3 were spinal cord injuries, and 1 was a traumatic brain injury. Contractures and decubitus ulcers, both complications of immobility, accounted for 18 of the diagnoses. Ambulatory impairments were present in all of the patients, and 4 patients had major impairments in activities of daily living.

Pantoprazole versus one-week Helicobacter pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects

AIM

To compare the efficacy of pantoprazole vs. a one-week Helicobacter pylori eradication therapy for the prevention of NSAID-related gastroduodenal damage.

METHODS

Patients over 60 years old with symptoms and/or a history of ulcer who needed NSAID treatment were evaluated by endoscopy. H. pylori positive subjects who had no severe gastroduodenal lesions were randomized to take, concomitantly with NSAID therapy, either: (i) pantoprazole 40 mg daily plus amoxycillin 1 g b.d. and clarithromycin 250 mg b.d. for 1 week (35 subjects, Group PAC) or (ii) pantoprazole 40 mg daily for 1 month (34 subjects, Group P). Endoscopy was repeated after 1 month.

RESULTS

A significantly higher incidence of severe gastroduodenal damage was found in Group PAC than in Group P (29% vs. 9%, P<0.05). The percentages of patients worsened, unchanged and improved after 1 month were, respectively: Group PAC: 46%, 46%, and 9% and Group P: 7%, 65%, and 29% (P<0.0008). The percentage of H. pylori-negative subjects was 89% in Group PAC and 52% in Group P (P=0.0009). The incidence of gastroduodenal damage was higher in Group PAC treatment failures than in cured patients (50% vs. 25.8%, P=ns).

CONCLUSION

One month of pantoprazole was more effective than a proton pump inhibitor-based triple therapy in the prevention of gastroduodenal damage in elderly H. pylori-positive NSAID users.

Cure of Helicobacter pylori-positive active duodenal ulcer patients: a double-blind, multicentre, 12-month study comparing a two-week dual vs a one-week triple therapy. GISU (Interdisciplinary Group for Ulcer Study)

AIMS

To compare a two-week dual therapy to a one-week triple therapy for the healing of duodenal ulcer and the eradication of the Helicobacter pylori infection.

PATIENTS AND METHODS

A total of 165 patients with active duodenal ulcer were enrolled in the study. At entry, endoscopy, clinical examination and laboratory tests were performed. Histology and the rapid urease test were used to diagnose Helicobacter pylori infection. Patients received either lansoprazole 30 mg plus amoxycillin 1 g bid for two weeks (two-week, dual therapy) or lansoprazole 30 mg plus amoxycillin 1 g plus tinidazole 500 mg bid for one week plus lansoprazole qd for an additional week (one-week, triple therapy). Two and twelve months after cessation of therapy, endoscopy and clinical assessments were repeated.

RESULTS

Duodenal ulcer healing and Helicobacter pylori eradication were both significantly greater (p<0.0001) in the triple therapy group (healing: 98.6%; Helicobacter pylori cure rate: 72.6%) than in the dual therapy group (healing: 77.3%; Helicobacter pylori cure rate: 33.3%). Ulcers healed more frequently in Helicobacter pyloricured than in Helicobacter pylori-not cured patients (94.9% vs. 77.2%; p<0.0022). After one year, Helicobacter pylori eradication was re-confirmed in 46/58 patients previously treated with the triple therapy and in 10/40 patients treated with the dual therapy [p<0.0001]. Only three duodenal ulcer relapses were observed throughout follow-up: all were in Helicobacter pylori-not cured patients.

CONCLUSIONS

Triple therapy was more effective than dual both in curing Helicobacter pylori infection and healing active duodenal ulcers. The speed of ulcer healing obtained after only 7 days of antibiotics and 14 days of proton pump inhibitors confirmed that longer periods of anti ulcer therapy were not necessary. Helicobacter pylori -not cured patients had more slowly healing ulcers which were more apt to relapse when left untreated.