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Background The use of administrative health databases (AHD) is a promising strategy to study the impact of rheumatoid arthritis (RA) at population level. Previous studies, using different methodologies, have shown moderate to excellent accuracy in case identification with sensitivity (Se) and specificity (Sp) ranging from 65 to 100% and from 55 to 97%, respectively. Objectives To derive and validate a diagnostic algorithm that accurately identifies RA cases in general population using AHD of the Italian health system. Methods A cross-sectional diagnostic study design was applied. To derive the algorithm, a first random sample of 900 visits between 2007-2010 was drawn from electronic medical records of a tertiary rheumatology centre, applying a case:control ratio of 1:2 [1]. A second sample of 138 patients from a secondary care rheumatology clinic with the same case control ratio and a third sample of 4457 subjects from general population (primary care registry) were used for external validation. Diagnoses were clinically validated, according to standardized criteria [2]. Clinical and administrative data were linked using deterministic record linkage through tax code. Useful items for the identification of RA cases were defined through a process informed by literature involving clinicians, analysts and statisticians. Using a priori beliefs and empirical data, an algorithm that applied the more specific criteria in the first step and progressively more sensitive criteria in the subsequent was developed. Accuracy was assessed calculating Se and Sp, and 95% confidence intervals (CI). The consistency of these estimates was tested both by internal validation (bootstrap), and by two fully independent external validations. Positive and negative predictive values (PPV and NPV) were also estimated in the general population sample. Results The following variables were included in the algorithm: ICD9 code 714.0 by rheumatologist, ICD9 codes for other rheumatologic diseases, cod

BACKGROUND: Dementia is a major public health problem because of its high prevalence in elderly individuals, particularly in the growing category of subjects aged 80 years or more. There is accumulating evidence that cholesterol may be implicated in the pathogenesis of dementia, and this has led us to assess the relationship between time spent with statins available and the risk of hospitalization for dementia. METHODS: A population-based, nested case-control study was carried out by including the cohort of 152,729 patients from Lombardy (Italy) aged 40 years or older who were newly treated with statins between 2003 and 2004. Cases were the 1380 patients who experienced hospitalization for dementia disease from initial prescription until 2010. Up to twenty controls were randomly selected for each case. Logistic regression was used to model the risk of dementia associated with the cumulative time during which statins were available. Monte-Carlo and rule-out sensitivity analyses were performed to account for unmeasured confounders. RESULTS: Compared with patients who had very short statins coverage (less than 6 months), those on 7-24, 25-48, and >48 months of coverage respectively had risk reductions of 15% (OR: 0.85; 95% CI: 0.74 to 0.98), 28% (OR: 0.72; 95% CI: 0.61 to 0.85), and 25% (OR: 0.75; 95% CI: 0.61 to 0.94). Simvastatin and atorvastatin were both associated with a reduced risk of dementia, while no similar evidence was observed for fluvastatin and pravastatin. CONCLUSIONS: Long-term use of statins seems effective for the prevention of dementia.

OBJECTIVE: To conduct a systematic review of observational studies on the risk of acute myocardial infarction (AMI) with use of individual nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: A search of Medline (PubMed) for observational studies published from 1990 to 2011 identified 3829 articles; 31 reported relative risk (RR) of AMI with use of individual NSAIDs versus nonuse of NSAIDs. Information abstracted in a standardized form from 25 publications was used for the meta-analysis on 18 independent study populations. RESULTS: Random-effects RR (95% confidence interval (CI)) was lowest for naproxen 1.06 (0.94–1.20), followed by celecoxib 1.12 (1.00–1.24), ibuprofen 1.14 (0.98–1.31), meloxicam 1.25 (1.04–1.49), rofecoxib 1.34 (1.22–1.48), diclofenac 1.38 (1.26–1.52), indometacin 1.40 (1.21–1.62), etodolac 1.55 (1.16–2.06), and etoricoxib 1.97 (1.35–2.89). Heterogeneity between studies was present. For new users, RRs (95% CIs) were for naproxen, 0.85 (0.73–1.00); ibuprofen, 1.20 (0.97–1.48); celecoxib, 1.23 (1.00–1.52); diclofenac, 1.41 (1.08–1.86); and rofecoxib, 1.43 (1.21–1.66).Except for naproxen, higher risk was generally associated with higher doses, as defined in each study, overall and in patients with prior coronary heart disease. Low and high doses of diclofenac and rofecoxib were associated with high risk of AMI, with dose–response relationship for rofecoxib. In patients with prior coronary heart disease, except for naproxen, duration of use ≤3 months was associated with an increased risk of AMI. CONCLUSIONS: Most frequently NSAIDs used in clinical practice, except naproxen, are associated with an increased risk of AMI at high doses or in persons with diagnosed coronary heart disease. For diclofenac and rofecoxib, the risk was increased at low and high doses.

Collagen matrices have been neoglycosylated with lactose by reductive amination at lysine side chains. AFM analysis highlights that the chemical neoglycosylation does not affect molecular assembly into fibrils. Moreover, ELLA biochemical assays show that the glycan moiety is efficiently exposed on the matrix surface for receptor recognition.

Biomaterials are needed for tissue regeneration applications that provide control of mechanical properties and enhanced toughness compared to conventional bioceramics. New sol-gel hybrids were developed with interpenetrating networks of silica and bis(3-aminopropyl) polyethylene glycol. Covalent coupling between the organic and the inorganic components was used to control mechanical properties of the hybrids. The objective was to synthesise and characterise a bis(3-aminopropyl) polyethylene glycol silica hybrid material with 35 wt% organic and 65 wt% inorganic and covalent coupling between the components. A coupling agent, 3-glycidopropyltrimethoxysilane (GPTMS) was used to form the covalent links. The hypothesis was that the epoxy ring of the GPTMS would react with the polymer, leaving a polymer functionalised with siloxane groups. In a sol of hydrolysed tetraethylorthosilicate (TEOS) the siloxanes from the GPTMS form –Si–O–Si– bonds between the functionalised polymer and the silica network. Bis(3-aminopropyl) polyethylene glycol contains two terminal amino groups available for the covalent functionalisation with the epoxy group of GPTMS. Hybrids with 35 wt% organic and 65 wt% inorganic with a ratio of GPTMS:PEG of 1:4 were proven to have an excellent balance between strain to failure (10 %) and compressive strength (20 MPa). However, the functionalisation of the polymer was followed by liquid NMR as a function of the aging time and temperature and the expected reaction of nucleophilic attack of the epoxy ring by the amino group of the polymer did not happen until the water was removed from the system during drying

Different methods for the functionalization of carbonate hydroxyapatite granules with free amine groups by reaction with (3-aminopropyl)triethoxysilane (APTES) have been compared in order to improve the potential for tethering of bioactive molecules to bioceramics. The combined use of tetraethoxyorthosilicate (TEOS) and APTES with acid catalysis resulted in an evident increase of amine surface grafting.

Metabolically stable arabinose 5-phosphate analogues possessing phosphate mimetic groups at the 5-position were synthesized and evaluated by saturation-transfer-difference (STD) NMR studies for their ability to interact with arabinose 5-phosphate isomerase. Isosteric methylphosphonate 1 and (difluoromethyl)phosphonate 3 were recognised and bound by the catalytic pocket of the enzyme. The synthesized compounds were tested in vivo on E. coli and P. aeruginosa strains in order to evaluate their antibacterial activity.

Hybrid organic–inorganic solids represent an important class of engineering materials, usually prepared by sol–gel processes by cross-reaction between organic and inorganic precursors. The choice of the two components and control of the reaction conditions (especially pH value) allow the synthesis of hybrid materials with novel properties and functionalities. 3-Glycidoxypropyltrimethoxysilane (GPTMS) is one of the most commonly used organic silanes for hybrid-material fabrication. Herein, the reactivity of GPTMS in water at different pH values (pH 2– 11) was deeply investigated for the first time by solution-state multinuclear NMR spectroscopic and mass spectrometric analysis. The extent of the different and competing reactions that take place as a function of the pH value was elucidated. The NMR spectroscopic and mass spectrometric data clearly indicate that the pH value determines the kinetics of epoxide hydrolysis versus silicon condensation. Under slighly acidic conditions, the epoxy-ring hydrolysis is kinetically more favourable than the formation of the silica network. In contrast, under basic conditions, silicon condensation is the main reaction that takes place. Full characterisation of the formed intermediates was carried out by using NMR spectroscopic and mass spectrometric analysis. These results indicate that strict control of the pH values allows tuning of the reactivity of the organic and inorganic moities, thus laying the foundations for the design and synthesis of sol–gel hybrid biomaterials with tuneable properties

The present invention concerns a family of sugar-based molecules for therapeutic use, comprising compounds with a structure having at least one sugar molecule with carrier function, bound to arsenic having active principle function, allowing the selective therapeutic treatment of tumoral pathologies and not, distinguished by a high cellular metabolism and, consequently, by a high glucose consumption. On the base of the preferential glucose absorption according to the Warburg effect, said compounds are adapted to penetrate inside tumoral cells and not, distinguished by a high cellular metabolism, by means of the glucose molecule integrated in their structure, so as to determine the selective therapeutic treatment of said cells and, consequently, of the pathologies deriving therefrom, by means of the arsenic molecule chemically bound to above mentioned glucose molecule.; Also a process for the production of synthetic sugar-based compounds is the object of the present invention, as well as a process for the production of extracted sugar-based compounds, produced from natural sources

The present invention concerns a family of sugar-based molecules for therapeutic use, comprising compounds with a structure having at least one sugar molecule with carrier function, bound to arsenic having active principle function, allowing the selective therapeutic treatment of tumoral pathologies, distinguished by a high cellular metabolism and, consequently, by a high glucose consumption. Also a process for the production of synthetic sugar-based compounds is the object of the present invention, as well as a process for the production of extracted sugar-based compounds, produced from natural sources. The compounds have the general formula I.

Examples of material functionalisation ("biodecoration") with signalling and relevant glycidic scaffolds will be outlined. Recent research concerning the development of smart biomaterials for Tissue Engineering (TE) applications will be considered.

Background: The risk of upper gastrointestinal (GI) complications associated with the use of NSAIDs is a serious public health concern. The risk varies between individual NSAIDs; however, there is little information on the risk associated with some NSAIDs and on the impact of risk factors. These data are necessary to evaluate the benefit-risk of individual NSAIDs for clinical and health policy decision making. Within the European Community's Seventh Framework Programme, the Safety Of non-Steroidal anti-inflammatory drugs (NSAIDs) [SOS] project aims to develop decision models for regulatory and clinical use of individual NSAIDs according to their GI and cardiovascular safety. Objective: The aim of this study was to conduct a systematic review and meta-analysis of observational studies to provide summary relative risks (RR) of upper GI complications (UGIC) associated with the use of individual NSAIDs, including selective cyclooxygenase-2 inhibitors. Methods: We used the MEDLINE database to identify cohort and case-control studies published between 1 January 1980 and 31 May 2011, providing adjusted effect estimates for UGIC comparing individual NSAIDs with non-use of NSAIDs. We estimated pooled RR and 95% CIs of UGIC for individual NSAIDs overall and by dose using fixed- and random-effects methods. Subgroup analyses were conducted to evaluate methodological and clinical heterogeneity between studies. Results: A total of 2984 articles were identified and 59 were selected for data abstraction. After review of the abstracted information, 28 studies met the meta-analysis inclusion criteria. Pooled RR ranged from 1.43 (95% CI 0.65, 3.15) for aceclofenac to 18.45 (95% CI 10.99, 30.97) for azapropazone. RR was less than 2 for aceclofenac, celecoxib (RR 1.45; 95% CI 1.17, 1.81) and ibuprofen (RR 1.84; 95% CI 1.54, 2.20); 2 to less than 4 for rofecoxib (RR 2.32; 95% CI 1.89, 2.86), sulindac (RR 2.89; 95% CI 1.90, 4.42), diclofenac (RR 3.34; 95% CI 2.79, 3.99), meloxicam (RR 3.4

AIMS: To quantify the risk of cardiac valvulopathy (CV) associated with the use of antidepressant serotoninergic medications (SMs). METHODS: We conducted a case-control study nested in a cohort of users of antidepressant SMs selected from The Health Improvement Network database. Patients who experienced a CV event during follow-up were cases. Cases were ascertained in a random sample of them. Up to 10 controls were matched to each case by sex, age, month and year of the study entry. Use of antidepressant SMs during follow-up was defined as current (the last prescription for antidepressant SMs occurred in the 2 months before the CV event), recent (in the 2-12 months before the CV event) and past (>12 months before the CV event). We fitted a conditional regression model to estimate the association between use of antidepressant SMs and the risk of CV by means of odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Sensitivity analyses were conducted to test the robustness of our results. RESULTS: The study cohort included 752,945 subjects aged 18-89 years. Throughout follow-up, 1663 cases (incidence rate: 3.4 per 10,000 person-years) of CV were detected and were matched to 16,566 controls. The adjusted OR (95% CI) for current and recent users compared with past users of antidepressant SMs were 1.16 (0.96-1.40) and 1.06 (0.93-1.22), respectively. Consistent effect estimates were obtained when considering cumulative exposure to antidepressant SMs during follow-up. CONCLUSIONS: These results would suggest that exposure to antidepressant SMs is not associated with an increased risk of CV.

OBJECTIVES: Health care utilization (HCU) databases are widespread sources of data for pharmacoepidemiologic investigations. Possible confounders are typically not measured in such databases. We show how to assess the impact of confounders in a study aimed at comparing cardiovascular (CV) risk according to drug regimen prescribed at starting antihypertensive therapy, nominally one agent (monotherapy) or a combination of agents in a unique tablet (fixed-dose combination) or in at least two distinct tablets (extemporaneous combination). STUDY DESIGN AND SETTINGS: A nested case-control study was carried out by including the 209,650 patients from Lombardy (Italy) newly treated between 2000 and 2001. Cases were the 10,688 patients who were hospitalized for CV disease until 2007. Three controls were selected for each case. Logistic regression was used to model the CV risk associated with initial therapeutic regimen. A Monte Carlo sensitivity analysis was performed for accounting unmeasured confounders (hypertension severity and chronic disease score) by means of external adjustment with medical record (MR) data. RESULTS: Compared with patients on fixed-dose combination, those on extemporaneous combination or monotherapy, respectively, had CV risk increased to 15% (95% confidence interval [CI]: 3%, 29%) or 17% (95% CI: 8%, 26%). External adjustment did not modify the risk associated with monotherapy. In contrast, the excess of risk associated with extemporaneous combination was annulled when external adjustment was applied. CONCLUSION: MR data can be used to assess confounding bias unmeasured from HCU database. Starting antihypertensive therapy with a combination of agents probably reduces the CV risk with respect to monotherapy, even in the setting of primary prevention.

Obiettivi. Per valutare l’effetto della compliance ai farmaci antipertensivi sul rischio di esiti cardiovascolari in una popolazione in prevenzione primaria cardiovascolare, è stato condotto uno studio di coorte prospettico, con base di popolazione, tramite il record-linkage tra gli archivi sanitari elettronici della Regione Lombardia. Metodi. È stata reclutata una coorte di 242.594 pazienti, di età superiore ai 18 anni e residenti nella Regione Lombardia, che hanno ricevuto per la prima volta un trattamento con antipertensivi durante gli anni 2000-2001. La coorte è stata seguita dalla prima prescrizione di farmaci antipertensivi (prescrizione indice) fino alla fine del 2007. Durante questo periodo sono stati identificati tutti i pazienti che hanno sperimentato un’ospedalizzazione per malattia coronarica o cerebrovascolare (esito). È stata valutata la compliance ai farmaci antipertensivi dalla prescrizione indice fino alla data dell’esito o di censura. Per stimare l’associazione tra persistenza e aderenza alla terapia con farmaci antipertensivi ed esito, è stato interpolato un modello multivariato a rischi proporzionali di Cox. Risultati. Durante un periodo di follow-up medio di 6 anni, 12.016 soggetti della coorte hanno sperimentato l’esito in studio. Rispetto ai pazienti che hanno sperimentato almeno un episodio di interruzione del trattamento antipertensivo, coloro che hanno continuato il trattamento rischiano il 37% in meno di sperimentare l’esito cardiovascolare (intervallo di confidenza al 95%: 34%-40%). Confrontati con i pazienti con bassa aderenza al trattamento (proporzione di giorni coperti ≤25%), quelli con aderenza intermedia (dal 51% al 75%) ed elevata (>75%) mostrano una riduzione del rischio rispettivamente del 20% (16%-24%) e del 25% (20%-29%). Effetti simili sono stati osservati considerando separatamente gli eventi coronarici e gli eventi cerebrovascolari. Conclusioni. Nella pratica clinica corrente una buona compliance alla terapia con antip

The development of advanced materials with biomimetic features in order to elicit desired biological responses and to guarantee tissue biocompatibility is recently gaining attention for tissue engineering applications. Bioceramics, such as hydroxyapatite-based biomaterials are now used in a number of different applications throughout the body, covering all areas of the skeleton, due to their biological and chemical similarity to the inorganic phases of bones. When bioactive sintered hydroxyapatite (HA) is desired, biomolecular modification of these materials is needed. In the present work, we investigated the influence of plasma surface modification coupled to chemical grafting on the cell growth compliance of HA 3D scaffolds.

A small set of nojirimycin- and pyrrolidine-based iminosugar derivatives has been synthesized and evaluated as potential inhibitors of porcine and insect trehalases. Compounds 12, 13 and 20 proved to be active against both insect and porcine trehalases with selectivity towards the insect glycosidase, while compounds 10, 14 and 16 behaved as inhibitors only of insect trehalase. Despite the fact that the activity was found in the micromolar range, these findings may help in elucidating the structural features of this class of enzymes of different origin, which are still scarcely characterised.

Great interest is presently given to the analysis of metabolic changes that take place specifically in cancer cells. In this review we summarize the alterations in glycolysis, glutamine utilization, fatty acid synthesis and mitochondrial function that have been reported to occur in cancer cells and in human tumors. We then propose considering cancer as a system-level disease and argue how two hallmarks of cancer, enhanced cell proliferation and evasion from apoptosis, may be evaluated as system-level properties, and how this perspective is going to modify drug discovery. Given the relevance of the analysis of metabolism both for studies on the molecular basis of cancer cell phenotype and for clinical applications, the more relevant technologies for this purpose, from metabolome and metabolic flux analysis in cells by Nuclear Magnetic Resonance and Mass Spectrometry technologies to positron emission tomography on patients, are analyzed. The perspectives offered by specific changes in metabolism for a new drug discovery strategy for cancer are discussed and a survey of the industrial activity already going on in the field is reported.

Carbonated hydroxyapatite (CHA) has been successfully biodecorated with carbohydrate derivatives, via silylation of the hydroxy groups of the apatite and subsequent covalent bonding with a suitably functionalized carbohydrate moiety. The presented procedure opens the way toward covalent biofunctionalisation of CHA with carbohydrates. © Georg Thieme Verlag Stuttgart New York.

Guidelines recommend a combination of 2 drugs to be used as first-step treatment strategy in high-risk hypertensive individuals to achieve timely blood pressure control and avoid early events. The evidence that this is associated with cardiovascular (CV) benefits compared with initial monotherapy is limited, however. The objective of this study was to assess whether, compared with antihypertensive monotherapy, a combination of antihypertensive drugs provides a greater CV protection in daily clinical practice. A population-based, nested case-control study was carried out by including the cohort of 209 650 patients from Lombardy (Italy) aged 40 to 79 years who were newly treated with antihypertensive drugs between 2000 and 2001. Cases were the 10 688 patients who experienced a hospitalization for CV disease from initial prescription until 2007. Three controls were randomly selected for each case. Logistic regression was used to model the CV risk associated with starting on and/or continuing with combination therapy. A Monte-Carlo sensitivity analysis was performed to account for unmeasured confounders. Patients starting on combination therapy had an 11% CV risk reduction with respect to those starting on monotherapy (95% CI: 5% to 16%). Compared with patients who maintained monotherapy also during follow-up, those who started on combination therapy and kept it along the entire period of observation had 26% reduction of CV risk (95% CI: 15% to 35%). In daily life practice, a combination of antihypertensive drugs is associated with a great reduction of CV risk. The indication for using combination of blood pressure drugs should be broadened.

We describe a new methodology that combines high resolution magic angle spinning (HR-MAS) techniques with saturation transfer difference (STD) NMR spectroscopy. This approach significantly improves the versatility of the STD experiment, and expands its use for samples containing living cells derived from solid tissues

A small virtual library of iminosugar derivatives was evaluated by docking experiments carried out by sampling a protein region corresponding to the phosphoinositide binding site of the PH domain of Akt. Four compounds were selected and efficiently synthesised from a common precursor. All compounds were subjected to preliminary biological evaluation on purified enzyme, and - among them - compound 9 exhibited the best inhibitory activity. A small virtual library of iminosugar-based Akt inhibitors have been designed and evaluated by using docking calculations. Selected compounds have been conveniently synthesised, and preliminary biological evaluation identified compound 9 as a possible lead compound for further development of iminosugar-based Akt inhibitors.