Search

Thyroid hormones (THs) are essential in normal brain development, and cognitive and emotional functions. THs act through a cascade of events including uptake by the target cells by specific cell membrane transporters, activation or inactivation by deiodinase enzymes, and interaction with nuclear thyroid hormone receptors. Several thyroid responsive genes have been described in the developing and in the adult brain and many studies have demonstrated a systemic or local reduction in TH availability in neurologic disease and after brain injury. In this review, the main factors and mechanisms associated with the THs in the normal and damaged brain will be evaluated in different regions and cellular contexts. Furthermore, the most common animal models used to study the role of THs in brain damage and cognitive impairment will be described and the use of THs as a potential recovery strategy from neuropathological conditions will be evaluated. Finally, particular attention will be given to the link observed between TH alterations and increased risk of Alzheimer's Disease (AD), the most prevalent neurodegenerative and dementing condition worldwide.

Nurse managers play a vital role in healthcare organizations, wielding the ability to substantially enhance work environments, foster nurses' autonomy, and bolster retention within workplaces. In this context, this study focuses on the Nurse Manager Actions scale, aiming to evaluate its items' scalability as well as the scale's validity and reliability among nurses and nurse managers operating within the Italian healthcare context. The study protocol was not registered. To ensure linguistic and cultural alignment, an iterative and collaborative translation process was undertaken. Subsequently, a multi-center cross-sectional design was adopted. Using a web-survey approach, data were collected among 683 nurses and 188 nurse managers between August 2022 and January 2023. The Nurse Manager Actions scale was found to be a valid and reliable instrument in Italian after a Mokken Scale Analysis. For nurses ( H T = 0.630, Molenaar-Sijtsma rho = 0.890), the scale included 6 items, while 11 items were confirmed for nurse managers ( H T = 0.620, Molenaar-Sijtsma rho = 0.830). Nurse Manager Actions scale scores were correlated with increased satisfaction and decreased intention to leave for both nurses and nurse managers. The employed validation process enhanced the scale validity for use in Italy and provided a model for other researchers to follow when assessing similar measures in different populations. Measuring and empowering nurse manager actions in work contexts is essential to improve the general well-being and retention of nurses, especially in the current nursing shortage.

For decades, scholars have studied leader-member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used in empirical studies, but its psychometric properties have been poorly explored. The aim of this study was to test the psychometric characteristics (content, structural and construct validity, and reliability) of the Italian version of the LMX-7 scale and to support its cultural adaptation. We used a cross-sectional multi-center design. The forward-backward translation process was used to develop the Italian version of the scale. The scale was administered through an online survey to 837 nurses and nurse managers working in different settings. The factorial structure was tested using both exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated using Cronbach's alpha. For the construct validity, we used hypothesis testing and differentiation by known groups. The Italian version of the LMX-7 scale presented one dimension. All the psychometric tests performed confirmed its validity and suggested its usefulness for future research.

Thyroid hormones (TH) perform a plethora of actions in numerous tissues and induce an overall increase in metabolism, with an augmentation in energy demand and oxygen expenditure. Oxidants are required for normal thyroid-cell proliferation, as well as for the synthesis of the main hormones secreted by the thyroid gland, triiodothyronine (T3) and thyroxine (T4). However, an uncontrolled excess of oxidants can cause oxidative stress, a major trigger in the pathogenesis of a broad spectrum of diseases, including inflammation and cancer. In particular, oxidative stress is implicated in both hypo- and hyper-thyroid diseases. Furthermore, it is important for the TH system to rely on efficient antioxidant defense, to maintain balance, despite sustained tissue exposure to oxidants. One of the main endogenous antioxidant responses is the pathway centered on the nuclear factor erythroid 2-related factor (Nrf2). The aim of the present review is to explore the multiple links between Nrf2-related pathways and various TH-associated conditions. The main aspect of TH signaling is described and the role of Nrf2 in oxidant-antioxidant homeostasis in the TH system is evaluated. Next, the antioxidant function of Nrf2 associated with oxidative stress induced by TH pathological excess is discussed and, subsequently, particular attention is given to the cardioprotective role of TH, which also acts through the mediation of Nrf2. In conclusion, the interaction between Nrf2 and most common natural antioxidant agents in altered states of TH is briefly evaluated.

Background: Standard precautions (SPs) are first-line strategies with a dual goal: to protect health care workers from occupational contamination while providing care to infected patients and to prevent/reduce health care-associated infections (HAIs). This study aimed at (1) identifying the instruments currently available for measuring healthcare professionals' compliance with standard precautions; (2) evaluating their measurement properties; and (3) providing sound evidence for instrument selection for use by researchers, teachers, staff trainers, and clinical tutors., Methods: We carried out a systematic review to examine the psychometric properties of standard precautions self-assessment instruments in conformity with the COSMIN guidelines. The search was conducted on the databases PubMed, CINAHL, and APA PsycInfo., Results: Thirteen instruments were identified. These were classified into four categories of tools assessing: compliance with universal precautions, adherence to standard precautions, compliance with hand hygiene, and adherence to transmission-based guidelines and precautions. The psychometric properties of instruments and methodological approaches of the included studies were often not satisfactory. Only four instruments were classified as high-quality measurements., Conclusions: The available instruments that measure healthcare professionals' compliance with standard precautions are of low-moderate quality. It is necessary that future research completes the validation processes undertaken for long-established and newly developed instruments, using higher-quality methods and estimating all psychometric properties.

Beyond its key role in calcium homeostasis, vitamin D has been found to significantly affect the cardiovascular (CV) system. In fact, low vitamin D levels have been associated with increased CV risk, as well as increased CV morbidity and mortality. The majority of effects of this molecule are related directly or indirectly to its antioxidative and anti-inflammatory properties. Generally, vitamin D insufficiency is considered for 25-hydroxyvitamin D (25(OH)D) levels between 21-29 ng/mL (corresponding to 52.5-72.5 nmol/L), deficiency as 25(OH)D levels less than 20 ng/mL (<50 nmol/L), and extreme deficiency as 25(OH)D less than 10 ng/mL (<25 nmol/L). However, the definition of an optimal vitamin D status, as defined by 25(OH)D, remains controversial for many extra-bone conditions, including CV disease. In this review, confounding factors affecting the 25(OH)D measurement and status will be discussed. In particular, available evidence on the mechanism and role of vitamin D in relation to CV risk and disease through its antioxidant effect will be reported, also facing the aspect regarding the debate on the minimum blood 25(OH)D level required to ensure optimal CV health.

Background: Nursing education consists of theory and practice, and student nurses' perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools., Methods: We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC., Results: In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools., Conclusion: Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments' external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties.

The combined approach of ex situ normothermic machine perfusion (NMP) and nanotechnology represents a strategy to mitigate ischemia/reperfusion injury in liver transplantation (LT). We evaluated the uptake, distribution, and efficacy of antioxidant cerium oxide nanoparticles (nanoceria) during normothermic perfusion of discarded human livers. A total of 9 discarded human liver grafts were randomized in 2 groups and underwent 4 h of NMP: 5 grafts were treated with nanoceria conjugated with albumin (Alb-NC; 50 µg/ml) and compared with 4 untreated grafts. The intracellular uptake of nanoceria was analyzed by electron microscopy (EM) and inductively coupled plasma-mass spectrometry (ICP-MS). The antioxidant activity of Alb-NC was assayed in liver biopsies by glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) assay, telomere length, and 4977-bp common mitochondrial DNA deletion (mtDNA 4977 deletion). The cytokine profile was evaluated in perfusate samples. EM and ICP-MS confirmed Alb-NC internalization, rescue of mitochondrial phenotype, decrease of lipid droplet peroxidation, and lipofuscin granules in the treated grafts. Alb-NC exerted an antioxidant activity by increasing GSH levels (percentage change: +94% ± 25%; p = 0.01), SOD (+17% ± 4%; p = 0.02), and CAT activity (51% ± 23%; p = 0.03), reducing the occurrence of mtDNA 4977 deletion (-67.2% ± 11%; p = 0.03), but did not affect cytokine release. Alb-NC during ex situ perfusion decreased oxidative stress, upregulating graft antioxidant defense. They could be a tool to improve quality grafts during NMP and represent an antioxidant strategy aimed at protecting the graft against reperfusion injury during LT., (© 2022 American Association for the Study of Liver Diseases.)

COVID-19 represents a worldwide public health emergency, and, beyond the respiratory symptoms characterizing the classic viral disease, growing evidence has highlighted a possible reciprocal relationship between SARS-CoV-2 infection and thyroid dysfunction. The updated data discussed in this review suggests a role of SARS-CoV-2 infection on the thyroid gland, with multiple thyroid pictures described. Conversely, no conclusion can be drawn on the association between pre-existing thyroid disease and increased risk of SARS-CoV-2 infection. In this scenario, selenium (Se), an essential trace element critical for thyroid function and known as an effective agent against viral infections, is emerging as a potential novel therapeutic option for the treatment of COVID-19. Large multicentre cohort studies are required to elucidate the mechanisms underlying thyroid dysfunction during or following recovery from COVID-19, including Se status. Meanwhile, clinical trials should be performed to evaluate whether adequate intake of Se can help address COVID-19 in Se-deficient patients, also avoiding thyroid complications that can contribute to worsening outcomes during infection.

The thyroid hormone receptors are the mediators of a multitude of actions by the thyroid hormones in cells. Most thyroid hormone activities require interaction with nuclear receptors to bind DNA and regulate the expression of target genes. In addition to genomic regulation, thyroid hormones function via activation of specific cytosolic pathways, bypassing interaction with nuclear DNA. In the present work, we reviewed the most recent literature on the characteristics and roles of different factors involved in thyroid hormone function in particular, we discuss the genomic activity of thyroid hormone receptors in the nucleus and the functions of different thyroid hormone receptor isoforms in the cytosol. Furthermore, we describe the integrin αvβ3-mediated thyroid hormone signaling pathway and its rapid nongenomic action in the cell. We furthermore reviewed the thyroid hormone transporters enabling the uptake of thyroid hormones in the cell, and we also include a paragraph on the proteins that mediate thyroid receptors' shuttling from the nucleus to the cytosol.

Selenium (Se), a microelement essential for life, is critical for homeostasis of several critical functions, such as those related to immune-endocrine function and signaling transduction pathways. In particular, Se is critical for the function of the thyroid, and it is particularly abundant in this gland. Unfortunately, Se deficiency is a very common condition worldwide. Supplementation is possible, but as Se has a narrow safety level, toxic levels are close to those normally required for a correct need. Thus, whether the obtaining of optimal selenium concentration is desirable, the risk of dangerous concentrations must be equally excluded. This review addressed the contribution by environment and food intake on Se circulating levels (e.g., geographical factors, such as soil concentration and climate, and different quantities in food, such as nuts, cereals, eggs, meat and fish) and effects related to its deficiency or excess, together with the role of selenium and selenoproteins in the thyroid pathophysiology (e.g., Hashimoto's thyroiditis and Graves' disease).

Background and Aims: Vitamin D counteracts the reduction in the peripheral conversion of tiroxine (T4) into triiodothyronine (T3), which is the mechanism of low T3 syndrome (LT3) in acute myocardial infarction (AMI). The aim of this study was to assess the relationship between LT3 and hypovitaminosis D in AMI patients., Methods and Results: One hundred and twenty-four AMI patients were enrolled. Blood samples were taken at admission, and at 3, 12, 24, 48, and 72 h after admission. LT3 was defined as a value of fT3 ≤ 2.2 pg/mL, occurring within 3 days of hospital admission. Levels were defined as follows: sufficiency as a value of ±30 ng/mL, vitamin D insufficiency as 25-hydroxyvitamin D (25(OH)D) between 21 and 29 ng/mL, deficiency in 25(OH)D as below 20 ng/mL, and severe deficiency as values under 10 ng/mL. The percentage of subjects with severe 25(OH)D deficiency was significantly higher in the LT3 group (33% vs. 13%, p < 0.01). When LT3S was evaluated as a dependent variable, severe 25(OH)D deficiency (OR 2.6: 95%CI 1-6.7, p < 0.05) remained as an independent determinant after logistic multivariate adjustment together with age (>69 yrs, 50th percentile; OR 3.4, 95% CI 1.3-8.3, p < 0.01), but not female gender (OR 1.7, 95% CI 0.7-4.2, p = ns)., Conclusions: This pilot study shows a relationship between hypovitaminosis D and LT3 in AMI patients. This association opens potential therapeutic challenges concerning the restoration of euthyroidism through vitamin D administration, together with the normalization of hypovitaminosis.

Purpose: The deiodinases activate or inactivate the thyroid hormones (TH) in virtually all tissues in both physiological and pathological conditions. The three deiodinases, DIO1, DIO2, and DIO3, have different catalytic functions and regulate TH tissue distribution. The aim of the present study was to evaluate the modulation of gene expression of the deiodinases and TH transporters and protein levels of DIO1 in parietal and frontal areas of cerebral cortex of spontaneously hypertensive rats (SHRs), after two successive mandibular extensions (ME)., Methods: ME was performed on anesthetized rats by a dilatator appropriately designed and real-time PCR and western blotting techniques were employed for gene expression and protein level study., Results: Mean blood pressure (MBP) significantly decreased in 2ME-treated rats when compared to sham-operated rats (p < 0.001) and this decrease lasted for the entire observation period. In gene expression analysis, in 2ME-treated rats we did not observe any significant variation of DIO1 and DIO3 with respect to the sham-operated rats. Differently, DIO2 gene expression significantly increased in frontal area of 2ME-treated rats, with respect to sham-operated rats (p < 0.01). Furthermore, in parietal area, protein levels of DIO1 in 2ME-treated rats were significantly higher than in sham-operated rats (p < 0.01). Moreover MCT8 and OATP1C1 both resulted significantly higher (p < 0.05 and p < 0.001) in sham frontal cortex., Conclusion: In summary, our data on SHRs, while confirming the hypotensive effect of two MEs, show that the treatment also solicits the three deiodinases production in the cerebral cortex., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Thyroid hormone (TH) signaling is strictly regulated by iodothyronine deiodinase activity, which both preserves the circulating levels of the biologically active triiodothyronine (T3) and regulates TH homeostasis at the local level, in a cell- and time-dependent manner. Three deiodinases have been identified-namely iodothyronine deiodinase 1 (DIO1), DIO2, and DIO3-that differ in their catalytic properties and tissue distribution. The deiodinases represent a dynamic system that changes in the different stages of life according to their functions and roles in various cell types and tissues. Deiodinase activity at the tissue level permits cell-targeted fine regulation of TH homeostasis, mediating the activation (DIO1 and DIO2) and inactivation (DIO3) of THs. Deiodinase homeostasis is the driving force that leads T3-target cells towards customized TH signaling, which takes into account both the hormonal circulating levels and the tissue-specific response. This review analyzes the complex role of deiodinases in physiological and pathological contexts, exploring new challenges and opportunities deriving from a deeper knowledge of the dynamics underlying their roles and functions.

The role of thyroid hormones (THs) in the cardiovascular (CV) system, through several direct and indirect effects is recognized. Even very small modification in TH levels (as those observed in subclinical hypothyroidism or hyperthyroidism, and low triiodothyronine syndrome) may adversely affect the CV system, whereas thyroid hormones benefit the CV system and improve the prognosis. There is also evidence of vitamin D effects on cardiometabolic disease ( e.g. , through modulation of endothelial and smooth muscle cell activity, renin-angiotensin-aldosterone system, nitric oxide, oxidative stress, and inflammatory response), as well as an association between vitamin D [25(OH)D] deficiency and autoimmune thyroid diseases or cancer, and a relationship between vitamin D concentration and titers of antibodies and thyroid autoimmunity replacement. Interestingly, experimental data indicate a direct effect of vitamin D on Type 2 deiodinase expression causing subsequential peripheral conversion of T4 into T3. However, the functional links among THs, vitamin D and the cardiovascular system, and clinical effects of coexisting abnormalities in this new troublesome triad, have not yet been reviewed. The main aim of this review is to discuss pathophysiology of this relationship, proposing new mechanistic insights involving vitamin D in the modulation of cardiometabolic disease and thyroid profile., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Vassalle, Parlanti, Pingitore, Berti, Iervasi and Sabatino.)

The endothelium controls vascular homeostasis through a delicate balance between secretion of vasodilators and vasoconstrictors. The loss of physiological homeostasis leads to endothelial dysfunction, for which inflammatory events represent critical determinants. In this context, therapeutic approaches targeting inflammation-related vascular injury may help for the treatment of cardiovascular disease and a multitude of other conditions related to endothelium dysfunction, including COVID-19. In recent years, within the complexity of the inflammatory scenario related to loss of vessel integrity, hydrogen sulfide (H 2 S) has aroused great interest due to its importance in different signaling pathways at the endothelial level. In this review, we discuss the effects of H 2 S, a molecule which has been reported to demonstrate anti-inflammatory activity, in addition to many other biological functions related to endothelium and sulfur-drugs as new possible therapeutic options in diseases involving vascular pathobiology, such as in SARS-CoV-2 infection.

The incidence and prevalence of type 2 diabetes have increased in the last decades and are expected to further grow in the coming years. Chronic hyperglycemia triggers free radical generation and causes increased oxidative stress, affecting a number of molecular mechanisms and cellular pathways, including the generation of advanced glycation end products, proinflammatory and procoagulant effects, induction of apoptosis, vascular smooth-muscle cell proliferation, endothelial and mitochondrial dysfunction, reduction of nitric oxide release, and activation of protein kinase C. Among type 2 diabetes determinants, many data have documented the adverse effects of environmental factors (e.g., air pollutants) through multiple exposure-induced mechanisms (e.g., systemic inflammation and oxidative stress, hypercoagulability, and endothelial and immune responses). Therefore, here we discuss the role of air pollution in oxidative stress-related damage to glycemic metabolism homeostasis, with a particular focus on its impact on health. In this context, the improvement of new advanced tools (e.g., omic techniques and the study of epigenetic changes) may provide a substantial contribution, helping in the evaluation of the individual in his biological totality, and offer a comprehensive assessment of the molecular, clinical, environmental, and epidemiological aspects.

Purpose: Transitions in nursing education and professionalism that align with global nursing standards are elucidated as critical success factors in transforming health professionals and health care in Albania. Progressive educational and regulatory pathways throughout the 2000s (1999-2020) are emphasized for their impact on the Albanian health system, including the achievement of universal healthcare coverage., Methods: Data collected by the Ministry of Health and Sport and the Regulatory Authority for nursing and other healthcare professions in Albania were analyzed and outcomes explicated with regard to Albania's major health challenges., Discussion and Conclusions: Three milestones affirmed nursing as a driving force in the Albanian healthcare system: (a) nurses constitute the largest health professional workforce via a nurse-patient ratio of 1:400 in contrast to a physician-patient ratio of 1:2,500; (b) nurses are frontline care providers via clinical leadership in the management of primary healthcare centers, which ensure universal healthcare coverage; and (c) nurses are first responders via their presence and compassionate caring in the primary healthcare centers, including making critical shifts in converting primary healthcare centers to urgent care centers as needed., Clinical Relevance: Nursing advancements have implicated quality care and professionalism in Albania across the health professions via three critical pathways: (a) health professional education at a university degree level for entry into practice (since 1999), which was prompted by and driven by nursing's quest to be a self-regulated profession (achieved in 2007); (b) healthcare global standards sparked by nursing's mandate toward professional autonomy, as achieved via regulatory procedures and policies; and (c) interprofessional healthcare initiatives that serve as collaborative platforms for innovative educational, clinical, and research projects., (© 2021 Sigma Theta Tau International.)

The deiodinases regulate the activation and inactivation of Thyroid hormones (TH), in both physiological and pathological conditions. The three deiodinases, DIO1, DIO2 and DIO3, have different catalytic role and cellular and tissue distribution. Aim of this study is to evaluate a rat model of regional ischemia/reperfusion (I/R), the modification of cardiac main function after the administration of 6 µg/kg/day of triiodothyronine (T3), and the associated to DIO1, DIO2 and DIO3 gene expression. We also aim to study DIO1 and DIO2 protein levels in different left ventricular regions after an ischemic event. Four groups of rats were studied: sham-operated, sham-operated + T3, I/R rats and I/R rats + T3. DIO1, DIO2 and DIO3 expression were evaluated in I/R region (AAR: area-at-risk) and in a more distant region from ischemic wound (RZ: remote zone). In I/R group, circulating free-T3 (FT3) levels were significantly decreased with respect to basal values, whereas in I/R + T3 rats, FT3 levels were comparable to basal values. In AAR of I/R + T3 rats, DIO1 and DIO2 gene expression significantly increased with respect to sham. In RZ, DIO1 and DIO3 gene expression was significantly lower in sham and I/R rats when compared to I/R + T3. In sham + T3 group, DIO1 and DIO2 gene expression was not detectable, whereas DIO3 was significantly higher than in the other three groups. The present study gives interesting new insights on DIO1, DIO2 and DIO3 in the ischemic heart and their role in relation to T3-mediated amelioration of cardiac function and structure.

Background: Modulation of oxidative stress/inflammation during exercise may have both positive and negative health effects, depending by a number of factors (e.g. training status, and exercise type, intensity and duration) and the oxidative stress or inflammation-related biomarkers considered, which may reflect different levels of the oxidative stress/inflammatory multi entities. The aim of this study was to evaluate oxidative stress and inflammatory multi-biomarker panel in response to a half-marathon during early and delayed recovery., Methods: Blood samples (baseline, postrace within 20 min after the race end, and 24 h and 48 h after the run) from runners (N.=31, 20 males, mean age 47±6 years) were assessed for reactive oxygen species (ROM assay) and total antioxidant capacity (OXY test), leukocyte telomere length (LTL), procoagulant activity of circulating microparticles (MP-PCA), inflammatory parameters obtained by hemocrome, and irisin., Results: A significant decrease for OXY (from 375±71 to 280±66, 239±54, 239±45 µmolHClO/mL) after the half-marathon and during recovery was observed. A reduction for ROMs was also evidenced respect to baseline (from 328±46 to 301±39, 290±56, 320±55 AU). Instead, MP-PCA increased after the race (from 6.2±6 to 10.5±6, 7±4.3 and 5.8±2.1 nmol/L), whereas the other biomarkers did not significantly change., Conclusions: The oxidant counterpart did not increase in response to the half-marathon, likely counteracted by antioxidants, which appeared greatly worn out. MP-PCA and WBC increase, always within the normality range, may represent an adaptation to regular chronic endurance training. In any case, antioxidant supply could be considered and tailored for each athlete in this exercise setting.

Oxidative stress (OxS) is one of the main processes related to aging and a common denominator of many different chronic/degenerative diseases (e.g., cardiovascular and neurodegenerative conditions and cancer). Thus, its potential modulation by supplementation/pharmacological therapy caused a lot of interest. However, these expectations have been mitigated by the obtainment of controversial results (beneficial, null, or adverse effects) following antioxidant interventions. Here, we discuss the current understanding of OxS assessment in health and disease, challenges and the potential of its evaluation in clinical practice, and available and future development for supplementation and pharmacologic strategies targeting OxS.

Osteopontin (OPN), a novel hepatic damage marker, as well as several non-coding RNA seem to be associated with liver aging, a little studied and not yet defined process. The aim of the study was to evaluate the expression variations of OPN and miRNA-181a, the transcriptional profiling of long non coding (lnc) RNA GAS-5/miRNA-222 axis and lncRNA NEAT-1 in liver tissue of rats. In addition, to monitor the senescence process, the telomere shortening and TERT/TERC gene expression were also measured. Three groups of male Wistar rats were studied: A (n = 6, young); B (n = 13, adult); C (n = 10, old). Total RNA, including miRNAs, was extracted from liver and analysed by Real-Time PCR. Ultrasound and biochemical evaluation were performed in all rats as well as the histological analysis. OPN mRNA resulted lower in C with respect to A and B while miRNA-181a expression was significantly increased as a function of age. An increasing of both NEAT-1 and miRNA-222 expression as a function of age in parallel with a decreasing of GAS-5 expression in young and old rats, but not in the adults, was observed. A positive correlation was detected between miRNA-181a and miRNA-222. The hepatic ultrasound analysis revealed areas of hyperechogenicity distributed as a function of age. A significant telomere shortening was measured as a function of age while the two subunits TERT and TERC expressions showed an opposite trend. This work could provide a valid starting point to better understand the physiopathological changes during aging, pinpointing in the OPN/miRNA-181a axis significant predictors of successful aging., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Oxidative stress has a pivotal and widely described role in the onset and progression of atherosclerotic plaque and cardiovascular disease. Many oxidative stress-related biomarkers can be measured in biological samples; however, there are still many aspects that limit the adoption of oxidative stress assessment in clinical laboratory practice. Here, we report an overview of the different sources and main common oxidative stress biomarkers relevant for cardiovascular physiopathology, describing in detail a recently proposed lipidomic assay for ceramide assessment, as a promising future development in oxidative stress evaluation among the many available redox-related tests.

Ischemic heart disease is the main cause of morbidity and mortality worldwide and is becoming more widespread with population aging. Cardioprotection is a dynamic process characterized by mechanisms related to myocardial damage and activation of protective factors. Targeting these processes could be attractive as a new therapeutic strategy in the evolution of post-ischemic heart failure (HF). In this context, the role of thyroid hormone (TH)-mediated cardioprotection is supported by a number of findings regarding the modulation of neuroendocrine systems, inflammatory and oxidative stress status, pro-survival intracellular pathways, and epigenetic factors, its effects on cardiac angiogenesis, structure, and function and on the preservation of mitochondrial function and morphology, and its beneficial effects on cell growth and redifferentiation. Moreover, the numerous effects of TH on the heart involve genomic mechanisms, which include cardiac differentiation during the perinatal period and non-genomic action, directed toward the maintenance of cardiovascular homeostasis. This evidence suggests that there is an opportunity to treat HF patients with TH. This review is mainly focused on the clinical evidence of the role of the thyroid system in the complex setting of HF., (Copyright © 2020 Mastorci, Sabatino, Vassalle and Pingitore.)

Cerium oxide nanoparticles (nanoceria [NC]) have attracted much attention in biomedicine due to their surface composition that confers interesting redox activities and regenerative properties. Studies have demonstrated that the application of NPs in biomedicine can influence components of hemostatic system, inducing blood clotting, alterations of blood cells, and endothelial cell functions. NC were tested in vitro to assess their hemocompatibility and anticoagulant, anti-inflammatory, and anti-senescence activity in human endothelial cells. Hemocompatibility has been evaluated in vitro looking at the impact of NC on coagulation times, fibrinogen, and platelet aggregation. The effect of NC on vascular endothelial cells were assayed by testing cell viability, antioxidant activity, anticoagulant (tissue factor [TF]-mRNA expression) and anti-inflammatory properties (VCAM-1 exposure, cytokine release), and senescence (telomere shortening). NC did not show significant effects on coagulation process, hemolysis, or platelet aggregation. In endothelial cells, NC did not affect cell viability, reduced oxidative stress, inhibited mRNA-TF expression, VCAM-1 expression, and cytokine release. Moreover, NC reduce telomere shortening, possibly counteracting premature senescence. The hemocompatibility combined with anticoagulant and anti-inflammatory phenotype and the ability of counteract the premature senescence in vascular cells make NC a promising therapeutic tool in oxidative stress-related conditions. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2019., (© 2019 Wiley Periodicals, Inc.)

Aims and Objectives: To determine the relevance of nursing's professional dignity in palliative care., Background: Dignity is a valued concept in the ethical discourse of health disciplines. Nursing's professional dignity, a concept related to professional identity, is not clearly defined nor have its characteristics been delineated for its clinical relevance in palliative care., Design: A qualitative methodological approach., Methods: Focus groups elicited dialogues of nursing's professional dignity among 69 nurses working in hospices and home-care in Italy. Data were content-analysed via an inductive process. The COREQ checklist for qualitative studies was used for reporting this research., Results: A central theme related to (a) "Intrinsic dignity of persons" was embedded in the essence of palliative care. Several corollary themes underscored this central theme: (b) Professional (intra- and inter) relationships and teamwork; (c) Nursing professionalism; (d) Ethical dilemmas; and (e) Relationships with patients and their significant persons., Conclusions: Nurses valued the essence of respect as persons and the essence of respect for their work as coherent with intrinsic dignity and work dignity in palliative care. Nurses perceived their psycho-social relationships with patients and their families as rewarding incentives amidst disputatious interactions with peers and/or other healthcare professionals. They experienced ethical dilemmas, which they perceived as inherent in palliative care., Relevance to Clinical Practice: Study findings corroborate the literature regarding the concept of nursing's professional dignity which is intrinsic in respect of the human person. The intrinsic dignity in palliative care manifests as nurses are working in juxtaposition of a demanding yet rewarding care ambience., (© 2018 John Wiley & Sons Ltd.)

Triiodothyronine (T3) and renin-angiotensin system (RAS) are functionally related in cardiovascular system. Recently, in an in vivo myocardial ischemia/reperfusion (I/R) model in rats, we showed that T3 treatment improved the post-ischemic recovery of cardiac function. In the present study, we used the same experimental model of regional I/R, obtained by 30 min occlusion of the left descending coronary artery, followed by 3-days of reperfusion, to investigate the effect of 48-h treatment (started 1 day after ischemia) with 6 µg/kg/day T3 or vehicle. T3 was delivered by constant subcutaneous infusion via miniosmotic pump. In particular, aim of this work is to evaluate the effects of T3 on the gene expression of the main receptors and enzymes involved in the two cardiac arms of RAS in an in vivo rat model of I/R: AT1R-ACE (detrimental arm) and AT2R/MAS1-ACE2 (protective arm). Gene expression was evaluated by Real-Time PCR in infarct zone (Area-At-Risk: AAR) and in tissues distant from ischemic wound (Remote Zone: RZ). Three different rat groups were used: sham-operated; I/R and I/R + T3. Main result of the study is the opposite response of AT1R and AT2R/MAS1 expression to I/R procedure and to T3 administration after I/R in both AAR and RZ. Moreover, T3 significantly increased ACE and ACE2 enzyme expression in AAR and RZ. This study reveals that T3 stimulates the expression of protective genes related to RAS such as AT2R/MAS1-ACE2 mainly in BZ, suggesting that, at least in part, T3 could be involved in the local cardiac ameliorative response to I/R procedure.

Previous studies in anesthetized normotensive rats demonstrated that a single mouth opening for 10 min obtained by an ad hoc dilator (mandibular extension [ME]) produced a blood pressure reduction by about 20 mmHg lasting for about 2 h and that once-repeated ME prolonged this effect. We here describe these effects in hypertensive rats. Mean (intra) arterial blood pressure (MABP) and heart rate (HR) was followed for up to a maximum of 470 min after single or repeated 10 min-lasting ME in two groups of anesthetized, male, 6-9 months old hypertensive rats. In one group, hypertension was induced by dexamethasone (20 μg/kg/day, subcutaneously for 7 days; Dex-HT); the other group was spontaneously hypertensive rats (SHR). Studies were done, in Dex-HT rats, after only surgical procedures (no ME, sham-operated rats), single ME, early repeated (after 10 min) ME (ER-ME) and late repeated (after 160 min) ME (LR-ME) and, in SHR, after only surgical procedures and ER-ME. One-way ANOVA for repeated measures revealed no significant effect on MABP and HR in sham-operated groups. In Dex-HT rats, single ME was followed by a significant MABP decline by 25 mmHg, lasting for 100 min; ER-ME and LR-ME were followed by an even greater significant MABP decline by 40 mmHg, which outlasted the experimental observation period. In SHR, ER-ME gave similar results as in Dex-HT rats. HR significantly declined in all, except sham-operated groups. In conclusions, ME is followed by a prolonged MABP decline also in hypertensive rats. This effect is even more pronounced, in length and magnitude, after repeated ME., (© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)

There is an ongoing interest in the renin-angiotensin system (RAS) contribution either to pathological mechanisms leading to hypertension (mainly regarding the ACE/AngII/AT1R axis), or, to RAS protective and pro-regenerative actions, primarily ascribed to the mediation of the AT2R and the MAS1 receptor. In the present study, we evaluated the modulation of gene expression and protein levels of "deleterious" (ACE/AngII/AT1R) and "protective" [ACE/AngII/AT2R and ACE2/Ang(1-7)/MAS1 arms] RAS components in parietal and frontal areas of cerebral cortex of spontaneously hypertensive rats (SHRs), after two periods of mandibular extensions (MEs). Blood pressure, BP and heart rate, HR were also measured. While no significant changes in BP and HR were present in the sham operated (SO) group, in rats after two MEs (2-ME rats), BP displayed a marked decrease ( p < 0.001) at ME2, and remained then stably low for the subsequent observation period. In gene expression analysis, in SHRs undergoing two MEs, either in parietal or frontal cortex, we did not observe any significant variation of AT2R and ACE2 with respect to SO rats. In contrast, we observed a decrease in Mas1 gene expression in parietal area ( p < 0.01) and an increase in frontal region ( p < 0.01). AT1R and ACE gene expression was significantly higher in 2-ME rats than SO in parietal cortex ( p < 0.05) but no difference was observed in the frontal area. Concerning protein levels, in parietal area, AT1R and AT2R did not change whereas MAS1 significantly decreased in 2-ME rats ( p < 0.05). In frontal area, both AT1R and AT2R significantly decreased in 2-ME rats ( p < 0.05), whereas MAS1 did not significantly change. Gene expression analysis in normotensive (NT) rats revealed the non-detectability of AT1R in both parietal and frontal zone. In parietal area, AT2R ( p < 0.0001) and Mas1 ( p < 0.01) were significantly decreased in 2-ME NT rats, when compared to SO, and ACE and ACE2 resulted not detectable whereas there was some expression of these genes after 2-ME procedure. In conclusion, our data in rat models indicated that a 2-ME procedure induced a hypotensive response and that a modulation of gene expression and protein levels of RAS components occurred in different cerebral cortex areas.

Background: There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context. Research question/aim: The purpose of this study was to develop better understandings of perceptions of nursing's professional respect in community and hospital settings in England., Research Design: The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing's professional respect. Participants and research context: A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study., Methods: Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes. Ethical considerations: To conduct the research, permission was obtained from the selected universities., Results: Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses' professional autonomy and decision-making., Conclusion: Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals.

Purpose: Cardiac Troponins (cTnI, cTnT), NT-proBNP, and galectin-3 (GAL-3) mirror cardiomyocyte injury, stretch, and fibrosis. However, although these biomarkers has been thoroughly studied in marathon or ultramarathon, the effects occurring running shorter distances, as half-marathon, are less known and data are generally limited to immediately post-race evaluation. Moreover, significant variation of alpha-1 antitrypsin (AAT), an anti-protease factor with anti-inflammatory properties, has been recently observed in heart failure, but not investigated in paraphysiological settings. The aim of the study was to evaluate these biomarkers concentration and trends in trained runners before half-marathon run and during a 48-h recovery period., Methods: In 18 half-marathon runners (15 males, 46 ± 6 years), cTnI, GAL-3 (Architect, Abbott), cTnT, NT-proBNP (Cobas e411, Roche), and AAT (Abcam, Cambridge, UK) were evaluated at rest, immediately post-run, and at 24 and 48-h recovery period., Results: cTnT, NT-proBNP, and GAL-3 transiently increased after post-race, but normalized at 24 h (GAL-3 p < 0.01, cTnT < 0.001) or 48 h (NT-proBNP < 0.001), while cTnI and AAT did not significantly change. The frequency of values exceeding the diagnostic threshold, as evaluated at baseline and after the race, did not differ for cTnI ([Formula: see text] = 1.1, p = ns), and NT-proBNP ([Formula: see text] = 6, p = ns), but significantly increased for cTnT ([Formula: see text] = 23, p < 0.001) and GAL-3 ([Formula: see text] = 6.3, p < 0.05). None of the subjects showed AAT values exceeding the reference range at baseline and at any of the time points after the race., Conclusion: The transient cTnT, NT-proBNP, and GAL-3 increase may suggest a temporary stress on the myocyte. However, being the increase of all biomarkers moderate and reversible, it may represent a physiological response to acute exercise.

Serum angiopoietin-2 level is elevated in several diseases suggesting its possible role as a mediator of angiogenesis and vascular network remodeling. Triiodothyronine and thyroxine have well documented effects on angiogenesis in vitro, but only few reports have studied angiopoietin-2 in thyroid-disease patients. The aim of the present study was to measure soluble angiopoietin-2 serum levels in a group of thyroid-disease patients with different levels of free triiodothyronine and thyroxine. Angiopoietin- 2 were quantified by ELISA in sera of fifteen healthy volunteers and forty-two thyroid ambulatory patients: nine with hyperthyroidism, four in therapy for hyperthyroidism, seven with subclinal hyperthyroidism, twelve with hypothyroidism, five with thyroiditis and five in therapy for thyroiditis. Median angiopoietin-2 level was significantly elevated in hyperthyroid patients (p < 0.01) and it was significantly increased vs all the other groups (p < 0.0001). In hyperthyroid patients anti thyroid therapy seems to reduce angiopoietin-2 level. A significant positive correlation was observed between Log angiopoietin-2 levels and serum concentration of Log free triiodothyronine (r = 0.4, P < 0.001) and Log free thyroxine (r = 0.4, P < 0.001) respectively. In conclusion, increased levels of angiopoietin-2 are present in hyperthyroid patients, and seems to correlate with free triiodothyronine and free thyroxine levels but not with anti-thyroid antibodies. These findings suggest angiopoietin-2 as a mediator of angiogenesis and vascular network remodeling in this disease, but further studies will be needed to determine the role of this biomarker in the pathophysiology and progression of hyperthyroidism., (Copyright: © 2016 by Fabrizio Serra editore, Pisa · Roma.)

Aims and Objectives: To investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration., Background: To study the worldwide, nursing flux is a health priority in the globalised world. The growth in migration trends among nurses, not only from Philippines or India, has proliferated in recent years. The research on nurses' mobility for Southern European countries is underexplored, and in Italy, the out-migration flows of Indian nurses were never analysed., Design: Qualitative methodological approach., Methods: Semi-structured interviews (n = 20) were completed with Indian clinical nurses working in Italy for more than one year mainly in private organisations. A purposive sampling technique was used for recruitment. The data were then content-analysed using an inductive method., Results: The findings were categorised into four themes: (1) aspects of professional integration and working experience, (2) intra- and interprofessional relationships and perceptions of the IPASVI Regulatory Nursing Board, (3) initial nursing education and continuous professional development and (4) perceptions of social integration., Conclusion: The results show that for Indian nurses in Italy emigration is important to gain opportunities to expand economic and social privileges as well as escape from historical assumptions of stigma associated with nursing work, especially for women. However, these conclusions have to be seen in wider socio-cultural complexities that are at the basis of transnational fluxes (Prescott & Nichter )., Relevance to Clinical Practice: The research offers an insight into the complicated reasons for Indian nurses out-migration to Italy. Without comprehending the interwoven textures of the political and social relations that are continually constructed and re-constructed among different nations, it is difficult to understand nurses out-migration and consequently have a better and safer collaborative teamwork in the host countries., (© 2017 John Wiley & Sons Ltd.)

Aim: Evaluation of gender-related differences in uric acid (UA), homocysteine and inflammatory biomarkers as metabolic syndrome (MetS) determinants., Patients & Methods: Anthropometric and routine data were obtained from 825 obese subjects (591 F, mean age 54 ± 14 years)., Results: Hyperuricemia was 24% in both genders. Waist circumference, creatinine, triglycerides, C-reactive protein and γ-glutamyltransferase were identified as UA-independent determinants in females and creatinine and insulin in males. Hyperuricemia increased MetS risk in both genders (2.8-fold and 1.5-fold in males and females)., Conclusion: UA and γ-glutamyltransferase positively relate to MetS in both genders, although inflammatory abnormalities are closer related to UA and MetS in females. These differences in gender physiology may account for epidemiologic gender disparities and help to develop gender-targeted clinical strategies.

Purpose/Introduction: Osteoporosis (OP) and cardiovascular (CV) disease emerge as closely related conditions, showing common risk factors and/or pathophysiological mechanisms. The aim of this study was to evaluate the association between bone health markers (BHM) and individual CV risk factors and overall CV risk (FRAMINGHAM-FRS, and PROCAM scores) in a general adult population., Methods: In 103 subjects (21 males; age: 56 ± 12 years), vitamin D (25(OH)D), osteocalcin (OC), bone alkaline phospatase (BALP), procollagen I aminoterminal propeptide (P1NP), CTx-telopeptide, as well clinical history and life style were evaluated., Results: Aging ( p < 0.001) and glycemia ( p < 0.05) emerged as independent 25(OH)D predictors. Aging ( p < 0.001), male sex ( p < 0.05), and obesity ( p < 0.05) represented independent OC determinants. Aging ( p < 0.05) was the only independent BALP determinant. After multivariate adjustment, low 25(OH)D (<20 ng/mL) (Odds ratio OR (95% confidence intervals CI)) (5 (1.4-18) p < 0.05) and elevated OC (>75th percentile-16.6 ng/mL) (6.7 (1.9-23.8) p < 0.01) were found to be significant FRS predictors, while subjects with elevated OC and/or BALP (>75th percentile-9.8 μg/L) showed a higher CV risk as estimated by PROCAM (3.6 (1.2-10.7) p < 0.05). CTx and P1NP did not significantly correlate with CV risk factors or scores., Conclusion: As we go further into bone and CV physiology, it is evident that a close relationship exists between these diseases. Further studies are needed to investigate mechanisms by which bone turnover markers are related to metabolic risk and could modulate CV risk. This knowledge may help to develop possible multiple-purpose strategies for both CV disease and OP prevention and treatment., Competing Interests: The authors declare no conflict of interest.

Introduction: Evaluation of calcium status is important in the osteoporotic risk assessment. Although guidelines indicate total calcium (tCa) as first-line measurement, directly measured ionized calcium (m-iCa), considered as the gold standard, is more and more often required. Aim of this study is to evaluate the agreement between m-iCa, tCa and iCa calculated from a formula based on total calcium and albumin (c-iCa) in osteopenic/osteoporotic postmenopausal outpatients., Methods: A total of 140 postmenopausal outpatients, 41 osteopenic (OPN) and 99 osteoporotic (OP) were enrolled. Levels of tCa, m-iCa, c-iCa, total protein and albumin, vitamin D (25-OHD), parathyroid hormone 1-84 (PTH), bone alkaline phosphatase, osteocalcin and serum collagen type 1 cross-linked C-telopeptide (CTX) were also measured., Results: There were no statistically significant differences between OPN and OP groups regarding values of tCa, m-iCa, and c-iCa, 25-OHD and PTH. However, OP women had lower levels of CTX (p < 0.05). A significant direct correlation between m-iCa and tCa (r = 0.60, p < 0.001) and c-iCa (r = 0.61, p < 0.001) was found. Women with isolated hyper-m-iCa had similar DEXA parameter levels respect to the other patients. However, one patient with confirmed primary hyperparathyroidism presented hyper-m-iCa versus normal tCa and c-iCa values., Conclusions: The use of tCa could be sufficient to characterize the calcium status in postmenopausal outpatients, but reflexive calcium testing strategy for m-iCa test is necessary to women presenting the low or high extremes of tCa levels, or in women with suspected PHPT.

Angiogenesis is a physiological process required for embryonic vascular development and involved in the pathophysiological progress of diseases such as atherosclerosis. In fact, hypoxia, ischemia and oxidative stress are common events in atherosclerotic plaque that stimulate angiogenesis, leading to the formation of a neovascularization in the intima of atherosclerotic lesions. The presence of these capillaries favours the progression of the plaque instability. Several studies indicate oxidized low-density lipoprotein (ox-LDL) and its endothelial receptor lectin-like oxidized low-density lipoprotein (LOX-1) as the major responsible for the occurrence and progression of atherosclerosis through apoptosis. At the same time, some authors showed that moderate concentrations of ox-LDL stimulate angiogenesis via LOX-1 activation of NADPH oxidase, MAPKs-NF-KB pathways and the generation of low levels of reactive oxygen species (ROS). Thyroid hormones have well documented effects on angiogenesis through genomic and non-genomic action and increased levels of ROS have been reported in hyperthyroidism. Moreover, by in vitro studies triiodothyronine (T3) and L-thyroxine (T4) significantly increased the intracellular ROS production based on the oxidation of 2',7'-dichloro dihydrofluorescein to a fluorescent 2',7'-dichlorofluoresein. Previous findings showed that ROS directly increase LOX-1 production in microvascular endothelial cells. New in vitro studies demonstrated the capability of T3 at supra-physiological doses to upregulate the LOX-1 expression in human microvascular endothelial cells. Thus, we can speculate the existence of a crosstalk between LOX-1-ROS and high levels of T3, suggesting that high levels of T3, as in hyperthyroidism, could cause a worsening of plaque vulnerability inducing angiogenesis., (Copyright: © 2016 by Fabrizio Serra editore, Pisa · Roma.)

Angiogenesis is important for recovery after tissue damage in myocardial ischemia/reperfusion, and tri-iodothyronine (T3) has documented effects on angiogenesis. The angiopoietins 1/2 and tyrosine kinase receptor represent an essential system in angiogenesis controlling endothelial cell survival and vascular maturation. Recently, in a 3-day ischemia/reperfusion rat model, the infusion of a low dose of T3 improved the post-ischemic recovery of cardiac function.Adopting this model, our study aimed to investigate the effects of T3 on the capillary index and the expression of angiogenic genes as the angiopoietins 1/2 and tyrosine kinase receptor system, in the thoracic aorta and in the left ventricle. In the thoracic aorta, T3 infusion significantly improved the angiogenic sprouting and angiopoietin 2 expression. Instead, Sham-T3 group did not show any significant increment of capillary density and angiopoietin 2 expression. In the area at risk (AAR) of the left ventricle, T3 infusion did not increase capillary density but restored levels of angiopoietin 1, which were reduced in I/R group. Angiopoietin 2 levels were similar to Sham group and unchanged by T3 administration. In the remote zone, T3 induced a significant increment of both angiopoietin 1/2. In conclusion, T3 infusion induced a different response of angiopoietin 1/2 between the ventricle (the AAR and the remote zone) and the thoracic aorta, probably reflecting the different action of angiopoietin 1/2 in cardiomyocytes and endothelial cells. Overall, these data suggest a new aspect of T3-mediated cardioprotection through angiogenesis., (© 2016 Society for Endocrinology.)

Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity., Objectives: The purpose of this study was to determine how nurses described nursing's professional dignity in internal medicine and surgery departments in hospital settings., Research Design: The research design was qualitative., Ethical Considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study., Participants: A total of 124 nurses participated in this study., Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes., Results: Nursing's professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing's professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses., Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries., (© The Author(s) 2014.)

Uric acid (UA) is a potent endogenous antioxidant. However, high concentrations of this molecule have been associated with cardiovascular disease (CVD) and renal dysfunction, involving mechanisms that include oxidative stress, inflammatory processes, and endothelial injury. Experimental and in vitro results suggest that this biomarker behaves like other antioxidants, which can shift from the physiological antioxidant action to a pro-oxidizing effect according to their level and to microenvironment conditions. However, data on patients (general population or CAD cohorts) are controversial, so the debate on the role of hyperuricemia as a causative factor for CVD is still ongoing. Increasing evidence indicates UA as more meaningful to assess CVD in women, even though this aspect needs deeper investigation. It will be important to identify thresholds responsible for UA "biological shift" from protective to harmful effects in different pathological conditions, and according to possible gender-related differences. In any case, UA is a low-tech and inexpensive biomarker, generally performed at patient's hospitalization and, therefore, easily accessible information for clinicians. For these reasons, UA might represent a useful additive tool as much as a CV risk marker. Thus, in view of available evidence, progressive UA elevation with levels higher than 6 mg/dL could be considered an "alarm" for increased CV risk.

Oxidative stress has been suggested to affect age-associated physiological dysfunction. Therefore, it is speculated that antioxidant supplements could have a potential role in preventing age-related diseases and death. Among different dietary habits, the highly antioxidant Mediterranean dietary pattern, which includes high vegetable and fruit intake, consumption of legumes, cereals, and fish, low intake of meat and dairy derivatives, moderate red wine consumption, and use of extra-virgin olive oil, is characterized by other aspects than food, such as conviviality, sensory stimulation, socialization, biodiversity, and seasonality that can reinforce the Mediterranean diet's (MeD) beneficial effects on wellbeing, quality of life, and healthy aging. The present review aims to discuss available data on the relationship between oxidative stress and aging, biomarkers of oxidative stress status, protective effects of the MeD, and the adoption of the Mediterranean lifestyle as a non-pharmacological and natural tool to cope with oxidative stress damage for a longer life span, and-even more important-healthy aging beyond the biological, psychological, and social challenges that old age entails.

This research explored the perceptions of third-year undergraduate nursing students in Italy in relation to the perceptions they had about factors that promoted or diminished the development of professional identity and the professional respect in themselves, and in nursing during their clinical training. Clinical training was meaningful to develop specific knowledge, communication skills, and interpersonal and inter-professional relationships in the area considered. It was also found to be equally important to have good role models to foster the moral development and build a solid professional identity for nursing students. Building a professional identity is an ongoing process and depends on social contexts and on the students' development of the ability to act morally. In this framework, student nurses have to be strongly supported to develop their identity as moral agents in spite of the conflicting demands on them in hostile settings that often do not make them feel respected for their actions. Based on our evidence, we identified two conceptual areas: positive role models and supportive working environments; both have to be strongly connected each other if the student nurses have to develop a strong respect for the ethical values of their profession., (Copyright © 2014. Published by Elsevier Ltd.)

Objectives: This study sought to assess the association between long-term radiation exposure in the catheterization laboratory (cath lab) and early signs of subclinical atherosclerosis., Background: There is growing evidence of an excess risk of cardiovascular disease at low-dose levels of ionizing radiation exposure., Methods: Left and right carotid intima-media thickness (CIMT) was measured in 223 cath lab personnel (141 male; age, 45 ± 8 years) and 222 unexposed subjects (113 male; age, 44±10 years). Leukocyte telomere length (LTL) was evaluated by quantitative reverse transcriptase polymerase chain reaction. The DNA repair gene XRCC3 Thr241Met polymorphism was also analyzed to explore the possible interaction with radiation exposure. The occupational radiological risk score (ORRS) was computed for each subject on the basis of the length of employment, individual caseload, and proximity to the radiation source. A complete lifetime effective dose (mSv) was recorded for 57 workers., Results: Left, right, and averaged CIMTs were significantly increased in high-exposure workers compared with both control subjects and low-exposure workers (all p values<0.04). On the left side, but not on the right, there was a significant correlation between CIMT and ORRS (p=0.001) as well as lifetime dose (p=0.006). LTL was significantly reduced in exposed workers compared with control subjects (p=0.008). There was a significant correlation between LTL and both ORRS (p=0.002) and lifetime dose (p=0.03). The XRCC3 Met241 allele presented a significant interaction with high exposure for right side (pinteraction=0.002), left side (pinteraction<0.0001), and averaged (pinteraction<0.0001) CIMTs., Conclusions: Long-term radiation exposure in a cath lab may be associated with increased subclinical CIMT and telomere length shortening, suggesting evidence of accelerated vascular aging and early atherosclerosis., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Endothelial system acts as a large endocrine organ in the human body; however, little is still known about the regulative role of THs on endothelial cells. Aim of the present study was to investigate the expression of the TH deiodinases (D1, D2, and D3) and TH receptors (TRα1, TRα2, and TRβ1) in an endothelial microvascular cultured cell model (HMEC-1), after stimulation with triiodothyronine (T3, 10-100 nM), thyroxine (T4, 10-100 nM), and reverse T3 (rT3, 1-10 nM). DIO1 was significantly inhibited by T4 at 10 and 100 nM (p < 0.001). rT3 significantly inhibited DIO1 at 1 nM concentration (p < 0.01) and stimulated DIO1 at 10 nM dosage (p < 0.001). T4 and rT3 significantly inhibited DIO2 at all concentrations. DIO3 was induced at 100 nM T3 (p < 0.05) and 100 nM rT3 (p < 0.01), and TRα1 and TRα2 mRNAs were significantly increased after 100 nM T3 treatment (p < 0.05) and decreased after 1 and 10 nM rT3 (p < 0.05). TRβ1 was significantly increased by all THs at different concentrations: 10 nM T3 and 100 nM T3 (p < 0.05), 1 nM rT3 (p < 0.001), and 100 nM T4 (p < 0.01). D1 and D2 protein levels were evaluated, but no significant difference was observed for any hormonal treatment. For the first time, we found that the TH deiodinases and receptors are expressed in endothelial HMEC-1 cells. These findings might be of significant clinical relevance, given the important regulatory role of the endothelium as first barrier to the bloodstream.

We explored the perceptions of Italian nurses regarding their developing culture as a health profession. We sought to understand the ongoing evolution of the nursing profession and the changes that were central to it becoming an intellectual discipline on par with the other health professions in Italy. In 2010, the Regulatory Board of Nursing established a center of excellence to build evidence-based practice, advocate for interdisciplinary health care, and champion health profession reforms for nursing. In this study, focus groups-involving 66 nurse participants from various educational, clinical, and administrative backgrounds-were utilized to better ascertain how the profession has changed. Six themes, three of them metaphors-"vortex," "leopard spots," and "deductive jungle"-explain nurses' experiences of professional change in Italy between 2001 and 2011 and the multiple dimensions that characterize their professional identity and autonomy., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Heart failure (HF) is an intriguing model of chronic disease. It starts as an organ disorder developing, in its progression, into a systemic disease in which the dysfunction of other organs plays a relevant clinical and prognostic impact. Furthermore, continuous activation of systemic pathways plays a role in disease progression, switching their effect from protective to harmful. In this combination of organ dysfunction and systemic derangement, thyroid hormone (TH) have an important regulative impact from cardiovascular to systemic level and from molecular/cellular processes to clinical setting. Whether it is accepted to include TH and thyroid stimulating hormone assessment in the clinical HF course, the next challenge will be to ascertain the benefit of TH replacement therapy in HF patients, taking into consideration the type of hormone to administer, dosage and treatment schedule.

Background: Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years., Objectives: The purpose of this meta-synthesis was to determine the various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept., Research Design: The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare., Method and Findings: Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements., Conclusion: The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients' dignity, patients' safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships., (© The Author(s) 2014.)

Purpose: Homozygous ABCA1 gene mutation causes Tangier disease (TD). The effects reported in heterozygous state regard plasma HDL, cell cholesterol efflux and coronary artery disease. We investigated whether in vitro replicative skin fibroblast senescence shown in TD proband (Hom), his father (Het), and in a healthy control might be induced in a "gene-dosage way"., Methods: Senescence was evaluated by staining test for β-Galactosidase and telomere length (TL) on fibroblast DNA at different replicative stages. ABCG1 and LDLR (low density lipoprotein receptor) gene expression was also evaluated., Results: Hom cells showed early senescent morphology and reduced growth at all passages in vitro. The cell positive percentage for β-Galactosidase test was highly increased in Hom compared to Het cells at late replicative status (66.1% vs 41.3% respectively). TL was significantly shorter at high stage either in Hom (p<0.0001) or in Het (p<0.005). At early replication cycles ABCG1 gene expression was about 3-fold higher in Hom compared to Het cells (0.44 vs 0.14 arbitrary unit)., Conclusions: ABCA1 gene mutation may have "gene-dosage way" effect on in vitro fibroblast senescence. Furthermore, increased ABCG1 and LDLR gene expression could highlight a role of ABCA1 on cytoskeleton regulation associated to cell cholesterol metabolism., (Copyright © 2014 Elsevier Inc. All rights reserved.)