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Background: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. Methods: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin

Renal resistance index (RRI) is a parameter which is easily evaluable by the echo Doppler technique and which has been demonstrated to predict worsening of renal function (WRF) in patients affected by chronic heart failure as well as among those undergoing coronary angiography. The aim of this study was designed to evaluate the role of the RRI in predicting WRF after cardiac surgery. Methods Thirty–one patients were enrolled. Their clinical characteristics are shown in Table 1. All patients underwent cardiac surgery. Before surgery, RRI was evaluated according to Peurcelot’s formula by renal interlobular arteries pulsed Doppler. WRF was defined as an increase in serum creatinine of > 0.3 mg/dl associated with a change > 25% or the need of renal replacement therapy due to severe acute kidney injury. Results Among the patients in 12 WRF occurred, in 10 a worsening of creatinine serum levels and in 2 a severe AKI requiring RRT were observed. As shown in Table 1, RRI and the presence of peripheral artery disease were the only parameters which were significantly different among patients with and without WRF, whereas no difference in GFR values was observed. Baseline RRI showed a significant AUC of 0.74 (95% CI, 0.55–0.93) whereas baseline GFR of 0.52 (95% CI, 0.28–0.75) was not significant. Conclusions Among patients with WRF after cardiac surgery an increased RRI but not a different baseline GFR is observed. This parameter could allow a more accurate stratification of the risk of cardiorenal syndrome worsening among patients candidated to cardiac surgery.

Worsening of renal function (WRF) is frequently observed after cardiac surgery and it is associated with both short– and long–term worse outcome. Among the pathophysiological conditions favoring the occurrence of WRF, the abnormalities in renal blood flow could play a key role. The aim of this study was to evaluate the changes in renal resistance index (RRI), a parameter reflecting renal parenchymal and hemodynamic parameters, after cardiac surgery. Methods Thirty–one patients were enrolled (age 65±12 years, 29% males, mean left ventricular ejection fraction 55±5%, mean creatinine serum levels 0.89±0.18 mg/dl, mean eGFR 89±28 ml/min*1.73 m2). All patients underwent cardiac surgery. Before cardiac surgery, after 3 days and before discharge, RRI was evaluated according to Peurcelot’s formula by renal interlobular arteries pulsed Doppler. Worsening of renal function was defined as an increase in serum creatinine of > 0.3 mg/dl associated with a change > 25% or the need of renal replacement therapy due to severe acute kidney injury. Results As shown in the table 1, after cardiac surgery a significant increase in RRI was observed at 3 days after cardiac surgery but not before discharge. The significant increase in RRI was observed both in patients with and without WRF. However, in patients with WRF significant higher values of RRI were observed before as well as after cardiac surgery. Conclusions Among patients undergoing cardiac surgery a significant increase in RRI values is observed after surgery. Among patients with WRF a significant greater values of RRI are observed before as well as cardiac surgery thus suggesting that a critical increase in renal resistance could play a role in the cardiorenal syndrome worsening.

Background Myocardial deformation evaluated by two–dimensional speckle tracking echocardiography (STE) is a useful tool to evaluate both left and right ventricular function. However, there are no conclusive data about the relationship between strain measures and heart rate (HR). Aim of the Study To analyse changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of HR in patients with and without chronic heart failure (CHF). Methods. We enrolled 45 patients. Of the 38 patients diagnosed with CHF, 21 were carrying an ICD (Group 1), and 17 an ICD with CRT (Group 2). Group 3 included 7 participants without CHF with sinus node dysfunction that were carrying a pacemaker. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR, together with other echocardiographic parameters. Worsening or improvement of strain measures was defined as a relative change from baseline of 10%. Results The reproducibility of strain measurements was assessed in all the images obtained at the different HRs for 19 of the study participants. A high degree of reproducibility was observed for LVGLS (ICC = 0.96; 95% CI, 0.93 – 0.97) as well as for RVGLS (ICC = 0.91; 95%CI, 0.86 – 0.94) and RVfwLS (ICC = 0.91; 95%CI, 0.85 – 0.94). When analysed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed (left panels of the figure). Patients with worsening of LVGLS (76% overall) were more likely to present lower baseline LV function and maximum relative changes of LVGLS correlated significantly with the E/e’ ratios (r = –0.56; p Conclusions Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality at rest in patients diagnosed with CHF.

Baby lettuce leaves are generally produced for the unwashed ready-to-eat market. The aim of this research was to predict sensory and microbiological aspects of this product based on physicochemical properties during storage at 4 and 10°C. Products were analysed at sampling times chosen on the basis of five sensory visual quality (VQ) levels. Samples scoring VQ5 and VQ4 were considered acceptable (Ac), whereas the remaining scores were defined as unacceptable (UAc). Each VQ level was then characterized for physico-chemical (colour, ammonium, antioxidant activity, electrolytic leakage, phenols, chlorophyll, respiratory activity) and microbiological (total viable count, Pseudomonas spp., Enterobacteriaceae, lactic acid bacteria, yeast and moulds) parameters. UAc samples also proved unsatisfactory from a microbiological point of view (total viable count >=107 CFU g-1). Partial least squares (PLS) regression analysis allowed us to identify colour change (?E*) and total chlorophyll (TC) as suitable variables to predict the microbial load (TVC) associated with each sensory VQ level. The model obtained showed R2CV=0.94, RMSECV=0.41 and a relative error of 5.61%. In conclusion, the use of these parameters as quality indicators could be a new strategy for discriminating green leafy vegetables into acceptable or unacceptable products.

Background: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. Methods: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin

Ready-to-eat (RTE) swordfish fillets were used in a human feeding study involving 8 volunteers to assess the suitability of the fish matrix in delivering viable cells of the probiotic Lactobacillus paracasei IMPC 2.1. The strain did not affect the protein profile and total free amino acid content along the fillet shelf life. Volunteers consumed 100 g of probiotic RTE portion delivering 9 log CFU of bacterial cells, on alternate days over 20 days. Five subjects resulted to be colonized by the probiotic strain, at levels ranging from 6.30 to 7.74 log CFU/g of faeces, after eating 5 portions of the product (T1, 10 days). After 20 days (T2, 10 portions) the probiotic strain was recovered in the faeces of all subjects at concentrations ranging from 6.15 to 7.47 log CFU/g. This study demonstrated that 5 portions of probiotic RTE fish fillets consumed on alternate days allowed the transient colonization of gut by L. paracasei IMPC 2.1.

Summary Introduction Medical assistance for detainees is often hampered by logistic and procedural limitations. Telemedicine may represent the solution by which such limitations can be overcome. We therefore report an update on an experience of remote telemedicine support by pre-hospital electrocardiograms and remote tele-consultation with a cardiologist implemented in a group of Italian penitentiaries. Methods Eleven State penitentiaries situated in Apulia (South-Eastern Italy) were provided with a pocket electrocardiogram recorder. The electrocardiograms were interpreted by a remote cardiologist available 24/7, which also gave a brief consultation. Results A total 3213 pre-hospital electrocardiograms were performed from January 2008 to October 2014. In 1.1% of pre-hospital electrocardiograms a supra-ventricular tachycardia was found: pre-hospital electrocardiogram showed in 7.2% anomalies suggestive for acute myocardial ischemia, in 0.8% an ST-elevation requiring immediate transfer for primary PCI. Clinical indications after pre-hospital electrocardiogram were hospitalization in 29 cases, primary PCI in 26; direct cardiologist referral in 162, a cardiac troponin assay in 142; in 252 cases outdoor further medical examinations were suggested. By converse, thanks to pre-hospital telemedicine screening, immediate hospitalization was avoided in 99% of tele-consultations; in 2961 cases with suspected acute cardiovascular disease detainees were examined with an electrocardiogram without leaving the penitentiary. Conclusions Pre-hospital electrocardiogram telemedicine screening strategy in the case of suspected acute cardiovascular disease in detainees is feasible. A single regional telemedicine ‘hub’ may provide support to a region-wide network with 11 penitentiaries and about 3500 detainees.

This study aims at the characterisation of growth behaviour of three strains of Bacillus amyloliquefaciens, isolated from ropy bread (ATCC8473), wheat grain (ISPA-S109.3) and semolina (ISPA-N9.1) to estimate rope spoilage risk in pan bread during shelf-life using the Sym'Previus tool. Cardinal values and growth/ no growth boundaries were determined in broth, while artificial spore inoculations were performed in dough for various pan bread recipes to compare experimental counts with in silico growth simulations. Finally, two storage scenarios were tested to determine the probability to reach a spoilage threshold during bread shelf-life. Similarly to the safety criteria fixed for Listeria monocytogenes contamination in foodstuff complying with EC regulation, a potential rope spoilage threshold was arbitrary fixed at 5 log CFU/g for B. amyloliquefaciens. This study further underlines a higher rope spoilage potential of the ISPA strains as compared to the ATCC strain, thus emphasizing the interest to characterise both wild strains and reference strain to account for biological variability. In conclusion, this study showed that available decision making tools which are largely recognized to predict behaviour of pathogenic strains, shall also be used with spoilage strains to help maintain food quality and extend shelf-life.

Background Pulmonary arterial hypertension (PAH) represents one of the main clinical expression of the vascular changes in Systemic Sclerosis (SSc). Many clinical and experimental evidences suggest that lung microvascular changes play a role in the pathogenesis of idiopathic PAH (IPAH) also. Objectives The aim of this study is to investigate the presence of capillaroscopic abnormalities in patients with idiopathic PAH and to evaluate the differences in capillary naifold changes between patients with IPAH and SSc patients with and without PAH. Methods 37 subjects with SSc (of whom 17 with PAH), 21 subjects with IPAH and 20 healthy subjects were recruited. PAH was diagnosed by right heart chateterization. Periungual capillaroscopy was performed in all recruited subjects, considering the following parameters: loops length and width, capillary density, microhemorrhages, avascular areas, neoangiogenesis. To define the pattern of capillary changes in IPAH and healthy subjects a semiquantitative scoring (normal, minor abnormalities, major abnormalities) was used, whereas in SSc subjects the capillary changes were defined as early, active and late pattern. Results In all SSc subjects a capillaroscopic scleroderma pattern was found. Particularly, comparing SSc-PAH vs SSc-nonPAH we found an early pattern in 26,7% vs 50%, an active pattern in 66,6% vs 33,3% and a late pattern in a 6,6 vs 16,7% of subjects. None of IPAH subject presented a capillaroscopic scleroderma pattern, but interestingly in 36,4% of minor or major capillaroscopic changes were found. Analysing the single capillarocopic parameters, capillary density was lower in SSc subjects compared to the other groups; in SSc-PAH was lower than in SSc-nonPAH; in IPAH capillary density was lower compared to healthy control. Capillary width was higher in SSc patients compared to healthy and IPAH subjects, being higher in SSc-PAH compared to SSc-nonPAH. The number of megacapillaries, bushy capillaries and microhemorrages was significantly higher in patients with SSc-PAH compared to SSc-nonPAH patients. Interestingly, compared to healthy controls, the IPAH subjects presented a significantly lower capillary density and a significantly higher mean capillary width. Further, IPAH subjects presented a significant increase of number of microhemorrages and ectasic capillaries compared to healthy controls. Conclusions Microcirculation alterations, and particularly the reduction of capillary density and the increase od capillary width appears to be more severe in SSc subjects with PAH compared to SSc subjects without PAH. Capillaroscopic changes can be present in IPAH subjects also. These data support the hypothesis that in SSc peripheral microcirculation changes can be related to the entity of pulmonary microcirculation changes and that an altered vascular lung remodelling could play a role in IPAH also. References Cutolo M et al. The contribution ofcapillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol. 2007 Dec;21(6):1093–108. Riccieri V. Systemic sclerosis patients with and without pulmonary arterial hypertension: a nailfoldcapillaroscopy study. Rheumatology (Oxford). 2013 Aug;52(8):1525–8. Disclosure of Interest None declared

Pulmonary arterial hypertension (PAH) represents one of the main clinical expressions of the vascular changes in systemic sclerosis (SSc). Lung microvascular changes can play a role in the pathogenesis of idiopathic PAH (IPAH) also. The aim of this study is to investigate the presence of capillaroscopic abnormalities in patients with IPAH and to evaluate the differences in capillary nailfold changes between patients with IPAH and patients with SSc with and without PAH.39 SSc patients (19 with PAH - SSc-PAH and 20 without - SSc-noPAH), 21 subjects with IPAH and 20 healthy subjects were recruited. PAH was diagnosed by right heart catheterization. Nailfold videocapillaroscopy was performed (NVC) in all recruited subjects; capillary quantitative parameters (loops length and width, capillary density, neoangiogenesis) were evaluated and a semiquantitative scoring was used (normal, minor or major abnormalities for healthy controls and IPAH subjects and specific patterns - early, active and late - for SSc subjects) to define microvascular alterations.The presence of capillaroscopic abnormalities was detected in 38,1% subjects with IPAH; particularly, compared to healthy controls, capillary density was significantly lower (7,5±1,65loops/mm vs 9±1,37loops/mm p0,05) and mean capillary width was significantly higher (21±13μm vs 17±3μm p0,05). A more severe NVC pattern (active/late) was described. SSc-PAH patients compared to SSc-noPAH patients (73,2% vs 50% respectively, p0,05), with a significantly lower capillary density (5,64±1,9loops/mm vs 6,5±1,3loops/mm p0,05) and a significantly higher capillary width (55±7μm vs 35±8μm - p0,05) and mean number of neoangiogenesis (N/mm) (1±0,33 vs 0,2±0,22 respectively p0,05).These data, beyond to confirm the role of microvascular damage in SSc-related PAH, support the hypothesis of systemic microvascular involvement in IPAH also, which can be detected by NVC, although further studies are needed to establish whether the changes in the systemic microcirculation are causal or consequential to PAH.

Summary Background Pre-hospital triage supported by electrocardiogram assessment and telemedicine was used to shorten time to reperfusion in subjects with acute myocardial infarction (AMI). Timely treatment of AMI presupposes huge geographical areas covered by one primary angioplasty network, one emergency medical service (EMS), and that pre-hospital electrocardiograms are interpreted by a physician, preferably a cardiologist. Methods We report preliminary data on a telemedicine network which provides remote interpretation of pre-hospital triage EMS electrocardiograms for Apulia, Southern Italy (4 million inhabitants): the region is served by one public health care service, one public EMS, one hospital network and one telemedicine service provider. Results From October 2004 to September 2013, 598,140 electrocardiograms were read by the telemedicine hub. Fifty percent of subjects triaged via the pre-hospital telemedicine electrocardiogram network were male, 50% were aged over 70 years, 36% were triaged during night shift. Fifteen percent of electrocardiograms in subjects with chest pain were abnormal, therefore requiring direct access to the cath-lab or hospitalization. Frontline diagnosis was ST-elevation in 6178 subjects, while 40,106 electrocardiograms showed arrhythmias other than premature contraction or sinus rhythm. Typical chest pain was found in less than 50% of subjects diagnosed with ST-elevation AMI. Conclusions The region of Apulia (4 million inhabitants, Southern Italy) is served by a unique combination of one telemedicine hub that reads pre-hospital electrocardiograms and provides cardiology consultations, one EMS, one hospital network for primary angioplasty in ST-elevation AMI. More than half a million electrocardiograms have been interpreted since 2004.

Direct inkjet printing of a complete and working amperometric biosensor for the detection of hydrogen peroxide, based on horseradish peroxidase (HRP), has been demonstrated. The device has been realized with a commercial printer. A thin layer of PEDOT:PSS, which was in turn covered with HRP, was inkjet printed on top of an ITO-coated glass slide. The active components of the device retained their properties after the thermal inkjet printing. The whole device has been encapsulated by means of a selectively permeable cellulose acetate membrane. The successful electron transfer between the PEDOT:PSS covered electrode and the enzyme has been demonstrated, and the biosensor evidenced very good sensitivity, in line with the best devices realized with other techniques, and a remarkable operational stability. This result paves the way for an extensive application of “biopolytronics”, i.e. the utilization of conductive/semiconductive polymers and biologically active molecules to design bioelectronic devices using a common PC, and exploiting normal commercial printers to print them out.

Summary We present a model of telecardiology ECG triage in cases of acute chest pain. A 61-year-old man with recurrent chest pain, radiating to the neck, was referred to the emergency room (ER) at Foggia University Hospital, Italy, with a red triage code. Due to a large number of red code patients present at the ER all immediately requiring medical examination for suspected acute myocardial infarction (AMI), the patient first underwent ECG triage evaluation with the Cardio Vox P12 telecardiology recorder device by a nurse. The ECG was transmitted to the regional telecardiology hub, where the ECG was immediately read by a cardiologist; signs of an inferior ST-elevation acute myocardial infarction (STEMI) were present. The catheterisation lab was therefore immediately alerted and the patient underwent primary percutaneous coronary intervention (PCI) within thirty minutes of hospitalisation. Therefore, in emergency settings with high-volume work-loads, telecardiology screening may “speed up” STEMI diagnosis and treatment.

Background Few works have evaluated the effect of statins on left ventricular dysfunction in patients with chronic heart failure (CHF), by using tissue Doppler imaging (TDI). We therefore aimed to investigate whether atorvastatin treatment may influence prognosis and myocardial performance evaluated by TDI in subjects with CHF. Methods Five hundred thirty-two consecutive CHF outpatients enrolled in a local registry, the Daunia Heart Failure Registry, were prospectively analysed. 195 patients with CHF and left ventricular ejection fraction (LVEF) ≤40 %, either in treatment with atorvastatin (N: 114) or without statins (N: 81), underwent TDI examination. Adverse events were evaluated during follow-up. Results The atorvastatin group showed a lower incidence of adverse events (cardiac death: 0 % vs 7 %, p

Background The independent prognostic impact of diabetes mellitus ( DM ) and prediabetes mellitus (pre‐ DM ) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐ DM on survival outcomes in the GISSI ‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial. Methods and Results We assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI ‐ HF trial, who were stratified by presence of DM (n=2852), pre‐ DM (n=2013), and non‐ DM (n=2070) at baseline. Compared with non‐ DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐ DM patients and those with pre‐ DM . Cox regression analysis showed that DM , but not pre‐ DM , was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI , 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI , 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI , 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI , 1.01–1.29, respectively). Conclusions Presence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00336336.

The cardiopulmonary exercise test (CPX) is an affordable tool for risk prediction in patients with chronic heart failure (CHF). We aimed to determine the role of CPX parameters in predicting the risk of incidence of sustained ventricular arrhythmias (SVA) in CHF.Sixty-one consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent CPX and were followed for 327 ± 247 days. Clinical follow-up was performed every month and anticipated in case of re-hospitalisation for cardiac disease. Incidence of SVA was evaluated by direct clinical examination (ECG, ambulatory ECG).Patients with episodes of SVA (N 14) showed lower values of pVO2 and PetCO2, and higher values of VE/VCO2, VE/VCO2 slope, and VE%. After correction for age, gender, diabetes, ischaemic heart disease and left ventricular ejection fraction, peak VO2 (hazard ratio (HR) 0.68, 95 % confidence interval (CI) 0.51-0.91, p 0.05), VE% (HR 1.38, 95 % CI 1.04-1.84, p 0.05), VE/VCO2 (HR 1.38, 95 % CI 1.04-1.82, p 0.05), VE/VCO2 slope (HR 1.77, 95 % CI 1.31-2.39, p 0.01), PetCO2 (HR 0.66, 95 % CI 0.50-0.88, p 0.01) were found as predictors of SVA. At Kaplan-Meier analysis, lower event-free rates were found in subjects with peak VO2 values below median (log rank p 0.05), values of VE/VCO2 above mean (p 0.05), higher VE/VCO2 slope tertiles (p0.05), and values of PetCO2 below median (p 0.05).CPX provides prognostic independent information for risk of SVA in subjects with CHF.

This study examines the diversity of spore-forming bacteria isolated from raw materials/bread using molecular methods along with a rapid and innovative technology, the FT-NIR spectroscopy. Microbiological analysis showed that 23% of semolina and 42% of other raw materials (including grain, brewer yeast, improvers) contained more than 100 spores/g and more than 50% of each kind of sample was contaminated at a level ranging from 1 to 100 spores/g. A high bacterial diversity characterized raw materials. In total 176 isolates were collected and characterized: 13 bacterial species belonging to Bacillus (10) and Paenibacillus (3) genera were identified by sequencing of 16S rRNA, gyrA or gyrB genes. The two closely related species Bacillus amyloliquefaciens (strain N45.1) and Bacillus subtilis (strain S63) were also analyzed by the spectroscopic technique FT-NIR. This analysis gave clear discrimination between the strains in the score plot obtained by the PCA and allowed to identify the spectral region 5600–4000 cm− 1 as the information-rich region for discrimination. B. amyloliquefaciens, possibly misidentified as B. subtilis in previous studies, was recognized as the most frequent species, found also in ropy bread. Moreover, the screening test for rope production indicated that mainly B. amyloliquefaciens, together with B. subtilis and Bacillus pumilus, could cause spoilage in bread, even if the last two species were represented by a low number of isolates. The Bacillus cereus group and Bacillus megaterium showed a lower percentage (30–70%) of isolates potentially able to cause the rope, but considering the high number of B. cereus group isolates detected in this study, this bacterial group should also be considered important in rope spoilage. In conclusion, results demonstrate that raw materials used to produce bread represent a rich source of spore-forming bacteria, therefore their microbiological quality should be monitored before use. Moreover, this study highlights for the first time the importance of the species B. amyloliquefaciens in rope spoilage and indicates that other species may also cause this alteration although strains of the same species may behave differently.

Fungal growth is the most frequent cause of spoilage in baked goods determining great economic losses. Lactic acid bacteria (LAB) are applied in the process of several bakery products since they significantly contribute to technological and nutritional properties, influence the food flavour and prevent spoilage by producing organic acids, hydrogen peroxide, cyclic dipeptides, bacteriocins, fatty acids, carbon dioxide, ethanol and diacetyl. Among organic acids, lactic, acetic, phenyllactic (PLA) and p-OH-phenyllactic acids (OH-PLA) play a role in inhibiting fungal and bacterial growth [1]. In particular, the inhibitory properties of PLA have been demonstrated against several fungal species. Recently, the research has been moved towards the application of biotechnology aimed to improve PLA production by microorganisms (bacteria and yeast). PLA is a by-product of phenylalanine (Phe) metabolism and its production can be significantly improved by the addition of precursors such as Phe, phenylpyruvic acid (PPA) and ?-ketoglutaric acid to the growth medium. The aim of the current study was to improve the antifungal activity of eight lactic acid bacterial (LAB) strains by the addition of PPA to a defined growth medium (DM) [2]. The effect of PPA addition on the LABs antifungal activity related to the production of organic acids (PLA, D-lactic, L-lactic, acetic, citric, formic and 4-hydroxy-phenyllactic acids) and of other phenylpyruvic-derived molecules, was investigated. In the presence of PPA the inhibitory activity (expressed as growth inhibition percentage) against fungal bread contaminants Aspergillus niger and Penicillium roqueforti significantly increased and was, even if not completely, associated to PLA increase (from a mean value of 0.44 to 0.93 mM).While the inhibitory activity against the yeast Endomyces fibuliger was mainly correlated to the low pH and to lactic, acetic and p-OH-PLA acids. When the Principal Component Analysis (PCA) analysis based on data of growth inhibition percentage and organic acid concentrations was performed, strains grown in DM + PPA separated from those grown in DM and the most active strains Lactobacillus plantarum 21B, Lactobacillus fermentum 18B and Lactobacillus brevis 18F grouped together. The antifungal activity resulted to be strain-related, based on a different mechanism of action for filamentous fungi and the yeast and was not exclusively associated to the increase of PLA. Therefore, a further investigation on the unique unidentified peak in HPLC-UV chromatograms was performed by LC- MS/MS analysis. Full scan mass spectra (negative ion mode) recorded at the retention time of the unknown compound, showed a main peak of m/z 291.0 which was consistent with the nominal mass of the molecular ion [M-H]- of polyporic acid, a PPA derivative whose antifungal activity has been previously reported against 12 species of fungi [3]. Actually, in microorganisms different from LAB, as fungi and lichens, PPA is a precursor of other categories of natural bioactive compounds as the antifungal allantofuranone that originates from phenylalanine through the formation of PPA and polyporic acid [4]. In conclusion, the addition of PPA to the growth medium contributed to improve the antifungal activity of LAB strains and resulted in the production of the polyporic acid, here ascertained for the first time in LAB strains. Furthermore, our results indicate that the antifungal activity shown by lactic acid bacteria can be improved and optimized through the addition of phenylpyruvate to the growth medium and that it is the result of the presence of several metabolites which act in a synergistic way. To be effective and competitive, the food industry must respond to consumer demands, and recent trends have included the desire for high-quality foods that are not extremely processed and that do not contain chemical preservatives. Recently, the levels of chemical preservatives permitted in bakery products in Europe have been reduced due to application of EU Directive 95/2/CE (1995). Because the antimicrobial compounds produced by lactic acid bacteria are considered natural preservatives, the use of selected lactic acid bacteria to decrease the fungal contamination of baked products has interesting actual applications.

Background Coronary flow is influenced by several determinants and may change according to external stimuli. In patients with dilated cardiomyopathy (DC), adaptive mechanisms could induce alterations in coronary flow, possibly related to oxygen consumption. Methods In 67 consecutive patients with DC (mean age 52.06±13.84, 52 male gender, left ventricle ejection fraction (LVEF) 29.49%±8.68) and normal coronary angiography findings, coronary flow in left anterior descending (LAD), right coronary artery (RC) and left circumflex (LCx) was reported as TIMI frame count (TFC). All patients underwent a cardiopulmonary test with VO 2 peak and anaerobic threshold (AT) measurement, New York Heart Association (NYHA) class stratification, two-dimensional echocardiographic evaluation including LVEF and left ventricle end-diastolic diameter (LVEDD) assessment. All patients were receiving optimal medical treatment. Results In a multivariate analysis, a statistically significant correlation was found between VO 2 peak and TFC ( B 7.61, p R 2 0.61 for LAD; B 3.42, p R 2 0.33 for RC); an inverse correlation was found between AT and TFC ( B −9.77, p R 2 0.61 for LAD; B −4.26, p R 2 0.33 for RC). Conclusions Coronary flow is related to VO 2 peak and AT in patients with DC, suggesting a "compensatory" mechanism.

C-reactive protein (CRP) plasmatic levels might increase in patients with acute coronary syndrome (ACS) or atherosclerosis and evaluation of CRP is relevant for prognosis in case of ischemic heart disease. This clear role played by CRP in risk stratification of cardiovascular diseases is however biased by non-cardiac determinants: genetic heritable factors, seasonal or daily variability, and gender differences probably based on hormonal differences. Also non-steroidal hormones seem to be involved in CRP determinism, in a complicated interaction not easy to extricate. Nevertheless, CRP determination in patients with ACS should be considered as crucial for its prognostic relevance, even after a careful consideration of all these bias factors.

AimsThe ESC-HF Pilot survey was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). The pilot phase was also specifically aimed at validating structure, performance, and quality of the data set for continuing the survey into a permanent Registry.MethodsThe ESC-HF Pilot study is a prospective, multicentre, observational survey conducted in 136 Cardiology Centres in 12 European countries selected to represent the different health systems across Europe. All outpatients with HF and patients admitted for acute HF on 1 day per week for eight consecutive months were included. From October 2009 to May 2010, 5118 patients were included: 1892 (37%) admitted for acute HF and 3226 (63%) patients with chronic HF. The all-cause mortality rate at 1 year was 17.4% in acute HF and 7.2% in chronic stable HF. One-year hospitalization rates were 43.9% and 31.9%, respectively, in hospitalized acute and chronic HF patients. Major regional differences in 1-year mortality were observed that could be explained by differences in characteristics and treatment of the patients.ConclusionThe ESC-HF Pilot survey confirmed that acute HF is still associated with a very poor medium-term prognosis, while the widespread adoption of evidence-based treatments in patients with chronic HF seems to have improved their outcome profile. Differences across countries may be due to different local medical practice as well to differences in healthcare systems. This pilot study also offered the opportunity to refine the organizational structure for a long-term extended European network. © 2013 The Author.

Background The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. Methods Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N=15); and controls (Group C, N=42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. Results Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p

The efficacy of ondansetron, a selective 5-HT3 receptor antagonist, in preventing postoperative nausea and vomiting in surgical patients was studied. Fifty women were randomized in a double-blind manner to receive either two 8 mg doses of intravenous ondansetron or two doses of placebo vehicle: the first given just before general anesthesia induction and the second 8 hours later. During the first 24 postoperative hours, the number of emetic episodes was recorded and the subjects rated their nausea on a scale from 0 to 10. Ondansetron-treated subjects had fewer emetic episodes (p < 0.001) and lower subjective nausea scores (p < 0.001). The number of complete responders (no emetic episodes and no rescue therapy) was 1 of 24 (4%) and 15 of 26 (58%) in the placebo and ondansetron groups, respectively (p < 0.001). Ondansetron is clearly more effective than placebo in the prophylaxis of postoperative nausea and vomiting. The adverse event profile for ondansetron was similar to that of placebo. Clinical Pharmacology and Therapeutics (1992) 52, 96–101; doi:10.1038/clpt.1992.107

In the latest years several manuscripts have showed some new possible advantages of the three-dimensional (3D) echocardiography in daily practice. 3D echocardiography allows imaging and analysis of cardiovascular structures as they move in time and space, thus creating possibility for creation of 4D datasets (3D and real-time). Real-time three-dimensional echocardiography (RT3DE) is a major innovation in the history of cardiovascular ultrasound. Advances in computer and transducer technologies, especially the fully-sampled matrix array transducer, have permitted real-time 3D image acquisition and display. The aim of this manuscript is to give a brief review of the development of the 3D echocardiography and of comparison of two-dimensional echocardiography versus 3D echocardiography and RT3DE.

The electrocardiographic patterns, observed during 24-h Holter monitoring, of 10 patients (mean age 35 +/- 22 years) with first and second degree A-V block due to dual A-V nodal pathways are reported. Recordings were selected according to the presence of: sudden and persistent prolongation of the PR interval: sudden normalization of the PR interval: 'atypical' Wenckebach sequences showing sudden and pronounced prolongation of any PR interval prior to the blocked P wave. Besides the already recognized pattern, new aspects were identified: (1) Wenckebach sequences in the slow and fast pathways characterized by a progressive increase in the PR interval until a blocked P wave occurred during long and short PR interval periods, respectively; (2) Wenckebach periods first in the slow and then in the fast pathway; (3) 2:1 A-V block with a normal PR interval in the conducted beat after a Wenckebach sequence in the slow pathway; (4) Wenckebach in the fast pathway and, subsequently, in the slow one characterized by a slight prolongation of the PR interval for some beats followed by a sudden and pronounced increase in the PR interval of one beat and a subsequent progressive slight PR prolongation until a blocked P wave occurred; (5) Wenckebach sequence in the fast pathway with subsequent conduction over the slow pathway without a blocked P wave; (6) blocked P waves during both long and short PR interval periods with slight prolongation of the preceding PR interval. The electrophysiological mechanisms involved in these electrocardiographic patterns together with the nature (anatomical or functional) of the intranodal pathways and the clinical significance of this type of block are discussed.

Stress is usually defined as the experience of negative events or the perceptions of distress and negative affect that are associated with the inability to cope with them. The parameter most suitable for large-scale field studies is the determination of endocrine activity by measurement of salivary cortisol. The aim of the present study is to identify the presence of sources of stress in an emergency team of urban police and to objective such stress using the PSS (Professional Stress Scale) test and bioumoral markers as salivary cortisol and interleukin 1 beta (IL1-B). Moreover it will be determined the Heart Rate Variability (HRV) that is able to mirror the sympathetic-parasympathetic balance. We studied 30 policemen who belonged to an emergency team. Thirty policemen made cardiologic exams as ECG, Heart Eco-doppler and Holter Ecg during the work and during the holiday. Particularly we studied HRV using frequency-domain based HRV measures. The results were evidenced as the differences of the spectral power. As control we used the same subjects during the holiday. T test was performed to evaluate the differences between the means, the Chi Square's Test was performed to determine the statistically significant association between PSS subscales, HRV, salivary cortisol and IL1-B concentrations. The study of HRV demonstrated a statistically significant association between HRV parameters during the holiday, salivary cortisol concentrations and PSS test. IL1-B, instead, was not associated with HRV parameters. Several precedent studies agree with our results. Our study has suggested a work related stress in urban police employed in an emergency team. We might conclude that salivary IL1-B and cortisol are useful markers of stress. The study of HRV parameters gave evidence that LF/HF during the holiday is a useful marker of work stress, because it correlated with cortisol difference during the work. Conclusively we can believe that the HRV parameters evaluated during the work are useful as confront, instead the HRV parameters during the holiday are surest indexes of work stress. Probably the effect of stress on the heart aren't present during the work because the work experience reduces these effects, they appear during the holiday when the imagination could make the conflicts or the problems more complex than they are. It might be useful to repeat this study after some structure organizational modifications and after training that will teach the workers coping strategies. If we consider only the bioumoral and PSS results, we might conclude that the stress discovered in this study is not hazardous for the health when the workers have adequate holidays, but if we evaluate the HRV parameters, we have believe that, for a heart health, it's necessary either to increment the holidays or, it can appear paradoxical, to work again.